Infected Blood Inquiry

Earl Howe Excerpts

Tuesday 15th October 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, before this debate began, I reflected that we were about to experience one of those rare occasions in this House in which neither party politics nor personal disagreements would rear their heads even for an instant—and so indeed it has proved. I follow the lead of every speaker this afternoon in saying that we cannot approach this most grave of topics, other than with a sense of deep shame and humility, alongside a willingness to open our minds, to listen and to learn. That is surely the only attitude possible for parliamentarians as we digest the findings of this magisterial report by Sir Brian Langstaff. In his report, the full agony of this seemingly never-ending story of failure and deceit is rolled out before us like a blood-stained carpet. Painful as his message is to us all—government, clinicians, regulators, civil servants and the NHS hierarchy—Sir Brian has done the nation a signal service. It behoves us to thank him now for the qualities he brought to his task—his thoroughness, clarity of thought and transparent humanity—all of which have given encouragement and hope, where for years none seemed possible, to the infected blood community.

The overriding purpose of Sir Brian’s report, as he makes clear, was threefold: to expose what happened and why; to describe how authorities reacted to what had happened and why they did so; and, importantly, to articulate the lessons to be learned from those findings and the recommendations that should follow from them. I am sure we all believe that Sir Brian has amply fulfilled his mission. However, for that very reason, we cannot hope to do justice today to the wide range of his findings, still less to the vast quantity of evidence given by the many individuals who came forward to tell their stories, often with enormous courage —although the noble Baroness, Lady Featherstone, gave us a vivid flavour of it.

The first and perhaps most important thing I will say is that we should regard today not as the culmination of a process but rather as the start of one. There are imperatives arising from Sir Brian’s recommendations that require swift action, as noble Lords have said—the most obvious being the need to deliver compensation expeditiously to the people infected and affected by this disaster, on a scale that properly reflects the degree of harm and suffering inflicted on them. Sir Brian, with good reason, criticises the pace at which appropriate arrangements have been put in place. Now that they have been, it is up to us to exercise oversight to make sure that the process of delivery is effective, efficient and, perhaps above all, sensitively handled.

That objective, important as it is, is one for the relatively short term. If one looks at the rest of Sir Brian’s recommendations, there is one feature that stands out a mile: to achieve what must be the ultimate aim of this inquiry—namely, to create a better future—there is an enormous amount of work to be done by a large number of people, in the NHS, the Civil Service, by Ministers across government and by Parliament. The reason for that, of course, is the need to change a culture —or, I should say, cultures; we all know that any serious endeavour in that vein, if it is to be truly successful, is bound not only to take time but to require constant renewal and reinvigoration over the years.

Although, as we know, Sir Brian lays much of the responsibility for the infected blood disaster at the door of successive Governments, in his summing up he addresses a number of audiences. The first of these is the medical profession and those responsible for codifying and imparting good clinical practice. I am quite sure that the royal colleges, the GMC and NHS England in their respective roles will have already picked up the clear messages in the report that are aimed at them. However, I hope the Minister will agree that this is one set of circumstances where the Government cannot be totally hands off when it comes to clinical practice and standards.

The noble Lord, Lord Darzi, in his recent, very valuable report on the state of the NHS, closely echoes Sir Brian Langstaff in stressing the need for a health service that is both safe and patient-centred. That is an aim that requires a certain mindset on the part of clinical staff, one in which safety and listening to patients are paramount considerations. Unfortunately, in some care settings, that mindset is in somewhat short supply. One of the noble Lord’s more depressing findings was that amid the many pockets of good and outstanding practice to be found in the NHS, there is also widespread evidence of disengagement, low morale and what he calls a “reduction in discretionary effort” among clinical staff—things that together can serve only to frustrate the good objectives that he espouses. The noble Lord, Lord Darzi, plainly sees them as objectives which are unlikely to be attainable without a very clear plan for climbing the hill in front of us, not just on the part of the NHS and the professions but on the part of government as to what regulatory structures and statutory measures are needed to support and underpin those efforts. In other words, this has to be a concerted endeavour that involves collective, open-minded thinking by all relevant bodies.

