Health and Social Care (Safety and Quality) Bill

Debate between George Freeman and Baroness Primarolo

Friday 7th November 2014 Commons Chamber

[George Freeman]

My hon. Friend makes another important point about the role of leadership in the culture change that we are seeking to drive. I believe all hon. Members would acknowledge the Secretary of State’s personal commitment to this crusade for patient safety, and it is symptomatic of the level of leadership that is required. If the leader—the accountable senior executive—in every trust and organisation in the NHS makes clear their personal commitment to this agenda, it helps to change the culture and to create the conditions in which the reporting of patient safety issues and concerns is welcomed and encouraged.

Safety is also a critical component of the CQC’s new inspection regime and one of the five key questions the chief inspectors ask when rating the quality of services. Currently, it is at the Secretary of State’s discretion as to whether registration requirements should cover safety of care. Clause 1 removes that discretion and instead places a duty on the Secretary of State to impose registration requirements about safety of care. We welcome that duty, because it absolutely fits with the Government’s wider commitment to putting patient safety right at the heart of our health and care system. The duty will cover all providers registered with the CQC across health and, importantly, adult social care, and will help ensure that no avoidable harm will come to patients and service users when they are being provided with a regulated service. It is important to say at this point that the duty will not place an obligation on the Secretary of State to ensure that care or treatment is risk-free—no Secretary of State could ever give that undertaking. Health care provision is of its nature a risky business and can be so. Chemotherapy, for example, saves lives but can have significant side effects. A test of reasonableness must be applied in assessing whether harm is avoidable. The registration requirements that are before Parliament do cover safety and will allow the CQC to take action against poor providers in a way that has not been possible up to now. The Government therefore welcome the clause, which reinforces what the regulations are seeking to achieve and will ensure that the key message of safety and harm reduction runs consistently through the CQC regulation, and across the system as a whole, for years to come.

Clauses 2 and 3 deal with the key changes requiring a common identifier and imposing the duty to inform other health care professionals along the care pathway. Far too often in the health care system, patients lead and their information follows and, particularly as patients migrate between primary, hospital and community care, they and often their loved ones are left driving the patient journey without access to the necessary information. Too often, the health care professionals do not have access to the very latest information on the treatment that their patient has received in another part of our health and care system. That is why we welcome the clauses.

Clauses 2 and 3 concern the sharing of information by providers and commissioners to support people’s direct care and treatment, as an essential part of the delivery of safe, effective and high-quality care. The sharing of timely, accurate and relevant information facilitates the provision of integrated care and treatment tailored to people’s needs and wishes, yet we know that that sharing does not always happen as it should. Anxiety about information governance and data protection can stifle the sharing of information between staff and organisations working together to care for an individual. Clauses 2 and 3 will require that providers and commissioners of publicly funded health and adult social care share the information which is so essential to the delivery of safe and high-quality care. That will relate only to the way in which information is shared by organisations directly involved in an individual’s direct care.

Clause 2 places a duty on providers and commissioners, within scope, to record and use consistent identifiers in people’s health and care records and correspondence. There is a requirement to include the identifier when sharing information with other organisations directly involved in that individual’s care. Clause 3—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. May I say to the Minister that he does not need to explain the whole Bill; the promoter has already done that. The Government have said that they support the Bill, so I am at a bit of a loss as to why the Minister does not appear to be giving us any new information, but is reiterating what has already been said. Perhaps he could clarify some things a bit more, but we do not need a commentary on every clause.

[George Freeman]

I completely understand, Madam Deputy Speaker, and I do not intend to give you a commentary on every line of the Bill; that happens in Committee. However, given that the Government are supporting this private Member’s Bill, I thought it was important that, as part of our wider commitment, I set out why and on what basis we are supporting it, and give some guidance to the House on where in Committee there may be differences and where and why the Government are taking the view that they are. None the less, I will heed your comments and ensure that I keep my remarks at an appropriate high level.

