Oral Answers to Questions

Mary Robinson Excerpts

Tuesday 5th March 2024 Commons Chamber

[Victoria Atkins]

The hon. Gentleman is right to say that a number of local warm homes prescription schemes have offered additional support to help people with health vulnerabilities to stay warm and well. Such schemes are excellent examples of local collaboration between the NHS, local government and other partners—tailored, of course, to the local needs of their areas—and I would be interested to see whether other parts of the NHS choose to take up these sorts of ideas in the future.

[Mary Robinson (Cheadle) (Con)]

2. What steps her Department is taking to improve urgent and emergency care.

[Mrs Flick Drummond (Meon Valley) (Con)]

9. What steps her Department is taking to improve urgent and emergency care.

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[The Minister for Social Care (Helen Whately)]

A year ago we set out a plan to improve urgent and emergency care, and the plan is working. Performance this winter has been better, with ambulance waits down by nearly a third, and we are learning the lessons from this year to make further improvements in the year ahead.

[Mary Robinson]

It is welcome news that the brand-new £30 million A&E campus at Stepping Hill Hospital is nearing completion. However, other buildings on this ageing site are failing and urgently need replacing. Will my hon. Friend ensure that Stepping Hill remains at the heart of hospital facilities in Stockport with rebuilt units, and support new hospital investment and specialist diagnostic hubs across Stockport?

[Helen Whately]

I am delighted that Stepping Hill Hospital will soon have a new emergency care campus, with all the benefits that that will bring to my hon. Friend’s constituents. I know that she is a great campaigner for her local NHS and has already met the Secretary of State about the concern she raises. As well as making her argument so clearly in Westminster, I would encourage her to continue discussions with her local NHS integrated care board, which is responsible for local decisions on capital investment.

Countess of Chester Hospital Inquiry

Mary Robinson Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

It will not surprise the hon. Gentleman that a central concern of the families when I met them was the extent to which they felt fobbed off when concerns were raised and the ability of those managers either to continue in post or to move to new posts. I think that concern is shared across the House. It is very much central to some of the safeguards that have been put in place through the recommendations from Kark that have already been accepted. It also opens up questions about the role of boards and how we strengthen non-executive directors, the training and induction, and the other provisions that we can put in place. Of course, some of those issues are the reason we are having the inquiry, and through the statutory process, there will be the opportunity to call people to give evidence and for the judge-led inquiry to put questions on behalf of the families.

[Mary Robinson (Cheadle) (Con)]

I am grateful to my right hon. Friend for the statement and for the announcement of the judge-led inquiry. The shocking murders of those babies and the attempted murders of so many others have shocked the nation. A major concern for me is that managers ignored consultants who had raised serious issues. It appears that there is in some hospitals a culture of people not being listened to when they raise concerns. Dr Stephen Brearey, one of the whistleblowers in this case, says that he has been inundated with emails from people who say that they have not been listened to when they have spoken about really serious issues. I thank the Secretary of State for everything that he has said today, but does he support a strengthening of the whistleblowing legislation so that all whistleblowers know that they will be heard and protected?

[Steve Barclay]

To provide some reassurance to my hon. Friend, the Public Interest Disclosure Act 1998 was strengthened in 2018. Obviously, that is post the appalling events covered today, but that Act has already been strengthened. The freedom to speak up guardians have also been implemented since these events, and their role has been strengthened further in the guidance. Significant work has also been done on the role of the child death overview panel and the role of data through the Getting It Right First Time team, picking up data where there are concerns. A significant amount of work has been done on that, but of course through the inquiry, we also need to interrogate more clearly why the concerns raised by clinicians were not acted on by those in leadership positions. I am sure that is something that the judge will want to test in significant detail.

Oral Answers to Questions

Mary Robinson Excerpts

Tuesday 6th December 2022 Commons Chamber

[Peter Gibson (Darlington) (Con)]

9. What plans he has to reduce health inequalities.

[Mary Robinson (Cheadle) (Con)]

18. What plans he has to reduce health inequalities.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

We are taking action on public health across the board. The £3 billion that we are investing in the drugs strategy will create an extra 50,000 places in drug treatment. We have doubled the duty on cigarettes since 2010 and brought in a minimum excise tax. We now have the lowest smoking rate on record and will go further. The £300 million that we are investing in Start for Life means new or expanded family hubs in 75 local authorities. We are taking action right across Government, from the £55 billion that we are investing in energy support to the measures that we are taking through at the moment to crack down on non-decent housing.

[Neil O’Brien]

My hon. Friend and I have discussed this, and we are due to meet again shortly. I repeat my offer to speak both to that practice and to local partners so that we can tackle this crucial problem.

