Health Service Safety Investigations Bill [HL]

Baroness Eaton Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Baroness Eaton (Con)]

My Lords, I am pleased that this important Bill with its overarching aim of improving patient safety is before us today for its Second Reading. According to the 2015 House of Commons Public Administration Select Committee report, there are 12,000 avoidable hospital deaths and 24,000 serious incidents reported every year in the NHS. In 2018, NHS services reported 10,000 incidents resulting in severe harm or death. These are worrying statistics and must motivate all of us to take action. A barrier to full investigation of these incidents is, as we have heard from lots of people, that we have a blame culture rather than a learning culture.

The Healthcare Safety Investigation Branch, established in April 2017 under the control of NHS Improvement, had the aim of improving the learning culture. However, as we know, this body lacked the independence and powers to make it fully effective. The Health Service Safety Investigations Body—HSSIB—established by the Bill will be independent of the NHS and have powers to investigate patient safety incidents that occur during the provision of NHS services.

The creation of a safe space, which we have heard much about, is modelled on the Air Accidents Investigation Branch, which we heard about from the noble Lord, Lord O’Shaughnessy. The safe space was a crucial part of the Joint Committee’s discussions and deliberations, and I know that the Ministry of Justice has been asked for advice on this aspect of the Bill. Having heard the noble Lord, Lord Hunt, ask whether the High Court will cherish confidentiality, as well as some of the other issues raised by Members in the debate, I would like to hear more from the Minister about the safety and security of the information and a little more about how the safe space will operate.

Some organisations have raised concerns that the work of the HSSIB would prevent other bodies such as the CQC carrying out their own investigations. However, the gathering of information by the HSSIB using the safe space should not impede any separate investigations by non-HSSIB bodies such as trusts, professional regulators and the health service ombudsman. The HSSIB should aim to work in parallel with them so as not to increase the burden on those giving evidence.

Another important aspect of the Bill is that there is clearly a need to improve the quality of death certification. I am pleased to see in the Bill the amendment to the Coroners and Justice Act 2009 giving the NHS the role of appointing medical examiners and placing a duty on the Secretary of State to ensure that the system is properly maintained. This is a major and essential improvement.

I fully support the recommendations in the Bill but would be grateful if my noble friend the Minister could clarify a number of points. As mentioned by others, it is of concern that the remit of the HSSIB does not cover all healthcare in England, including non-NHS provision. We have heard that the Paterson review will cause the Government to consider what should happen, but can we hear from the Minister whether it would be possible to extend the Bill to cover all providers—that is, NHS and private provision—so that we are all subject to the same patient safety standards? The noble Lord, Lord Scriven, made the rather stark point about the difference between people in adjoining beds where one was getting treatment considered to be necessary for safety and the other was not.

Will the Minister elaborate on the criteria for deciding on incidents that the HSSIB should investigate and on whether these criteria will be developed in consultation with professional and patient bodies? Will the scope of the Bill include safety incidents exacerbated by issues such as staffing levels? Will safe space investigations operate within a time limit? Will there be support for the clinicians involved, and will that support include access to mental health professionals?

During the Joint Committee’s deliberations on the draft health service investigation recommendations, the issue of the investigation of the large number of maternity cases was raised. That has been touched on today, but will the Minister clarify precisely what has happened with those investigations, where they will go next and how the HSSIB might, in future, be able to investigate more maternity activity?

I share the concerns of the noble Lord, Lord Hunt, on the reports from the HSSIB and how the reports will be acted on, and I worry that there is a likelihood of limited action, if any, being taken. I have a vision of dusty reports on dusty shelves. I hope for reassurance from the Minister as to how lessons will be learned, actions taken and real, effective improvements made. I welcome the Bill and look forward to the improvements that it will bring.

Adult Social Care

Baroness Eaton Excerpts

Wednesday 11th July 2018 Lords Chamber

[Baroness Eaton (Con)]

My Lords, I declare my interest as recorded in the register. The recent Local Government Association survey of council leaders and social care cabinet members found that 96% believe that there is a major national funding problem in social care. I think we all agree that we urgently need a long-term funding solution for social care. With that in mind, will the Minister commit to working with the Local Government Association, as it consults on its own social care proposals, and seek to start a debate on how best to fund the care we want to see for adults of all ages? Will he update the House on whether the Government’s Green Paper will commit to new funding for social care?