I want to pick up the issue of regulation briefly. The Parliamentary and Health Service Ombudsman is quoted as saying that there are now too many regulators in the health service. In fact, a lot of people are now saying that. Professor Charles Vincent and others, in an article published in the BMJ five years ago, made trenchant comments to that effect. Sir Brian’s view—surely right—is that the regulatory system needs to be easy for ordinary people to navigate, which it is not. Nor is it at all joined up. Sometimes, effort is poorly directed. I must confess to a personal view that too much of the CQC’s focus nowadays is on inputs and not enough on outcomes, both good and bad.

In matters of clinical safety, structures and culture are linked. Simplifying structures and redefining accountabilities are ideas crying out to be looked at. The Patient Safety Commissioner, whose appointment we owe to my noble friend Lady Cumberlege, has spoken alarmingly of a culture that is “getting worse”. She added that

“unless leaders set a strategic intention to listen and act, we are heading straight back to the days of Mid Staffs and other health scandals”.

Let those words serve as a warning.

It is not just the health service that needs to look carefully at its culture. Sir Brian’s frank exposure of the failings, defensiveness and downright deceit that have characterised the behaviour of parts of the Civil Service is chilling. At various stages of the Victims and Prisoners Bill earlier this year, we debated the merits of applying a legal duty of candour to those working in all branches of the public service. My view on that has not changed—I am not in principle against the duty of candour; I simply think that on its own it will be ineffective. It was the coalition Government who brought in a duty of candour for health service bodies in the wake of the Mid Staffs scandal. I was a member of that Government, and I wish I could say that the duty had had a measurable effect. Without somehow banishing the knee-jerk defensiveness that persists within some healthcare providers and without providers being genuinely willing to listen to the concerns of patients, a stand-alone duty of candour is simply not going to cut the mustard, either in the NHS or, mutatis mutandis, elsewhere.

How, then, to make it effective? Sir Brian believes that the missing link revolves around leadership, such that health service leaders are made directly accountable in law for the culture that they oversee. At first blush, that seems to me a pretty stiff duty to put into anyone’s job contract, but coming from Sir Brian, the idea must be one that we treat with due seriousness.

When it comes to the Civil Service, it is noteworthy that Sir Brian does not go so far as to insist that the Civil Service Code should be pensioned off. However, he does say that the duty of candour implicit in the Civil Service Code needs to have teeth if civil servants are not tempted to revert to what one witness, Dame Una O’Brien, described as a culture of hierarchy and dismissiveness. Again, her belief is that it is leadership within a government department that is the key to bringing about the desired opposite, which is a culture of trust and respect.

As with the health service, Sir Brian’s recommendation is for there to be a legal duty of accountability on senior civil servants for the candour and completeness of advice given to Ministers. Again, I cannot help thinking that so long as hierarchies exist, and for as long as civil servants are afraid of speaking out, let us say about a senior colleague, Dame Una’s aspiration may remain just that. But we must be open-minded to ideas of this kind—the gravity of the events that have unfolded over the past half a century is reason enough for us to do so.

The Minister has indicated that the recommendations contained in the Infected Blood Inquiry report will receive the closest attention from the Government over the weeks and months ahead. That is good but I should like her, if she can, to go a bit further. Many of us have observed that reports from statutory public inquiries have a tendency to disappear behind a Civil Service veil after a certain lapse of time unless there is a parliamentary mechanism to keep them squarely in the public view. In this particular instance, the sheer multitude of recommendations—I have not counted them but the number is enormous—bearing in great detail upon so many bodies, organisations and individuals surely requires a mechanism to be put in place whereby Parliament can be reassured of the progress being made in taking the recommendations forward across the piece.

In the first instance, it was helpful to hear the Minister commit to reporting back to Parliament, as Sir Brian suggested, before the end of this year on how the Government intend to proceed in this regard. However, without imposing a duty of candour on the Government—I would not be so impertinent as to do that—I would like to think that we can expect from Ministers a willingness to use this House and the other place, including a suitable Commons Select Committee or perhaps a Joint Committee, as a means of sharing and debating actions and ideas in a spirit of openness. Surely this kind of non-partisan honesty and openness is the least that we owe to those thousands of people whom our country has so cruelly betrayed.