[Mary Robinson]

Research by the University of Manchester adds to the significant body of evidence showing that addressing disparities in healthcare is key to levelling up. Inequalities have resulted in a 30% productivity gap in the north, which can be attributed to poorer health. Will my hon. Friend outline how the Government are working to address this and to ensure that residents of the north are not at a health and care disadvantage?

[Neil O’Brien]

I saw that important report, and we have to tackle the problem from both the health end and the economic end. Spending on health in the north grew from £36.5 billion in 2018-19 to £52.6 billion in 2020, so there is significant investment in health and preventing ill health in the north. Economic activity stops people sliding into a cycle of ill health and worklessness, and we are working jointly with the Department for Work and Pensions to roll out more disability employment advisers in jobcentres. The underlying key is to tackle and prevent ill health, hence the £3 billion drug strategy and the measures on smoking, energy and housing.

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[Steve Barclay]

The hon. Lady raises an important issue that is of concern across the House, as we have already seen in the exchanges the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) answered. That in part was why, during the pandemic, we used £1.7 billion of funding to protect dentistry and why we got a commitment through the £3 billion a year funding of dentistry, but we are looking at how we localise that commissioning to get better value out of the contract, which was the point my hon. Friend raised.

[Mary Robinson (Cheadle) (Con)]

T2. At 1 o’clock today, patient safety expert Dr Bill Kirkup will be speaking to MPs at the all-party parliamentary group for whistleblowing, to which all colleagues are invited. It is a timely meeting following last week’s “Newsnight” programme, which highlighted yet another NHS trust where a culture of fear left staff unable to speak up on patient safety concerns. It is clear change is needed. Does my hon. Friend agree that supporting whistleblowers in the NHS is crucial to patient safety?

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

My hon. Friend is so right. I praise her work with the APPG and I know many colleagues will want to attend. Whistleblowers can save lives and improve healthcare, as I have seen in my own constituency, and she is right to be pressing on this matter.

Oral Answers to Questions

Mary Robinson Excerpts

Tuesday 19th July 2022 Commons Chamber

[Mr Speaker]

Order. Minister, when I stand up, please do stop. You are the one who is dragging this out, so you tell these people why they cannot get in.

[Mary Robinson (Cheadle) (Con)]

I welcome the confirmation of the cohorts to be vaccinated against covid-19 and flu this autumn. Will my hon. Friend advise the House and my constituents whether the two vaccines will be co-administered?

[Maggie Throup]

My hon. Friend asks a really important question. The Joint Committee on Vaccination and Immunisation has advised that covid and flu vaccines can be given at the same time where that is operationally possible, and we will seek to maximise opportunities to co-promote and co-administer the flu and covid vaccines where it is possible and clinically advised, especially where this improves patient experience and vaccine uptake. Regardless of whether co-administration is offered, it is important that eligible people come forward as soon as they are called by the NHS for their jab, whether for flu or covid.

Health and Social Care Leadership Review

Mary Robinson Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

I thank the hon. Gentleman for bringing Mr Calvert’s case to my attention. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), has listened to that carefully. She is meeting some of the families affected by that case very shortly, and Mr Calvert is someone to whom she can reach out directly.

Like the hon. Gentleman and, I am sure, the whole House, I am very concerned about what I have heard about this ambulance service. I am not satisfied with the review that has already been done. We need a much broader and more powerful review. I will have more to say on the matter very shortly.

[Mary Robinson (Cheadle) (Con)]

I welcome this review and thank my right hon. Friend for bringing his statement to the House. Good leadership is important because it drives the culture within an organisation. It was terrible to hear what the hon. Member for Easington (Grahame Morris) had to say just now. We can see that bullying and harassment in an organisation often come down to how the leadership and the processes are operating.

Whistleblowers need to know that they can rely on the processes within organisations, but who do they go to as well? The National Guardian’s Office would be one, as would the local guardians in the hospitals. I recently introduced a whistleblowing Bill to ensure that people are able to go to another body, because they cannot be constricted within their organisation. We need to be able to benefit from whistleblowers who speak out and expose wrongdoing so that we can close down these cultures that we have seen operating in our organisations.

[Sajid Javid]

My hon. Friend is right: it is important that, where people who are working within the NHS or social care see wrongdoing or things that concern them, they have a safe space to report that and to make sure that their concerns are properly addressed. She will know that the Health and Social Care Act 2022 contains new provisions, including one for the Health Services Safety Investigations Body, but I have listened carefully to what she has said and I will consider what more we can do.

Health and Care Bill (Sixteenth sitting)

Mary Robinson Excerpts

Committee stage
Tuesday 26th October 2021 Public Bill Committees

[Edward Argar]

It is, as ever, a pleasure to serve under your chairmanship, Mrs Murray.

