Care Bill [Lords]

Charlotte Leslie Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

They did, and they put those posters up at the election to try to scare older people—I do not know how they thought that was appropriate, in the same way I do not know how their contributions today have been appropriate.

What my hon. Friend the Member for Coventry South (Mr Cunningham) says is exactly what is happening. People are not daft. They can see what is going on. They saw a Government legislate to place the market at the heart of the NHS in a way that means we now have the Competition Commission making decisions and forcing services out to open tender. We also have a Secretary of State who does not waste a day running down the NHS—“uncaring nurses”, “lazy GPs”, “coasting hospitals”; everything undermined, everything wrong—rather than celebrating good care. That is the agenda. They are softening the NHS up for more privatisation.

That will be the big choice come the next election. The Secretary of State can spin whatever lines he wants from that Dispatch Box, but that is the choice: a public, proud NHS under Labour, or a fragmented market under the Conservative party. I know which side of the debate I am on, and that is the choice we will put to people.

[Charlotte Leslie (Bristol North West) (Con)]

Independent sector treatment centres—the right hon. Gentleman’s party started competition!

[Andy Burnham]

Across the NHS, people are spending millions on competition lawyers thanks to the Bill that the hon. Member for Bristol North West (Charlotte Leslie) and others passed. That is being cited as the major barrier to the integration that the Secretary of State claims he wants. Let me quote the NHS chief executive to back up that point. He recently told the Health Select Committee:

“What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost in the system and great frustration for people in the service about making change happen… In which case, to make integration happen we will need to change it”.

By which he meant the Health and Social Care Act. It could not be clearer. It is the biggest barrier to the integration of care and support for older people. That is understood across the NHS, but the Bill does nothing about it.

Instead, the Government have left an NHS bogged down in competition law. How did it come to that? Who voted for that change? Who gave this Prime Minister and this Health Secretary permission to do something that Margaret Thatcher never dared—put the NHS up for sale? The answer is no one. Ministers talk the talk about integration, but they have legislated for fragmentation and privatisation, and the Bill does not change that. Only Labour will repeal the Health and Social Care Act, and that will be the big choice, as I say. We will bring health and care together, creating a public service working for the whole person. That is the only way we can reshape health and care services around individuals in their own homes.

In conclusion, the Bill makes some sensible changes that we will not oppose, but as our reasoned amendment makes clear, it falls far short of the durable solution that England needs. Social care in England is getting worse, not better, and the Bill does nothing to change that. It will not stop people having to lose their homes and savings to pay for care, and in the end it deceives older people about the amount they might have to pay for care, which is fundamentally wrong. Older people deserve better, and it will fall to Labour to have the courage to deliver it.

--- Later in debate ---

[Charlotte Leslie (Bristol North West) (Con)]

I greatly welcome much of what is in the Bill. I am slightly disappointed by the tone of some—not all—Labour Members, who seem to suggest that the challenges our society faces with social care are in some way new. I looked after an old lady from 2003, during the economic boom times, and became very well acquainted with her care package, care needs and care challenges, and the challenges faced by her social workers. Back then, social workers were expected to get across London in 20 minutes, which was obviously impossible, so the care time that they had with my friend was severely cut down; in fact, sometimes it was 15 minutes, a figure that we have already heard. There was also a massive challenge in terms of raising the status of the profession of social work. Those challenges existed back then, during the boom times, and they still exist now. It is very brave and ambitious for the Government to be making such significant steps in unifying health and social care at a time when the economic situation is very difficult.

Other Members have dealt with the care and support aspect of the Bill more eloquently than I can, and I am sure that others will too. I want to focus my brief remarks on part 2, which is about the response to Francis and care standards.

I think that one lesson we have learned following the Mid Staffs scandal is that making rules does not necessarily mean making change. I remind the House of the 2002 “Code of Conduct for NHS Managers”, which states:

“As an NHS manager, I will observe the following principles: make the care and safety of patients my first concern and act to protect them from risk;…be honest and act with integrity; accept responsibility for my own work and the proper performance of the people I manage”.

Following the unravelling of scandals in Mid Staffs and elsewhere, it is very hard to understand how NHS managers were adhering to that code of conduct, which was written for them, and why none of them has faced the consequences of not doing so. That is a salutary lesson: we need to be wary that putting things in writing does not always mean that they will happen culturally. People have remained unaccountable for a serious breach of that managerial code of conduct, many of whom, I am afraid to say, continue to work in the NHS today.

As the Bill progresses, I want to see more detail on how the contractual obligation for a duty of candour, which is welcome, will be enforced. I understand the desire for a statutory duty on individuals, but I share fears that it may oversimplify the blame culture that this House has discussed at length. Having seen what happened with our hospitals’ complaints system and the cover-up of blame, I am very worried that a statutory duty on an individual clinician could be abused, such that blame could be parked at a clinician’s door by a management system that does not want its own failings to be highlighted. That could lead to unfortunate false allocations of blame by the system in which clinicians work.