[Madam Deputy Speaker]

Order. I absolutely agree with the Minister. We would be interested to hear any qualifications from the Government and where they were, as that would give the House time to consider what will be occurring in Committee. I look forward to hearing him say that.

[George Freeman]

It is important to recognise that clauses 2 and 3 relate only to how information is shared by organisations involved in an individual’s direct care. My hon. Friend made the point that this Bill is solely focused on the needs of the patient; it is not in any way about the Government or the NHS seeking to collect information for any other purpose other than to ensure that patient care is first and foremost in the system.

Clause 3 places an express duty on direct care providers and commissioners of publicly funded health and adult social care. When providing care to an individual, organisations within scope would be required to ensure that the relevant information is shared with staff within their organisation, and also within other organisations along the care pathway, where it is in the individual’s best interests. That duty would apply only if it directly facilitated the individual’s care and if it was in his or her best interest. That will not only support the delivery of safe, effective and integrated care, but improve people’s experience of their care and support, sparing them the frustration of having to tell their story over and over again as they move along the care pathway.

Simply sharing is not enough. To realise fully the benefits of sharing information, it is vital that the information shared is accurate, relevant and timely. In order to provide safe and high quality care, especially where it is urgent or where multiple care teams are involved, information needs to follow the person, so that professionals can access the right information at the right time. Using a consistent identifier is essential to that aim, as it ensures that the information being shared relates to the right individual.

A number of people have asked about the common identifier. Clause 2 places a duty on the Secretary of State to make regulations that will specify the consistent identifier to be used. It is the intention of the Government that the prescribed identifier should be the NHS number.

The universal use of the NHS number is a long-standing priority of the Department. Ensuring that records include a person’s NHS number, especially when they move between providers on their care pathway, is vital to the safety and quality of care. A number of Members asked about our view of the appropriate identifier. We believe that consistent use of the NHS number will facilitate the co-ordination of care, reduce errors and support the integration of records.

Ensuring a reliable and seamless transfer of information is all the more vital when the patient is a vulnerable person. That vulnerable person could be an elderly patient with dementia and many complex needs, for whom large institutions can be difficult to navigate at the best of times. I must stress that these duties are strictly limited to sharing for direct care purposes, with only those organisations directly involved in the provision of care, and only where it is in the patient’s interests.

Let me be clear: this will not permit or require sharing of information for any other purpose. The duty would not apply where there were good reasons for it not to apply. Such reasons could include: when an individual objects to his or her information being shared, or to his or her NHS number being used; where the individual would be likely to object; or when an individual receives, or may receive, services, such as sexual health services, anonymously.

[George Freeman]

My hon. Friend makes an excellent point. As he is aware, there are a number of initiatives on data across the health and care system, which is why the Secretary of State has appointed Dame Fiona Caldicott to advise the Government and to look at the pilots that NHS England is currently running on the care.data programme. It is important that the data provisions of this Bill and the confidentiality provisions and guarantees are closely examined in Committee and that there is no confusion over the purposes for which the data provisions are being used, which are solely to do with patient safety.

Clause 4 creates a power for the Secretary of State to make regulations to exclude certain persons or their functions that would take them outside the scope of the new duties for continuity of information. The Government intend to make regulations that will exclude providers and commissioners of children’s social care and providers and commissioners of children’s health care within the Department for Education’s purview. Those exclusions will include local authorities and other organisations exercising educational functions and children’s social service functions, children’s homes and residential family centres, fostering and adoption support agencies and certain schools, nurseries and educational institutions. I am delighted to tell the House that the Department of Health and the Department for Education are working together to support information sharing and use of the NHS number, where appropriate, by those organisations.

The use of patient data can arouse significant public concern and controversy and lead to highly charged debates. The public rightly expect to see their data held securely and used only for their benefit. That sits full square at the heart of these proposals, which is why NHS England has taken back the care.data proposals to review, revise and pilot, and why we have appointed Dame Fiona Caldicott. The information-sharing provisions of this Bill are solely concerned with the sharing of information between health and care providers where it is in an individual’s direct care interests.