I am grateful to the hon. Member for Central Ayrshire not just for her amendments but for the opportunity to debate the issue, which goes to the heart of the challenges we face. I think there is broad consensus on clauses up to clause 119, perhaps with a challenge or a tweak here and there, but the provisions that we are considering are the one bit, as I know from the hon. Lady’s work on pre-legislative scrutiny and when the Bill was previously considered, that remains challenging. It is a matter of striking the appropriate balance to ensure the proper functioning of judicial authorities at the same time as achieving the overall objective of what we are trying to do with HSSIB: foster that learning culture, understand what goes wrong and avoid a repetition of it. It ultimately comes down to a subjective view of where that balance is most appropriately struck.

Clauses 106, 107, 108, 109 and 117, and schedule 14, address how HSSIB will protect the material it holds and outline the concept of safe space. Before getting into the detail of the clauses, I want to acknowledge that there has of course been extremely good and well-informed debate outside the Committee about how broad or narrow safe space should be; whether it should be as defined in the Bill with exceptions, or, to use the suggestion of the hon. Member for Central Ayrshire, flipped around to be the converse of that; and the merits of HSSIB sharing or not sharing information with other organisations. I feel it is important to set out how we came to the balance we propose.

The hon. Lady mentioned a previous Minister who visited Scotland. I am very conscious that I have a kind, outstanding invitation to visit from her and I look forward to taking that up at some point soon, I hope. I also spoke to the Scottish Cabinet Secretary for Health and Social Care, who endorsed that invitation. I therefore look forward to being able to come not only to Edinburgh, but possibly to Ayrshire, and finding a way to shoehorn that into the visit.

Key to our vision for a new model for investigations is that they are conducted in a safe space so that patients, families, NHS staff and other participants in an investigation are encouraged to speak freely and candidly and have the confidence that the information they provide will be protected, save in the most exceptional circumstances.

The objective is to encourage that open flow of information and get to the bottom of what may have happened with the best possible information available. Without guarantees that that information will not be shared—again, save in very limited circumstances, which I will come on to—we risk, as the hon. Lady said, eroding the confidence of all those who candidly trust HSSIB with that information.

We propose that information, documents, equipment or other items held by the new body in connection with an investigation will be considered protected material and must not be shared, apart from in certain limited circumstances, such as when necessary to address a serious and continuing risk to the safety of a patient or to the public, and then only to the extent necessary to allow a person to address the risk.

It is also important that people have certainty that the information they provide will not be used for the purposes of blame or liability. The current investigation branch does a good job under the current legislative framework but can only operate a weakened form of safe space. In addition, it has no powers to impose sanctions. We need to address that and put the HSSIB on a par with similar investigation bodies in the transport sector, as colleagues have said. Non-compliance with safe space protections may result in criminal sanctions.

[Mary Robinson (Cheadle) (Con)]

I have listened to the reasoning behind the amendments, and I feel that they are based on an acknowledgement that people in the health service have perhaps so far not found themselves willing to come forward and speak up when they see something wrong. The scope is much wider with this proposed body because evidence can be taken not just from people who work in the health service, but more widely. It is hugely important that we get to that place, because when we look at evidence taken on civil aviation and what happens in the civil aircraft space, we see that people always behave with the best interests of their sector, their workplace and the public at heart. People want to do the same with this Bill, so I am grateful that HSSIB has been set up. Can more consideration be given to how we ensure that people can speak up without feeling that they will blame another person or that they could be singled out for speaking out? That is exactly what we hope to address with the safe space.

[Edward Argar]

My hon. Friend is absolutely right. I should say that, even now, I am sure that many people in the health sector co-operate voluntarily, even when it is potentially challenging for them to do so. They do so because they want to foster that culture. This proposal will take that a step further forward and make it even easier for people to do so with confidence and to overcome any reticence that might exist because of, as she said, the fear of blame, the fear of opening up about something and the need to protect their sector and organisation, as they see it. She is absolutely right, and the key is to try to create a learning, rather than a blaming, culture. That is why the balance we strike in the definition of the safe space and exceptions to it is so important. We may or may not reach a consensus on where the balance should be struck, but this debate goes to the heart of the efficacy of the new body and how it will operate.

The Bill therefore sets out, on a statutory footing, a much stronger and more robust form of safe space. Clause 106 is the cornerstone of that. It is key to ensuring that all participants are completely candid with the information that they share, and it enables more thorough investigations and the development of meaningful recommendations. Investigations where protected material is held in the safe space should improve openness and co-operation between all participants and identify risks to the safety of patients, so that patients, families and the wider public can benefit from the experience of better investigations, and improvements can be made to the systems and practices in the provision of healthcare in England.