If a contract’s duty of candour is not met, what will be the consequences? It is an issue that there have been no consequences for those who have breached things written down in guidelines and codes of conduct. It is important to understand in more detail what the consequences will be of a breach of contract.

I would particularly like to know whether managers, organisations such as NHS England, and Department of Health officials will have the same duty of candour. The reason why scandals such as Mid Staffs have been allowed to go on and on is that it was not just the hospital that was complicit in it; the entire system around the hospital should have been acting in patients’ interests, but it did not.

Some have faced consequences for their actions—their actions were good, but the consequences have been diabolical—namely whistleblowers. I know and understand that real reform of how we treat whistleblowers and enable whistleblowing will require changes to the Public Interest Disclosure Act 1998. If a whistleblower has been found to be correct in raising concerns in the NHS and those concerns are recognised, I would like to know why any future employer would choose not to employ them. If an employer is a good employer, they would welcome a whistleblower into their ranks as someone who would not go native and accept appalling care when others might do so and who would also have the moral fortitude to stand up and talk about failings when others might not. The test of a good employer is how well they employ people who have been proven to be whistleblowers.

People such as Eileen Chubb and David Drew have sacrificed their careers to highlight bad care, but they have not seen the systemic changes for which they made those sacrifices and they are still suffering the consequences. Surely that is a part of NHS and health culture that the Bill should seek to change.

I welcome the fact that the Care Quality Commission will be looking at the issue of whistleblowers and I welcome James Titcombe’s involvement in the CQC. As someone who thought that the CQC brand was so damaged that it should probably just be scrapped and we should start again, I have to say that I think David Prior has made remarkable progress, given what he started out with, in beginning to turn this monolith around.

Statutory independence of the CQC is very long overdue. I think that everyone in the House has been concerned about the fact that the CQC’s mission seemed to be reputation management for itself and the NHS, and not a brave and courageous stand on behalf of the patients it was supposed to be protecting. In order to ensure that the CQC remains independent from Government—independence in words is fine, but independence in culture is what really matters—it might be illustrative to look back to the era before the CQC and other regulatory bodies were in place, when royal colleges used to send their members into hospitals. They would do so not to inspect hospitals as such, but for reasons of medical training. However, by getting a granular view of the training on offer they could see whether or not it was sufficient. If not, the royal colleges could, under bodies such as the hospital recognition committee, withdraw training from a hospital, which gave the inspection teeth. It was the royal colleges that went in—often without any pay at all; just enough to cover expenses—and interviewed junior doctors and consultants individually, and problems naturally came to light because the interviews were often confidential.

A Wigan hospital fell foul of an inspection in 2001 and its chief executive did not take kindly to it. Funnily enough, just after the inspection took place, the chief executive, who was quite close to Alan Milburn and the then Prime Minister, went into the Department of Health and abolished the system whereby professional clinicians could get a granular view of what was going on in hospitals, replacing it with the postgraduate medical education training board and then the medical training application service, which was disastrous. The more we can put those who do not have an interest in bolstering the Government of the day—namely the professionals, clinicians and members of the royal colleges—on the ground and doing granular investigations, the more confident we can be that the CQC will be independent.

[Grahame M. Morris]

I am not sure that I share the hon. Lady’s enthusiasm about the transformation of the CQC; nevertheless, some progress has been made. Does she share my concern that clause 85 proposes to dilute the CQC’s powers with regard to investigating the commissioning of adult social services and social care by local authorities? Is that not a step backwards, particularly if the hon. Lady is concerned about the issue of 15-minute visits and the impact that has on quality?

[Charlotte Leslie]

I am afraid that the quality of care and social care could be the next boil of scandal to erupt as we gain a more granular view of what is going on. Organisations need not just more effective tick-box inspections, but more effective granular inspections. I do not agree with the hon. Gentleman: I think the CQC is taking great steps forward. I am very sceptical, but I am cautiously optimistic of progress and will continue to look at what the CQC does.

I will make progress, because I do not want to prevent other Members from contributing to the debate. Essentially, the Bill can only put down regulation. One of my favourite things is to warn against systems so perfect that nobody needs to be good, yet this House really only has levers to change systems. We cannot always enable people to be good, but we can devise systems that enable them to be good. This House is attempting to turn around a massive cultural tanker and it is unrealistic to think that we can do so through the scope of a single Bill. I think, however, that the Bill takes very important steps forward in a very difficult context. I am disappointed that it is not supported throughout the House, although I think that constructive amendments and changes to it will be welcomed in the interests of the patients we are all here to serve. I heartily recommend the Bill to the House.