To summarise, the consistent patient identifier and information-sharing provisions will support three key things: better informed care decisions, leading to care and treatment being better tailored to people’s needs and preferences, and better health and care outcomes; safer care, with a reduced likelihood of errors, adverse events and sub-optimal care stemming from a lack of information;, and improved experience of care, with individuals being called upon less often to repeat their story, and having increased confidence that the person caring for them has all the information that they need.

Let me turn now to the third and final section of the Bill, which deals with the regulation for the Professional Standards Authority and the professional regulator. We welcome these clauses, which will bring in a consistent objective for the PSA and for the regulators of certain health and care professionals, including dentists, nurses, midwives and opticians.

That will ensure that public protection is at the heart of what the regulators do. This measure is about not changing what the PSA or the professional regulators do in relation to professional regulation, but ensuring a coherent, strategic approach by them in the performance of their functions. Patients and the public need to understand the role and purpose of the organisations that regulate our health professionals in order to have confidence in what the regulators do. Having clear and consistent objectives is vital to that.

Let me touch now on the automatic erasure provisions, which my hon. Friend said had been withdrawn. The intent of the policy is to enable the regulators automatically to erase from a professional register individuals tried and convicted of certain serious crimes. However, it would be necessary to amend the existing statutory framework for each of the regulators properly to achieve the policy and would result in a Bill that is much longer and more complex than is usually acceptable for a private Member’s Bill. In the light of that, and given the complexity of the drafting required to achieve the policy, we took the position that automatic erasure should not be taken forward.

Automatic erasure was one of the areas considered by the Law Commission in its review of the regulation of health professionals. The Government remain committed to legislating on this important issue at the earliest opportunity. We have explored all other possible legislative options for taking forward issues arising from that piece of work and therefore propose to take forward automatic erasure in a future parliamentary Session alongside other measures in response to the Law Commission’s review. The long title of the Bill, which sets its scope, specifically mentions the intention to provide for automatic erasure, but I believe that my hon. Friend the Member for Stafford has indicated his intention to table an amendment in Committee to remove that from the long title.

When I talk to people about the Bill, I am asked one or two key questions, which I believe those watching the debate will want to hear us answer, and which the hon. Member for Copeland has asked me to deal with. The first is, “Are my medical records already shared with others involved in my care?” Unfortunately, the sharing of information about one’s care is not as widespread in the system as it needs to be. Those who use the NHS the most often are often those who have the most to remember. It can be very frustrating for health professionals, and too often that lack of information is involved in the misdiagnosis and the mistakes that my hon. Friend the Member for Stafford spoke of.

The second question that we are often asked is, “Don’t these regulators already put patient safety at the heart of everything they do?” The CQC and the professional regulators are all there primarily to protect us. The measures in the Bill are not a reflection of any failure in that respect. However, these organisations are given legitimacy through legislation; their remit and ability to act are defined in law, and it is important, we believe, that their legislative basis is explicit about their respective roles and duties in public safety. It is not our intention that the Bill, if it becomes law, should result in a dramatic change to the way in which the regulators operate on a day-to-day basis. We know that they are already focused on patient safety. The Bill enshrines that focus and ensures that those organisations are never hindered in their important work.

The Bill is a big step forward. I urge hon. Members from both sides of the House to support it.

Later in the year, we shall publish a comprehensive update on achievements to date and the progress towards Sir Robert Francis’s vision of a system delivering safe, compassionate care.

The events at Mid Staffs were a shocking reminder of the systemic failings in patient safety and care that occur when the culture and practice of healthcare institutions cease to prioritise the human, the compassionate and the cultural aspects of health care. I am delighted to support the Bill, which fits very well with the Secretary of State’s crusade for accountability, transparency and patient safety. It complements the measures that we are putting in place, as a Government, to support patient empowerment, to integrate health and care, and to meet the need for seamless information that follows patients, rather than patients so often traversing the care pathway without that information to hand.