We believe that we have reached the right, balanced position after a lot of careful thought. In dealing with this legislation, my predecessors and I, along with my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is now Culture Secretary, wrestled a lot with the question of how to strike the right balance. I therefore turn to amendments 86 and 87. I am pleased that there is, I think, a consensus among all Members across the Committee that we need to protect materials, and about the value attached to protecting materials in the safe space, which is a key part of our approach to improving patient safety by allowing individuals to feel able to speak candidly.

Amendment 86 seeks to list in detail the types of material that will fall under the definition of protected material, while amendment 87, as the hon. Member for Central Ayrshire set out, is consequential on that. The definition given in clause 106(2) is intentionally broad. HSSIB will carry out a range of investigations, and it would be impossible to identify prospectively, in advance, all the material that will need to be gathered and should be protected by the safe space. By having a broad definition, we can give greater confidence to those who speak to HSSIB that all the material that it collects will be appropriately protected. There are very specific exceptions, which I will come on to.

As a future-proofing mechanism, the materials that are protected have not been listen in detail in the Bill. New technologies and ways of recording data are developing at a rapid pace. It is vital that HSSIB is able to adapt as these developments reach the frontline, rather than having to rely on returning to this House for further amendments to primary legislation. Listing the types of material in detail would have a number of practical implications. If we had a specified list, we could inadvertently leave out material that should be protected, when the vast majority of material the HSSIB will gather would be protected under the current definition. The Government endeavour to get everything right, but, as we all know, often do not.

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[Edward Argar]

I think I know what the shadow Minister means by cakeism. I see his point, but I think the Bill strikes the right balance by building in a further degree of flexibility, but with the safeguard of the affirmative procedure. As he knows, because he has debated such things with me in the past, the affirmative procedure is not always a friend to Ministers in obliging them to come to this House and debate and explain everything. It is, however, an important democratic safeguard when regulation-making powers are inserted into primary legislation, and that is why we have adopted the affirmative procedure in this context. I hope that that gives him a degree of reassurance that the Secretary of State’s regulation-making power is simply a future-proofing mechanism, with sufficient parliamentary and democratic safeguards attached to it.

It is crucial, of course, that the integrity of investigations is protected and that we take a careful approach to how information is protected, so that there is public confidence in the work of HSSIB. That goes to the heart of what we are seeking to achieve with this part of the legislation. To ensure that confidence, the Bill provides for the creation of offences for unlawful disclosure. That is the backbone to the creation of statutory safe space. Clause 108 creates three offences of unlawful disclosure. The offences extend to HSSIB and connected individuals, individuals who are no longer connected with HSSIB, and persons who are not connected with HSSIB but receive certain protected material. It is important that we send a robust message that there will be consequences if protected information is disclosed unlawfully. It will be a criminal offence, and the person who commits an offence will be liable on summary conviction to a fine.

Clause 109 prevents a power in any other legislation from being used to require the disclosure of any protected material by HSSIB, or to seize protected material from HSSIB. That is, as we have debated, with the exception of certain parts of the Coroners and Justice Act 2009, which allows coroners to require disclosure in some circumstances due to provisions made in schedule 14 of the Bill. However, that provision respects the devolution settlement agreement and therefore does not apply to any provision that is within the legislative competence of the devolved Administrations. The clause will help to enhance HSSIB’s safe space protections by prohibiting the unauthorised disclosure of protected material. It is important to ensure that safe space cannot simply be breached by the use of a power elsewhere in another part of the statute book, and this provision makes that position entirely clear.

As we have debated, safe space encourages all participants to be completely candid with the information that they share with HSSIB, enabling more thorough investigations into what went wrong. That will also help more widely to protect the “learning, not blaming” culture that hon. Members have spoken about and that HSSIB is hoping to embed.

[Mary Robinson]

I am so pleased to see and hear this balanced argument, and the way that all the considerations have been taken into account. With regard to the penalties for disclosure of information, how does the Bill add to or improve the provisions in the Public Interest Disclosure Act 1998? Does it improve on those provisions, or sit alongside it? Does it protect workers who disclose that there is an issue, not only from penalties such as losing their job, but also from the fine for disclosures put out there deliberately?

[Edward Argar]

I know that my hon. Friend has done a lot of work in this space, possibly involving the all-party parliamentary group for whistleblowing. I know she is very concerned to make sure that, while these protections are in place, the legitimate rights of whistleblowers seeking to disclose information are not inhibited. This provision sits alongside the 1998 Act, but it is a difficult balance to strike, as she rightly suggests. I pay tribute to her work in helping to foster a culture in which people feel able to speak up and bring matters to the attention of the appropriate body to address wrongdoing.

