End of Life Care

Bernard Jenkin Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I hardly feel worthy of catching your eye today, Mr Deputy Speaker, having not been in my place for a question earlier today. I apologise to you and to Mr Speaker for that. I was, in fact, preparing for this debate, as Chairman of my Select Committee. I commend my hon. Friend the Member for Totnes (Dr Wollaston), the Chair of the Health Select Committee, for her report and for securing time to debate end-of-life care on the Floor of the House.

I shall wantonly use this opportunity to promote one of the reports produced by my Select Committee, the then Public Administration Select Committee. I am not just talking about the report on dying with dignity, which followed a report by the Parliamentary and Health Service Ombudsman. That report underlines why my hon. Friend the Member for Totnes is absolutely on the right track in making her investigations.

We have urged the Government to recognise the shortcomings that exist in many of our health institutions. People are not recognised to be dying when they are dying, their symptoms are not addressed, and there is poor symptom control. People have watched loved ones dying in pain because of ineffective symptom management. As has been mentioned today, there has been poor communication. Professionals have failed to engage in open conversations with patients and family members. There have been inadequate out-of-hours services, and people have suffered because of difficulties in gaining access to palliative care out of hours. There has been poor care planning, and delays in diagnosis. And so it goes on.

What strikes me about so many of the accounts that we have heard this afternoon is the lack of learning, the sense of helplessness, the sense that this is just what happens in our health system. That is what drove my Committee, at the end of the last Parliament, to produce the report entitled “Investigating clinical incidents in the NHS”. Imagine what it would be like if we had an NHS in which, whenever something went wrong, there was a proper and open investigation, followed by learning from what had occurred—without blame—to prevent a repetition. So often, in debates such as this, we hear about the same things occurring again and again.

Our report revealed that

“there are 12,000 avoidable hospital deaths every year. More than 10,000 serious incidents are reported”

to the NHS, in England alone,

“out of a total of 1.4 million mostly low-harm or no-harm incidents annually. There were 338 recorded “never events” (such as wrong site surgery) during 2013-14”,

and there were 174,872 written complaints. The then latest estimate of clinical negligence liabilities on the NHS balance sheet was £26.1 billion. If we could get just 10% of that right, we would save millions of pounds. If we could avoid 10% of those incidents, we would save the NHS huge amounts of money.

We looked into the way in which other safety-critical industries dealt with safety management and incident investigation. The most notable is aviation, but similar considerations apply to marine accidents, accidents in the North sea oil industry, and the work of the Rail Accident Investigation Branch, which was set up after the Paddington rail crash. I learned a great deal when I was shadow Secretary of State for Transport at the time of that rail crash. For instance, I observed how hopeless it was that the safety regulator of the railway, the Health and Safety Executive, was responsible for investigating its own failings in the event of a rail accident.

The Committee concluded that what was needed was an independent clinical investigation service that would investigate untoward incidents in the health sector. It would have to have three key elements. First, it must provide a “safe space” in which clinicians, NHS managers, patients and patients’ families could discuss things without fear of recrimination or reprisals. Such a service does not currently exist in the health service. No one dares speak for fear of getting the blame. In aviation, it is quite normal for pilots to report each other and report themselves without fear or favour, because that safe space exists.

Secondly, the service

“must be independent of providers, commissioners and regulators”.

There is no such independent investigative capacity in the NHS. We have a higgledy-piggledy arrangement for investigating clinical incidents. It might be local, it might involve a regulator, but it ends up with the Secretary of State coming to the Dispatch Box and calling for a public inquiry. That is when we really know that it has all gone wrong. The Francis report was very much a jumping-off point for us.

The third requirement is that any such clinical incidents investigation service should have the power to publish reports and to disseminate its recommendations and learning. This should not be about blaming people; it should be about learning. I am very pleased that the Government accepted our recommendations and that they have set up an expert advisory group. The group has been holding discussions for many months on how to implement the proposals.

I am sad to say, however, that three things are still lacking from the Government’s proposals for what they are going to call the health safety investigation branch, which will operate in a clinical incident investigation capacity. The Government’s refusal to contemplate primary legislation on this matter means that there will be no safe space. Their refusal to create new public sector bodies outside the framework of the NHS will mean that the health safety improvement branch will be domiciled within NHS Improvement, which is one of the regulators from which it needs to be independent. And the Government’s refusal to contemplate primary legislation means, of course, that there will be no primary legislation.

I think the Minister understands these matters very well, but I have to say to him that if, having accepted our report, the Government go ahead and create the health safety investigation branch of the NHS on this basis, they will not be implementing our findings, which they say they have accepted. It is sad that we are going to lose the opportunity to do this, and I very much hope that the Government will continue to think about introducing at least a draft Bill that would enable us to work in the longer term towards the primary legislation that we need in order to set this up. That would transform lives, and the NHS, in a way that nothing else could do.