There are two other questions that I was—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. With respect to the Minister, I spoke to him nearly 15 minutes ago with regard to his comments on the Bill. He has now been speaking for 37 minutes to tell us how much the Government agree with the Bill. There are other Bills to be debated this morning. I tried asking the Minister very nicely and gently. Now I am saying to the Minister directly that it is not his job to use up time in the House. Could he please conclude what are the major points on the Bill?

[George Freeman]

Thank you, Madam Deputy Speaker. I have concluded my prepared remarks. I just want to deal, if I may, with the questions that were asked of me in the House.

[Madam Deputy Speaker (Dame Dawn Primarolo)]

With respect to the Minister, he should have integrated those into his remarks on the Bill, because I presume he was listening to the comments of the other speakers. He has now been speaking for nearly as long as the rest of the debate, and this is not really acceptable, Minister, given that there are other Bills to be debated this morning, and that this Bill seems to have the wholehearted support of the Department. The word succinct must be in the Minister’s mind, which means brief, and I will interrupt him again if he is not.

[George Freeman]

Thank you for that clarification, Madam Deputy Speaker. In that case, perhaps it would be appropriate for me to list the questions now and then deal with them by writing to Members.

There were important questions about the Law Commission, some of which I have addressed, but I will write more fully. The hon. Member for Copeland asked me about the duty of candour dropped under pressure from professionals. If he is happy, I will drop him a line on that. The hon. Gentleman also asked about the care.data issue. I think I have dealt with that in my comments, but he should feel free to contact me if there are any omissions. There were important comments about the BMA, Madam Deputy Speaker, which I am taking your guidance to mean I should not address. Its briefing arrived on my desk this morning, and obviously I will look at it very carefully and write to Members with our position on the concerns that it has raised, although I note that its report also seems to have a lot of support for the intent of the Bill.

Lastly, there was a question about making data sharing much more consistent. I want to confirm that the Department of Health is working with our partners, and will produce guidance to support compliance across the system.

On that basis, Madam Deputy Speaker, following your guidance, I express again our support for this important measure and resume my seat.

Francis Report

Debate between George Freeman and Baroness Primarolo

Wednesday 5th March 2014 Commons Chamber

[George Freeman]

On a point of order, Madam Deputy Speaker. I came to have a debate on the Francis report. The shadow Secretary of State is not mentioning the Francis report; he is launching a criticism of the Government’s record since the report, which has nothing to do with it.

[Madam Deputy Speaker (Dawn Primarolo)]

Frankly, that is my business and I do not require any help to decide what is in order. The shadow Secretary of State is remaining in order, as the Secretary of State remained in order. I think it is best that we continue with the Front-Bench opening speeches to make sure that we can get in all the Back Benchers who wish to speak in this important debate.

Consumer Rights Bill

Debate between George Freeman and Baroness Primarolo

Tuesday 28th January 2014 Commons Chamber

[George Freeman]

I will not take interventions because of the instruction from Madam Deputy Speaker to keep moving.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I was addressing my remarks only to the hon. Lady at the Dispatch Box speaking on behalf of the Opposition. If the hon. Gentleman or any other hon. Member wants to take interventions, it is entirely up to them. I have not put a prohibition on interventions.

[George Freeman]

Thank you, Madam Deputy Speaker, for that very helpful clarification. If I can finish my point, I will happily take an intervention.

I welcome the fact that there will be one simple Act to govern what has hitherto been covered by 12. I also welcome that, underpinning the Bill, are core consumer principles. People will have the right to get what they pay for; for goods and digital content to be fit for purpose; and for services to be provided with reasonable care and skill. We will also have the right to have faults in purchases put right free of charge, or to be provided with a refund or replacement. The reforms will enhance measures to protect consumers when appropriate.