[Lord O’Shaughnessy]

I absolutely agree with my noble friend. I know that she speaks from great experience. We have some good working practices now, through the better care fund, between health commissioners and local government, which is an essential part in making sure we have a sustainable system.

Abortion: Misoprostol

Baroness Eaton Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

In terms of the experiences in other countries, of course only the countries of the UK are operating under the auspices and obligations of the 1967 Act, which any Government would have to act under. The Scottish Government have made that decision, but the noble Baroness will know that it is subject to a dispute and that a judicial review has been brought against it by the Society for the Protection of Unborn Children, which is obviously testing the legality of the Scottish Government and their powers to act. We shall look closely at developments in these legal proceedings, as well as any other evidence that arises. Unfortunately, this is why I am not in a position to give her a timetable.

[Baroness Eaton (Con)]

My Lords, a study of 42,600 early abortions in Finland—where there is good registry data, unlike in England and Wales—found that, six weeks post abortion, complications after medical abortions were four times higher than after surgical procedures: 20% compared with 5.6%. The Royal College of Obstetricians and Gynaecologists cites one study in the UK where 53% of late medical abortions required surgical intervention. Given these facts, are Her Majesty’s Government not also concerned that so-called home abortions outside of a medical setting would compromise the health and safety of women, especially young women who may use these powerful chemicals secretly at home?

[Lord O'Shaughnessy]

This is obviously a concern. There has been an increase in women buying online the drugs necessary for medical abortions, and that is something on which we are attempting to crack down. It is worth pointing out that 90% of abortions are NHS funded and therefore provided for in that way. The noble Baroness was talking about medical abortions at a late stage; it is worth pointing out that, actually, there has been an increase in the number or percentage of abortions that are happening at an early stage, which is obviously in the interests of women’s health.

NHS and Social Care: Winter Service Delivery

Baroness Eaton Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Eaton (Con)]

My Lords, I declare my interests as a vice-president and former chairman of the Local Government Association.

Health and social care are vital services that support our nation. Social care helps to reduce pressures on the NHS, by both supporting people to be discharged from hospital and helping to prevent them needing hospital treatment in the first place. It is an essential public service that helps working-age disabled adults, older people and their carers, as well as promoting well-being and independence.

The money the Government have brought forward for both the NHS and social care is welcome, particularly during the winter, when there are increased demand on services but, as we have heard, the timing of such allocations needs to be more realistic to be really helpful. It is also encouraging, as mentioned by the noble Baroness, Lady Pitkeathley, that the Government have included “social care” in the Secretary of State’s job title and appointed a Minister in the department with responsibility for the service. This shows that health and social care should now be afforded the same level of political importance across government.

A great deal of the public debate this winter has focused on problems associated with the delayed transfer of care, particularly as the pressure increased on NHS beds and staffing. Local authorities remain committed to supporting people as they are discharged from hospital. It is positive that councils have reduced delayed transfers of care attributable to social care by 20% since July 2017, which was when the Government first introduced the target. As the noble Baroness, Lady Wheeler, said in her opening remarks, citing the LGA, delayed transfer of care is a symptom, not the cause, of the pressures on the NHS. In many cases, the solutions are additional investment in prevention, primary care, community services and initiatives that keep people out of hospital.

It is crucial that, in the important debate on how we make sure our NHS is funded, we do not lose sight of social care. We cannot have a sustainable health service without sustainable, and sustainably funded, social care. The LGA estimates that social care faces a £2.3 billion funding gap by 2020. According to the LGA, the financial situation is making it increasingly challenging for local authorities to fulfil their legal duties under the Care Act. The message from local government and the wider care and support sector is that the situation is now critical and we need political agreement nationally and locally on the solutions. That is why it is important that we have a national debate about how we ensure high-quality, sustainable health and care services in future. With this in mind, I welcome the Government’s commitment to bring forward a Green Paper on social care by the summer.

In my closing remarks, I ask the Minister whether, further to suggestions being made by Members in the other place and by the noble Lord, Lord Macpherson, today, the Government are considering hypothecated tax for the NHS. If they are, will the option be consulted on in the Green Paper as the Government look at the funding model for social care? Our health and social care services are essential to the nation’s well-being. These services look after people when they need it most, care for them and help them live healthy lives. We need to work hard across this House, in the other place and with national and local government to find political agreement on how to ensure that we can continue to provide a high level of care for generations to come.