Health and Social Care (Safety and Quality) Bill

Fiona Bruce Excerpts

Friday 7th November 2014 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

May I begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy) on his Bill, which, if implemented, has the potential to provide significant improvements right across this country to the treatment and care of patients requiring medical assistance? Indeed, the improvements proposed by the Bill would have an immediate and real impact.

The national health service is an institution of which the whole nation can be proud. It serves our society with outstanding professionalism and admirable compassion. However, as a few specific, terrible instances have shown, there is room for improvement.

I salute my hon. Friend’s tireless work to do everything possible to ensure that this country never again experiences tragedies of the type reported from Mid Staffordshire hospital. Indeed, my hon. Friend’s constituents have cause to be extraordinarily proud of him as their elected representative and of the thoughtful, tireless and effective work he has done on their behalf in response to the issues raised at Mid Staffordshire hospital. I do not believe that any other Member could have worked harder for their constituents in this connection. He has raised their concerns in this House countless times.

The Bill is another carefully considered and utterly compassionate response—so characteristic of my hon. Friend—to those events. It is a focused, effective and, above all, practical proposal. It has one overriding focus: patient care. It deserves to be fully supported in its passage through the House. Its proposals are specific, realistic and immediately applicable. It will bring about real changes in the lives of real people right across the country at their weakest and most vulnerable moments.

As I have said, particular situations hit the headlines. Although they were extreme, the House must remember that they are part of a wider national picture. We must use the lessons to inform future policy, and the Bill does just that. It is all about patients and their care, and about promoting consistency across the country so that all patients are cared for safely, and are seen to be cared for safely, to an accepted and understood standard. The NHS is an institution that the British people own, fund and use, and it is right for us to be concerned about public confidence in the quality and safety of the care it provides.

I understand the concerns of those who say that the NHS cannot be run on the basis of public opinion—I will speak about that when I come to clause 5—but that does not negate the fact that public confidence in the NHS is an essential concern, not an optional extra. Indeed, an NHS or local hospital that loses the confidence of the public will quickly cease to be able to serve effectively the community for which it is designed.

The first purpose of the Bill is to set in stone the priority of patient safety in NHS standards not just as a power but as a duty of the Care Quality Commission, as my hon. Friend has said. We have learned from the Francis report that patient safety is not an optional extra; it is essential and should be at the heart of good health care. The recognition of every single person’s dignity and value has characterised the proud history of the NHS and must always remain central to its practice, no matter what pressures it comes under on a wider scale.

The priority of safety in the work of the CQC will help to enshrine the dignity of individuals in a system that must inevitably focus on what is efficient in the wider structural picture. Putting safety first will ensure that it is not lost within bureaucracy and procedures. The nature of the NHS clearly means that health care professionals are always under all sorts of pressures to decide how they can most effectively allocate their resources of time, expertise and treatments.

Clause 1 will be a buttress to the rights and dignity of each and every individual within the larger picture. It will make sure that safety is one of the key non-negotiable factors that guide professionals and institutions as they make decisions. The clause acknowledges that there is no such thing as risk-free health care, and it allows for a certain margin when those providing the service cannot reasonably avoid risk. The responsibility that the clause will permanently place on health care professionals, institutions and those assessing the CQC should ensure that the recent tragedies in patient care are far less likely to happen in future. Ideally, no one in the House would want them to happen and to be reported again.

The second aim of the Bill relates to transparency and the integration of health care. A more integrated health care system must surely be a better system. It would promote shared expertise, shared learning and greater safeguards. The care provided for patients should reflect the fact that disconnected and fragmented health care is weak health care. These provisions will aid heath care professionals with regard to not just safety, but good practice across the board. I hope that it will simplify, rather than—as some fear—make more complex, the system of health care provision for patients. A consistent patient identifier and wider information sharing should create clearer channels for the integration of health and social care for individuals. This is the way of the future, particularly given the needs of our increasingly elderly population. I applaud my hon. Friend for those practical proposals.

As I have said, the NHS is a unique institution with a unique connection to the public. Public confidence is not an optional extra, but to achieve it requires transparency. I am sure that many health care professionals in the NHS will welcome greater transparency. The overwhelming majority of those who work in the NHS do an outstanding job, of which they—and we—can be proud.

The British Medical Association has certain concerns about the NHS number being used as a universal identifier, so I am pleased to highlight the fact that the Bill does not require any particular identifier to be used. The Bill seeks to promote the principle and merit of having an identifier, but which identifier is to be used can be left to the discretion of the Secretary of State, who I am sure will consult interested parties.