I welcome the deregulation to reduce business burdens and costs. I also welcome the modernisation of the legal framework to ensure that consumer law keeps pace with technology. It clarifies the law when it is written in legal jargon and streamlines consumer rights, remedies and enforcement powers.

Living Standards

Debate between George Freeman and Baroness Primarolo

Monday 5th March 2012 Commons Chamber

[George Freeman]

My hon. Friend makes an excellent point. I could not agree more. We need to rebalance the economy and realise that every pound spent here is a pound that has to be earned by businesses and the people who work for them.

The truth is that we inherited £1 trillion of debt—£25,000 for every man, woman and child in the country—and a situation in which £1 out of every £4 of Government expenditure had to be borrowed. We had debt interest payments of £120 million a day, and debt interest would have risen to £76 billion per annum over the Parliament had we not tackled the deficit. Yes, there was an international credit crunch, but it was the actions of the Labour Government that led us into a position of extreme vulnerability. They inherited a golden legacy in 1997 after the previous Conservative Government had had to put the country through a painful and difficult period. It was a golden legacy that, after two years, they set about—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. The hon. Gentleman has a minute less than the clock is showing before I interrupt him. There is a problem with the clocks.

[George Freeman]

After two years of sticking to the previous Administration’s prudence, the Labour Government set about the biggest spending spree in peacetime history, but because of their cynical promise to the electorate not to increase income tax, they set about a series of other measures: they sold the gold at the bottom of the market; they launched an unprecedented programme of indirect stealth taxes, which we are still feeling today; they bungled the regulation of the Bank of England—apparently planned in the back of a taxi by the former Prime Minister—which led to an explosion of cheap credit and the very crony capitalism that they accuse us of; they created an out-of-control boom that led to the very bust they promised to prevent for ever; and they set about, quite deliberately, a massive public sector expansion without the necessary structural reforms to make it sustainable. Unless we had tackled the deficit, we would have left the country facing the possibility of rising interest rates, triggering a massive and serious depression.

In truth, the squeeze is being felt not just by the middle but by the young and old in this country. Every child has £25,000 of debt and a mountain to climb. Every middle-income family—in more and more of them, every man and woman has to work to pay their way—will face a tidal wave of taxes, a rising cost of living and the ticking time bomb of inflation if we do not keep the deficit under control. Our elderly have been let down by the previous Government, who promised so much and delivered so little. They are now facing an NHS structurally unable to meet the challenges of the ageing population that depends on it.

The coalition Government have set out to tackle this legacy fairly, with great rigor and in a way that is progressive—meaning with the intention of driving social mobility and helping people to break out of Labour’s dependency culture through serious reforms to welfare and education. I want to cite several things that have been done that future generations will look back on kindly: the targeting of child benefit on the most needy; the raising of personal allowances, taking 1 million people out of tax and handing money back to 25 million of our poorest families; the freezing of council tax; the uprating of pensions and the triple lock, which will be worth £15,000 to the average pensioner family; and the protection of cold weather payments. The Labour party should hang its head in shame for coming here and posturing on behalf of the people who are paying the price of their irresponsibility.

Volunteering Bill

Debate between George Freeman and Baroness Primarolo

Friday 10th June 2011 Commons Chamber

[George Freeman]

Does my hon. Friend agree that in framing legislation to promote volunteering—I note that the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), who is responsible for the big society, is on the Front Bench—it is important that we embody notions of trust and responsibility in the culture of the revolution that we seek to trigger? Otherwise we are in danger of legislating for distrust.

[Madam Deputy Speaker]

Order. I will explain to hon. Members why it is necessary to face the Chair. The rule of the House is that when the Speaker or Deputy Speaker is on his or her feet, no other Member will stand. If a Member has their back to me, they will not see whether I am standing. It has been some time now—let us try to ensure we get it right.