Finally, clause 117 ensures that the disclosure of information, documentation or other items that are authorised by the provisions I have just discussed does not breach any obligation of confidence owed by the person making the disclosure or any other restriction. The clause also confirms that part 4 does not authorise any form of disclosure that would contravene data protection legislation, which is intended to ensure that where an individual is required or authorised to disclose material, they are protected from violating restrictions on disclosure. A disclosure to HSSIB in those prescribed circumstances therefore does not contravene any restrictions on disclosure, removing barriers that individuals may face in disclosing information to the current investigations branch and helping to instil trust in the new HSSIB investigatory process.

Safe space is an exciting and important development of recent years. What we are seeking to do today is a first for a health body in this country. The clauses are of great importance to the new HSSIB and the vision we have for it. The novelty of what we are seeking to do here, building on what happens in the transport space, and the challenges that that poses, are demonstrated in the debate we have had on what the right balance is. It is an incredibly difficult and, to a degree, subjective judgment for Members of this House and others to make. While I have set out where we believe it should sit, I entirely respect the perspective of the hon. Member for Central Ayrshire, who has a slightly different and entirely legitimate view. I commend the clauses to the Committee.

Health and Care Bill (Twelfth sitting)

Mary Robinson Excerpts

Committee stage
Thursday 23rd September 2021 Public Bill Committees

[Edward Argar]

I am happy to write to the hon. Lady to communicate that information to her.

We know how important patient choice is, and not just in terms of individual choice, although it is of course vital in that context, but also in helping drive the system to continuously improve. We take the view that it should be determined through regulations. We have chosen that approach to allow the legislation to be flexible and to reflect changing priorities and new policies in relation to patients’ rights to choice.

The shadow Minister raised the process and mechanism for complaints. The individual would in the first instance complain to the ICB, as the commissioner and main body providing and co-ordinating health services in their locality. If they are not satisfied with that, they could then escalate that complaint to NHS England. It is not straight to the top, as we all know through our casework. We recognise and advise our constituents to go through the complaints process, and only at the final stage does it reach Ministers and NHS England or ombudsmen or other national bodies. That would be our approach.

Regulations on patient choice have previously been made under section 75 of the Health and Social Care Act 2012. Opposition Members will of course be deeply saddened that that section is being repealed by the Bill, including its procurement elements. In so doing, the Bill also revokes the regulations covering patient choice, so clause 67 ensures that patient’s rights to choice continue to be protected.

The clause adds similar powers, including those relating to guidance and enforcement of the standing rules, into the National Health Service Act 2006, and introduces a requirement for the Secretary of State to make regulations on patient choice. The power to make guidance and enforcement of patient choice will be held by NHS England, following the planned merger with NHS Improvement, with the complaints process that I set out earlier. The clause will give NHS England powers, which NHS Improvement currently holds, to resolve any breaches of patient choice.

There is currently a wide range of choices that people should expect to be offered in the NHS services they use—for example, choosing a GP and GP practice and choosing where to go for your appointment as an outpatient—and the clause will allow for those and other aspects of patient choice to be preserved. The clause will make sure that, under the new model, bodies that arrange NHS services are required to protect, promote and facilitate the important right of patients to make choices about who provides those services.

We know that patient choice is an incredibly powerful tool for improving patients’ experiences of care. The clause will ensure that effective provisions to promote patient choice remain, will strengthen existing choice rights and will continue to make them a requirement of the decision-making bodies that commission healthcare services. Without the clause, patients’ right to choice would be removed along with section 75’s removal. NHS bodies would not be under duties to protect and promote patient choice. Clause 67 reinserts the right and inserts schedule 11.

Schedule 11 provides further details of the powers given to NHS England to resolve any breaches of the patient choice requirements imposed on an ICB. It requires NHS England to publish a procedure outlining how it will resolve failures of an integrated care board to comply with patient choice, and lays out the reporting and appeals process. It also allows NHS England to treat inaccurate, misleading or incorrect information from an ICB as failure to comply, which will, I hope, encourage the full and accurate engagement of an ICB in addressing a failure.

People should expect to be offered a wide range of choices, as I have alluded to, and the clause and schedule will allow for that. NHS England will be able to ensure that ICBs are required to protect, promote and facilitate that important and powerful right. We know how important that is for individuals and for driving the right behaviours in the system and to improving care.

[Mary Robinson (Cheadle) (Con)]

I am grateful to the Minister for highlighting this issue with such importance. We know that patient choice is vital when a person gets to those end-of-life stages and has a terminal illness. Could I request that consideration is also given to timeliness around choice-making? For some people, particularly those suffering with motor neurone disease, their disease can move quite swiftly, so timeliness in those conversations is important. I would be grateful if consideration could be given to that, and I am heartened by what I hear from the Minister.