Provisions for sharing information in the Bill are also important. They will facilitate better health care treatment for every individual across all areas of their treatment, allow professionals to do a better job, and allow patients to know with confidence that those looking after them are fully informed about their care requirements before they provide treatment. Currently, patients cannot be sure that their medical and care history and priorities are being shared between professionals responsible for their care. My hon. Friend has cited cases where that has caused problems, which is no doubt typical of many.

Care must be taken to ensure that information is shared in a responsible way that upholds the privacy of the individual—that is critical. Questions of who information is shared with and how consent is assumed or obtained from patients are important, and there will be the opportunity to discuss such matters further in Committee. As the Bill rightly points out, patient data should not be shared where that is not appropriate, or in an unsafe manner—for example, where a person’s medical record contains confidential information about another person. Critically, the sharing of information must always be in the best interests of that person’s care and treatment. The Bill would not require the sharing of identifiable information for purposes other than direct care. As Dame Fiona Caldicott said:

“For too long, people have hidden behind the obscurity of the Data Protection Act or alleged rules of information governance in order to avoid taking decisions that benefit the patient. Personal data must be protected lawfully, but common sense and compassion must prevail.”

The third and final aim of the Bill is to ensure that the various health care regulators, including the Professional Standards Authority when making decisions on cases of conduct or misconduct, have consistent overall objectives in mind: the maintenance of public safety, public confidence in the relevant profession, and proper professional standards of conduct on the part of health care professionals. The proposals have not sprung up in a vacuum; they are consistent with recommendations in the Law Commission’s report, “Regulation of Health and Social Care Professionals”. It noted with concern the inconsistencies in the way different professional regulators assess individual fitness to practise. The relevant section of the Bill, recommended by experts, should ensure fewer examples of poor practice, and that it is properly addressed. Everyone—practitioners and regulators —should know the primary principles by which professional performance in the health care system is to be judged.

I understand that some professionals, and the BMA, are concerned that the link to public confidence could lead to an inappropriate link between volatile public opinion and the decision of regulators. Those are reasoned concerns but they underestimate the capacity of regulators to make appropriately sound judgments against set benchmarks. The legal position already requires attention to be paid to public confidence. The Law Commission’s report stated that

“the concern is that in cases of clinical misconduct or deficient professional performance they—”

that is the regulators, and for the benefit of the House I will elaborate a little on what “the regulators” means, because it is an extensive group of organisations—

“are more likely to look at whether the instances of clinical misconduct or performance are remediable than to fully consider all of the factors, including public confidence in the profession.”

The Bill addresses that concern.

Concerns that this will lead to inappropriate links between regulation and public opinion, perhaps especially as it relates to so-called scare stories in the press, should prove unfounded. Far from it: the Bill should encourage greater clarity and rigour in the grave task of regulators in assessing professional standards and promoting best practice. The impact of the Bill in this regard should not be underestimated. The extensive list of regulators—the bodies that regulate health and care professionals in the UK and will be affected positively by the Bill—includes: the General Chiropractic Council, the General Dental Council, the General Medical Council, the General Optical Council, the General Osteopathic Council, the Health and Care Professions Council, the Nursing and Midwifery Council and the General Pharmaceutical Council.

[Jeremy Lefroy]

I am most grateful to my hon. Friend for taking on the role of enunciating all the regulatory bodies. Does she agree that we would be wrong to downplay the great common sense of the British people when talking about public confidence? Public confidence in health care professionals, by any objective reasonable measure, is at a very high level and we do not just need to look at press headlines for that. Does she agree that, when it comes down to it, the British people have a huge amount of common sense and the profession should not be afraid of public opinion? It is very much on its side.

[Fiona Bruce]

I entirely agree. In saying what I have said, I in no way want to denigrate my hon. Friend’s intervention. I absolutely agree with him.

In closing, let me repeat my support for this profound and potentially far-reaching Bill. If passed, it would influence the life of every citizen in this country. Let me repeat my support for the excellent work my hon. Friend has done in bringing it to the House, and in working to drive up standards in the NHS, both locally in his constituency and nationally, and protect people across the country from a repetition of the sad and tragic events documented at Mid Staffordshire. The Bill will strengthen relationships between patients and health care professionals, and between the NHS and the public in general. It will help to lift confidence in the NHS even further. Most of all, it will help to ensure that every person who relies on the NHS in their most vulnerable moments will be safer wherever they live and whatever their condition. For that reason, I commend my hon. Friend’s Bill to the House.