Health and Social Care Bill

Baroness Masham of Ilton Excerpts

Monday 7th November 2011 Lords Chamber

Moved by

[Baroness Masham of Ilton]

20: After Clause 2, insert the following new Clause—
“The Secretary of State’s duty to ensure transparency
After section 1A of the National Health Service Act 2006 insert—“1B Duty to ensure transparency
The Secretary of State must act with a view to securing—(a) that any persons providing health services should provide, within as short a period as possible, full information to patients, their carers or representative about any incident or omission in or affecting their care which may have caused harm, or may in the future cause harm,(b) that regulations are introduced to enable the Care Quality Commission to take action against a registered person or body who fail to disclose details of such incidents as set out in those regulations.””

[Baroness Masham of Ilton]

My Lords, Amendment 20 would establish a duty of candour so that any provider of National Health Service services would have to inform a patient, or their family or next of kin if they died or lacked capacity, when something went wrong with their care or treatment that had led to harm or could cause harm.

The principle of “no decision about me without me” has been stressed. If the patient is to be central to the legislation, the amendment should be taken very seriously. I hope that your Lordships agree with me that there are always risks in the treatment of patients, but that there should be openness and transparency, with no cover-ups, when things go wrong.

There is currently no statutory requirement on providers of National Health Service services to tell a patient, or their carer or representative, when something has gone wrong during their care and treatment, while a host of compulsory standards are set out in statutory regulations. The issue is left to guidance and a non-binding requirement in the National Health Service’s constitution to have regard to the principle of openness. This has allowed cases to occur where NHS organisations have withheld such information from patients, delayed its release or, worse, actively covered it up.

Organisations concerned with patient safety have campaigned for a statutory duty of candour to rectify this situation. The Government have agreed that a duty of candour is required, but their preferred route is a contractual duty built into the standard contracts between commissioners and some providers of NHS services. Patients’ organisations do not believe that that is adequate. It would not include all NHS providers, only those with standard contracts, and would not create access to the sanctions that the CQC has at its disposal.

It is not just patients and patients’ groups who advocate a statutory duty of candour. Action Against Medical Accidents presents an impressive list of organisations and leading clinicians who support it. Just recently, at the Mid Staffordshire Hospital NHS Foundation Trust public inquiry, Sir Liam Donaldson, the former Chief Medical Officer for England and internationally renowned champion of patient safety, reiterated his long-held belief in a statutory duty of candour. When asked directly, he said that he had always personally agreed that there should be a statutory duty of candour. He explained that he favoured it because he was of the view that professionals should be encouraged to take responsibility when they have done something wrong rather than withhold instances of harm. I believe that failure to commit to a more meaningful measure in this Bill will not only fail to have the desired effect, but is a snub and an insult to patients, patients’ groups and other experts.

There is little if anything in the Bill that is genuinely drawn directly from the priorities and wishes of patients. A commitment to a statutory duty of candour certainly would be. This is an opportunity to show that patients really are being listened to. If the Government agree that the requirement to be open really is fundamental and essential, why on earth would a different approach be taken to this essential requirement, with it being left to the commissioning process? Commissioners are simply not equipped to regulate issues of this kind. If one accepts the argument that this is the appropriate way to proceed, then all of the core standards currently in the CQC regulations could simply be dealt with in the standard contract for providers.

Another key weakness in the Government's proposal is that providers’ contracts relate only to NHS contracts with trusts, PCTs and private voluntary providers of NHS services. That would not include primary care practitioners such as GPs. The Government admit in their consultation document that GPs are subject to different arrangements and that the duty could be brought in only in negotiation with their representing organisations. Very significantly, the BMA General Practitioners Committee has already stated that it would not sign up to a duty of candour, but it should not be negotiable. A duty is a duty.

The Government’s proposed contractual duty of candour would be weak even where it did apply. It simply would not cover the area where so much NHS care is undertaken—in primary care.

--- Later in debate ---

[Earl Howe]

I shall have to get back to my noble friend on whether it is specifically mentioned in the consultation. I can say that it is absolutely pertinent to the subject matter on which we are consulting. It would be extremely helpful if some of the response to the consultation covered issues such as mediation. We need to factor that in and perhaps my noble friend, with her experience, will feel able to send us her views on the subject.

[Baroness Masham of Ilton]

I thank all noble Lords who have supported, or not supported, the amendment. I say to the noble Lord, Lord Winston, that the last thing one wants is to make a difficult situation more dangerous. One wants to achieve accident prevention. It is vital that patients have trust in the doctors, nurses and other professionals who are treating them. Something has to happen now about the culture. We have to look at what happened at the Mid Staffordshire General Hospital. I sincerely hope that something will be learnt from that. I know that the Government want to improve things. I think that all doctors in the House are trusted by their patients, but there are doctors who have lost their patients’ trust. That is why I feel very strongly that whatever the Government try to do will have to be done by statute. Many doctors just follow the book and do not do what they should do.

I feel very strongly that your Lordships’ House, with all its expertise, as displayed tonight, must find a way. I sincerely hope that that will happen with the blessing of the Minister and the Government. I hope that we can work together and, before Report, get something that is acceptable to everyone, especially to patients. One must remember the patients who have suffered so badly and who are suffering today. Every time I open a newspaper, I see something about the culture of nursing, and something has to be done. It is the Government’s responsibility. We should go for a statutory obligation to protect patients. With that, I beg leave to withdraw the amendment.

Amendment 20 withdrawn.