[Edward Argar]

My hon. Friend is absolutely right about timeliness, both from the system, in initiating those conversations, and as something that all of us need to pay heed to as individuals. Before the pandemic and before she stood down at the 2019 election, I held an event in my constituency with the former right hon. Member for Loughborough, Baroness Morgan of Cotes, about thinking and making choices early and preparing ourselves for getting older—things like preparing a will and powers of attorney. All too often, for very understandable psychological reasons, many of us do not want to think about such things, because they are an intimation of mortality. However, it is important that as individuals and as a system and a society we think and plan early, because it can make such a huge difference to the quality of our older years or the end-of-life period.

Therefore, if I may, Mr McCabe, I commend clause 67 and schedule 11 to the Committee.

Health and Care Bill (Eighth sitting)

Mary Robinson Excerpts

Committee stage
Thursday 16th September 2021 Public Bill Committees

[Jo Gideon (Stoke-on-Trent Central) (Con)]

It is a pleasure to serve under your chairmanship, Ms Elliott. I seek some clarification. With demand for palliative care set to soar because of our ageing population, I would be very grateful for any assurances that my hon. Friend the Minister can give that the reference in clause 15, in line 30 on page 13, to “after-care” includes palliative care and end-of-life care services.

[Mary Robinson (Cheadle) (Con)]

In supporting my hon. Friend the Member for Stoke-on-Trent Central, I also ask our hon. Friend the Minister to clarify this matter. As we all know, the voluntary sector is hugely important for palliative care. So many people at the end of life want to go home. We also know, in relation to discharge from hospital, that we need to get people into the right place, with the right care, so it is hugely important that we do everything we can to support that sector and to relate it to end-of-life care and palliative care.

From a personal and local perspective, I will also say, on the care that is provided, that my constituency has an excellent hospice—St Ann’s hospice. It is celebrating its 50th anniversary this year, and lots of events are taking place. The hospice relies on funding from donations from local people and the wider public. It does an enormous amount of work.

If we are to provide the personalised care that we want to achieve, and if we are to enable people to be at home and to be cared for in different settings at the end of their life, it is really important that we consider this matter in relation to the Bill, so I welcome this change to clause 15.

[Edward Argar]

A number of the points raised by hon. Members, while touching on the amendments, will be addressed substantively in the clause stand part debate that is just about to take place. I do not think that there is anything further to add on the amendments.

Amendment 12 agreed to.

Amendment made: 13, in clause 15, page 13, line 24, at end insert—

“(ca) ophthalmic services other than primary ophthalmic services (for primary ophthalmic services, see Part 6),”.—(Edward Argar.)

This amendment makes it clear that integrated boards have a duty to commission secondary ophthalmic services (replicating the current position for clinical commissioning groups). Although secondary ophthalmic services would appear to fall within new section 3(1)(f) and (g), in the existing legislation they are mentioned specifically so the amendment would continue that approach.

Question proposed, That the clause, as amended, stand part of the Bill.

Health and Care Bill (Fourth sitting)

Mary Robinson Excerpts

Committee stage
Thursday 9th September 2021 Public Bill Committees

[Edward Timpson]

Q So it is a natural progression from what is happening practically.

Nick Timmins: In large measure.

Nigel Edwards: I do not have anything to add, given the time. I agree with everything that has been said.

[Mary Robinson (Cheadle) (Con)]

Q Do you have any thoughts on the new HSSIB and its powers, which are set out in the Bill? I know that you are likely to be probed further on this later, but do you have any thoughts on how it will be implemented, the investigatory powers it will have and the safe spaces and protections it can give? Do you have a view on how it will sit with existing legislation on the protection of whistleblowers?

Richard Murray: I am afraid that is not an area we have focused on—sorry.

Nigel Edwards: Likewise.

[Mary Robinson]

Nice and easy—thank you.

[Karin Smyth (Bristol South) (Lab)]

Q I have three obsessions with the Bill, some of which I have shared with you. First, on local governance and accountability, I have tabled an amendment to follow the logic of the Bill and make accountability local rather than going via some obscure route to the Secretary of State.

Secondly, there is the treatment of capital in the system and how local communities, healthcare systems and trusts will be able to develop estates and capital planning. The third obsession has completely eluded me for the moment. It is generally about the tariff—that may be your subject, Mr Edwards—and how the vague nod to a new tariff framework in the Bill is working out. You may be more privy than the Committee to the details on how that might work out; it is about the flow of money within the system. Would you like to start, Mr Edwards, on governance, tariff and capital?

Nigel Edwards: Richard may be able to give a more up-to-date account on capital. You will be aware that the mechanisms for the allocation of capital in the NHS are a little arcane and somewhat out of date. There have been various attempts to update the mechanisms. Richard has been looking at this and can perhaps tell us more, but my impression is that it will flow following the allocation formula for revenue. There will still need to be a tariff. Despite the fact that there is integration, a tariff allows you do to a number of useful things. Certainly, patients will flow between different ICSs, so there will need to be a mechanism to account for that. It is also quite a useful budgetary tool, so in terms of financial control, it is probably quite important that the tariff is maintained.

