Queen’s Speech

Baroness Manzoor Excerpts

Monday 9th June 2014 Lords Chamber

[Baroness Manzoor (LD)]

My Lords, the gracious Speech mentioned a fairer society. We have sadly all heard of the scandalous and shocking events that took place at the mid-Staffordshire trust over a year ago, affecting some of the most vulnerable people in our society. Complacency and indifference to complaints was one of the many findings of the subsequent review led by Robert Francis QC. The Francis report called for cultural change, focus on patient experience, and much greater willingness to listen to the voice of patients and people who use the service.

The Government’s response to the Francis inquiry, Hard Truths: The journey to Putting Patients First, was published last year in November. This report demonstrated the Government’s commitment to supporting NHS organisations to create a culture of openness in the NHS, and to supporting staff and patients who raise concerns or complaints. This is to be welcomed, as is the subsequent duty of candour which places a requirement on all Quality Care Commission-registered providers of health and adult social care to be open with patients and service users about failings in care. Also to be welcomed are new leadership programmes for nursing and clinical staff.

These are important commitments, but little has been done to see things through the eyes of patients and the people who use the health and care services. Visibility and ease of accessibility of the current complaints system for the public is generally poor, and there is unnecessary complexity in it. There remains an overreliance on outdated methods of dealing with complaints. Good governance should be much more than following rules. The landscape of complaints handling and related issues of regulation is a very crowded place: who is supposed to do what, I suspect, is fully known and understood only by officials working in the Department of Health.

There are numerous organisations with overlapping roles and responsibilities, such as clinical commissioning groups, NHS trusts, the Care Quality Commission, Healthwatch England, chief inspectors for hospitals, primary care and social care, the Health & Social Care Information Centre in England, NHS England, the Parliamentary and Health Service Ombudsman—who has a dual role and is also, confusingly, known by another title—the Local Government Ombudsman, Monitor, and the NHS Trust Development Authority on finance. No doubt there are others.

In my view this unnecessary complexity has been further compounded as new or additional functions have been bolted on in an ad hoc fashion when failings in service delivery have emerged. This cannot, and is not, sustainable for the long run. It aids confusion and fosters a lack of clear accountability and therefore overall responsibility. Despite this, I recognise that some good innovations have been put in place, but their full potential will be difficult to achieve in an overcrowded field. Besides the burden of bureaucracy there are also significant costs at a time when the NHS can ill afford them.

The Government have a Bill on deregulation that will be coming before your Lordships’ House. I would welcome the Government considering modernising the deregulation framework for healthcare professionals and for users of health and social care services. I agree with the chairman of the Public Administration Select Committee, who said:

“There needs to be a revolution in the way public services are run, and how the public perceives government. As things are, most people believe there is no point in complaining”.

His statement is backed by a report undertaken by the consumer organisation Which?, which highlighted a survey showing that 35% of people who have cause to complain about the NHS choose not to do so. I suspect that the figure may well be even higher.

According to government statistics, there are 10 million patients aged over 65 and 15 million people living with a chronic condition in England. The number of these vulnerable people is rising, and increasingly there is a much greater blurring of lines between health and social care as more people move to receiving care in their home and budgets are pooled.

I, like the Public Administration Committee, urge the Government to create a new, accessible and transparent unified Public Services Ombudsman, which brings together the Parliamentary and Health Service Ombudsman and the Local Government Ombudsman, and to bring together health and social care complaints at the second tier of complaints handling. The Government should also consider establishing a supercomplainant power for Healthwatch England and simplifying the complexities of the regulatory burden. In that regard I agree with the comments made by the noble Lord, Lord Patel. Good things have happened but the NHS, patients and service users deserve more.