We have been promised guidance on the flow of funds more locally, but we have not yet seen it. My presumption is that there will be a negotiated process rather than just a straight use of the tariff in the way that we have seen up until now, with variations on block contracts, maybe using the tariff—or, more likely, the historical budgets—as the starting point. The business-as-usual capital, as opposed to major capital projects, remains as it always has been. Although it is subject to some review, at the moment I do not think a major change is proposed for it, but Richard probably knows better.

Nick Timmins: I have nothing particular to say about capital. I do think you need to retain a tariff—not for everything, because in some areas of healthcare it just does not work, but for electives and those sorts of procedures. That has two advantages: it means you need to understand your costs to construct the tariff in the first place so it is a driver of efficiency, and, equally importantly, it gives you a benchmark price with which to negotiate with the private sector whenever you do outsource some operations and procedures. You are able to say, “This is what is costs us, so this is what we’ll pay you.” If you do not have that, you are subject to a seller’s market and can be charged what you like because you do not know what your own costs are.

Richard Murray: On the flow of money, we are expecting revenue allocation to ICSs based on the current formula, trying to reflect need, inequalities, deprivation and age. The uncertainty is then how much those ICBs will allocate down to place level on a local government footprint. The expectation is that quite a large proportion of that funding—general practice, community services, quite a lot of mental health, and some acute services, too—will go down to that level, but none of that is in the Bill. The allocation to ICSs stops at that point, and as has been said, you need a payment mechanism to get the money off what are, effectively, commissioners and over into providers.

The changes to tariff are mostly about flexibility, so it should still be transparent; you should still be able to work out what people are being paid, which I think is important, and you should be able to benchmark between different providers, but instead of paying for each operation and each widget bit by bit, you can have formulas that try to reflect fixed costs. You can do it in a different way that adds some flexibility into the system, which I think is important when you are trying to bring providers and commissioners into common alignment over where the money is going. Tariffs had the problem of setting them at each other’s throats sometimes, because every time someone was admitted to a hospital you would get another payment, so commissioners wanted to keep it down and providers wanted to keep it up. There is the chance to try to align some of those incentives, but there is still a lot of gap around what actually will go down to place and what will determine it; of course, again, the budgets need to be equitable.

Nigel Edwards: Richard, if I may, I think a very important point that ought to be made here is that because the allocations will now shift from 100-plus clinical commissioning groups to 42 ICSs, the variations between them will be evened out. There will need to be some way of recognising the fact that within an ICS, you have very different patterns of need, which at the moment are recognised by the allocation formula, but in the future will not be. The money will be received by the ICS, so I think there is a question there. I know that local authorities—and, indeed, GPs and primary care networks—will want to say, “If we are in a particularly deprived area and we have historically had higher funding to recognise that, we would expect that to continue.” There ought to be a line of sight from the national allocation formula based on need to the money that is received by our locality.

Sorry, Richard. I thought you made a really good point.

Richard Murray: That is absolutely all right. On capital, the Bill does not really change the way that capital works in this system. The only difference is the ability of the Department, through NHS England, to cap the spending of foundation trusts, which they have not been able to do in the past. There are some limits around them being able to do that, but it gives an additional lever at national level. Having said that, the way that capital is working in the system has changed fundamentally already: some capital goes through an allocation system, a bit like the revenue funding, and I am leading a review for NHS England now on how that money flows.

The bit that I think is really uncertain is how the big hospital schemes get picked. That is the bit that looks very different. Obviously, there is a manifesto commitment. There used to be a process by which it was determined whether providers could afford to repay—if they could do it through loans, or if there was a need system. That is now going off in a completely different place, and I think that is the bit that is not quite clear. How does that work within this system? Who gets to choose how those projects get picked, so to speak? That is the big change but, again, it is not actually in the Bill; it is being done under the existing rules.

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[The Chair]

Thank you very much. We have until 4.30 pm for this session. I call Mary Robinson.

[Mary Robinson]

Q Welcome and thank you for coming along, Sir Robert. I am Mary Robinson, MP for Cheadle and, with another hat on, the chair of the all-party parliamentary group for whistleblowing, so I obviously know about the reports you have conducted into these issues and about the Freedom to Speak Up review in particular. How will the Bill’s provisions on the HSSIB further the ability of people in the NHS to come forward and speak up in a safe space?

Sir Robert Francis: That rather depends on what arrangements are made in the new system. I have seen no guidance issued yet as to how this should work, and I am not surprised at that, because until you know precisely what the structures are and what the accountability and information flows are, it is quite difficult to do that. But I would agree that it is vital in the ICB and the ICP world that sufficient provisions are made for people who have concerns—whether they be staff, patients or the public—to make those concerns known safely to those responsible for doing something about them. In terms of this new world, that means that the ICB and, I suspect, the ICP need to have people who are directly responsible for that. Unless that happens, whistleblowers are going to find themselves in an even more parlous and uncertain place than they are at the moment.

[Mary Robinson]

Q Could you expand on that? Why would they be in a more uncertain place?

Sir Robert Francis: Unless there is certainty on guidance, policies and guardians, of which I am a great supporter, people do not know where to go. Clearly, where things are going right in terms of an open culture, there are many people whom others will go to as a matter of ordinary business. But if we are talking about places where, unfortunately, that is not the case—I think they do exist—people do not know who to go to for help. They need to know that they have protection to go to places to provide information of concern, and they need to know that they are going to get support. If there is no guidance and no clear framework, none of that will happen, and secrets will remain at provider level, when they should be sent elsewhere. Existing mechanisms, such as going to the CQC and your local Freedom to Speak Up guardian in your trust, will still exist—I see no reason why those should not—but I suspect there will be areas and subjects where that will not necessarily be the answer to the question the individual wishes to pose.

[Mary Robinson]

Sorry, just to—

[The Chair]

I think I am going to move on. Jo Gideon.

Health and Care Bill (Second sitting)

Mary Robinson Excerpts

Committee stage
Tuesday 7th September 2021 Public Bill Committees

[The Chair]

Do you want to add anything to that, Mr Trenholm?

Ian Trenholm: No, thank you.

[Mary Robinson (Cheadle) (Con)]

Q I declare an interest as chair of the all-party parliamentary group for whistleblowing. I am interested in the powers that you are going to be taking on—how those will enhance your work—and also in what you said about properly protecting information. Of course, part of this is about properly protecting the person or individual who provides that information in very many cases. I am wondering whether this is going to enhance the ability to whistleblow and to highlight these issues, and whether there is more to be done legislatively and whether you see this as being a forerunner to it.

Could I also ask about the regulatory role? With regard to whistleblowers who raise these issues—we are talking about safety and the best interests of patients here—will this enhance the powers and abilities that you have, or is more needed still.

Keith Conradi: One of the clauses actually will require people to speak to us, so there is a compulsion on people to provide evidence. In a way, that might help some people who are undecided about what they should be doing. But to balance that, it is very important to be able to protect the evidence that is given, and there are protections within the clauses. I think they could be improved. But the whole idea is that we create this space, where really the only safety valve is the High Court, and I believe that is appropriate as the only place where that information can actually be released.

I think it is worth saying, however, that when people talk to us and use this sort of safe space, the whole idea is that it is not a place where they are going to unload stuff that will never see the light of day again; we use that information, either in our final reports or to help us further the investigation. It is just that it is non-attributable, so we do not mention people’s names. The idea is that we use it to further patient safety.

My concern about the way the Bill is currently written is that there is a provision for coroners—some coroners—to be able to see this information. I think that will inhibit some people from speaking to us—and the whole point is that people are uninhibited from doing so. Having that potential release of information into that sphere will, I think, degrade the ability of the investigation to do its job.

Ian Trenholm: Building on what Keith has just said, I think we would see the Bill as giving an opportunity to create a safe space. It creates an opportunity for people to talk about things that they may not otherwise have wished to talk about. What Keith’s team can then do is look at that information. We need to make sure that we have the right data-sharing protocols in place. Keith’s team can then talk to my team about what is happening on the ground. They can do whatever anonymisation is necessary. So we might get to hear about things that we perhaps would not otherwise get to hear about.

That is a real positive at provider level, but if you click up a level, you quite often find that, from a safety and quality point of view, people’s poor experiences are driven as much by their experience of it as a system and the way they transit between different providers as it is about the experience in an individual provider. So if you have a person who perhaps is working between providers or in some kind of community provision, they will see multiple providers and they will become, if you like, better whistleblowers. Our work on systems and our assurance on systems will help as well, I think. Of course, Keith’s team make recommendations to us as a regulator, in the way they do to other people. So I think this is generally a move in the right direction.

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[The Chair]

Mary, did I see you trying to come in with another point?

[Mary Robinson]

Q Thank you so much, Mr McCabe; that is very kind of you. I have just a very short question. How does any of this relate to the Public Interest Disclosure Act 1998 and the way you are required to protect the disclosures given by individuals, in terms of the issues that you have already raised?

Keith Conradi: I would probably need a lawyer to give you the proper answer, but I do not think any of this would trump anything else. We would still need to acquiesce and accept those disclosures as they happened, so I do not think that would be an issue for us.

[The Chair]

Anyone else? It does not look like it. I thank both our witnesses for their evidence.

Examination of Witnesses

Councillor James Jamieson and Professor Maggie Rae gave evidence.