Health and Social Care (Safety and Quality) Bill

Jamie Reed Excerpts

Friday 9th January 2015 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

I beg to move, That the clause be read a Second time.

Before I begin, I am sure that the eyes of every Member are on events in France and we wish the French authorities the very best of luck in their endeavours in the aftermath of Wednesday’s events.

I congratulate the hon. Member for Stafford (Jeremy Lefroy) on navigating his Bill to this stage. Not many private Members’ Bills make it to this point. This is a good Bill and I am sure we would all like to see it on the statute book. I hope that it can complete its final Commons stages today.

On 13 November 2014, the Secretary of State for Health announced that Dame Fiona Caldicott would be the new national data guardian for health and care, and that her role would become

“the patients’ champion on security of personal medical information.”

She will

“be able to intervene if she is concerned by how an organisation is sharing data. She can refer concerns directly to the Information Commissioner’s Office (ICO) and the Care Quality Commission (CQC)”.

Those principles are supported by all Opposition Members. Sharing data and information can and, indeed, should improve health care, but we must ensure that patient privacy is protected at all times.

If Dame Fiona’s role is to look at how organisations share data, that role will become directly relevant to the provisions in clause 3. In his announcement, the Secretary of State for Health said:

“I intend to put the National Data Guardian on a legal footing at the earliest opportunity”.

The business of the House is not so demanding that he can blame a lack of parliamentary time for not introducing such plans, especially as there have been concerns about data for a very long time. Those concerns have become even more acute since the bungled implementation of the care.data scheme, which is so important to our research base.

In Committee, I told the Minister that if the Government did not make progress on their announcement, the Opposition would help them out. That help has arrived today. The Government have done nothing, so I have tabled new clause 1 to place a duty on the Secretary of State to hold a consultation process on the role of a statutory national data guardian. We do not wish to prejudice the role by prescribing its functions. It is right that the role should be determined by consulting those on whom it will have an impact, not least Dame Fiona herself. Many stakeholders will be keen to contribute to a consultation process; they are crying out for progress.

The Bill places a duty on health care providers to share information wherever relevant. As new systems are put to the test, there will inevitably be more pressure on the national data guardian. The new clause would place a duty on the Secretary of State to start a consultation within 30 days of the passage of the Bill. We are all keen to see progress, and the new clause would ensure that the process got under way almost immediately.

We want the consultation to be meaningful and thorough to ensure that the new role is as effective as possible in maintaining standards by highlighting and, more importantly, fixing poor practice as and when it occurs. The Minister said in Committee that the delay to date was because the Government wanted to consult widely with stakeholders. That is the precisely the purpose of new clause 1, so I can only imagine that the Government will support it. If they oppose it, will he explain why? Will he commit himself to writing to me about the proposed timeline for the consultation and the planned legislative timetable for putting the role on a statutory footing, as we discussed in Committee?

Sharing data can lead to much better outcomes for patients throughout the health and social care sector, but we must ensure that personal data are used safely, and that any promotion of data sharing is done responsibly to improve health outcomes. That principle has already been explored in depth, and the Labour party is clear that it supports that principle, as I am sure do all Members. There is wide support for the role of the national data guardian. Putting it on a statutory footing has cross-party support. I hope that the Government will get on with it today.

[Jeremy Lefroy (Stafford) (Con)]

I thank the hon. Member for Copeland (Mr Reed) for tabling new clause 1, which allows us to debate the issue. I am most grateful to him for his full and constructive engagement with the Bill. A consultation on making the role of the national data guardian statutory is extremely important, and I fully appreciate the reasons why he has tabled the new clause.

I welcome the appointment last November of Dame Fiona Caldicott as the first national data guardian. Her extensive knowledge and experience in this area will ensure strong and visible leadership. She, together with her panel, will act as a source of clear authoritative advice and guidance across the health and care system. The Secretary of State said at the time of her appointment:

“We need to be as determined to guarantee personal data is protected as we are enthusiastic to reap the benefits of sharing it. Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence.”

Let me make it quite clear that the clauses on the duty to share information are not about care.data, which is another issue for another time. My Bill is about data being shared only with those who are directly responsible for an individual’s care for the purposes of that care. Its remit is very restrictive.

A consultation should, as the new clause provides, include reference to

“oversight of data sharing as set out in”

the Bill. Understandably, concerns have been raised that a duty to share information might somehow dilute the vital principle of patient confidentiality, which is protected by statute and common law. As I have explained before, I do not believe it will do so.

The seventh of the revised Caldicott principles, as set out in “The Information Governance Review”, is that

“The duty to share information can be as important as the duty to protect patient confidentiality. Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles.”

As was set out on Second Reading and in Committee, clause 3 introduces a duty to share information. That must be done when it is in the person’s best interests and it is

“likely to facilitate the provision to the individual of health services or adult social care”.

Having a statutory duty to share information for the benefit of a person’s care, within the clear limits set out in the Bill, would, alongside the existing strong statutory protection for confidentiality, provide health and social care professionals with the confidence to which Dame Fiona’s report refers.

The consultation on the national data guardian will provide the opportunity to set out how oversight would work for the duty introduced by the Bill, should it become law, under the legislation that will make the role of the NDG statutory. If the consultation cannot be established through a clause in the Bill, which I understand may be the case due to the timing of the general election—the Minister will go into that, I believe—it needs to happen at the earliest possible opportunity.

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As there is so much common ground on the role of the national data guardian, and a clear commitment to consult fully, I hope the hon. Gentleman will agree with the approach I have outlined and be satisfied with my reassurances, and that he will withdraw the new clause.

[Mr Jamie Reed]

I am grateful to the Minister for his response and for the constructive way that we have dealt with the Bill, which in many ways demonstrates some of the best traditions of the House. I am a little disappointed, given the fallow—dare I say useless—fifth year of this five-year Parliament, that time has not been found to address these issues. The protection and use of individual data, not just in health services but across the public sector, is one of the biggest and most important emerging issues facing our politics and society, and the Minister is right to say that such matters need to be treated carefully, judiciously, and with diligence and attention to detail.

Given the cross-party support and the Minister’s assurances, I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 2

Care and Quality Commission reviews and performance assesments

‘(1) Section 46 of the Health and Social Care Act 2008 (health and adult social care services: reviews and performance assessments) is amended as follows.

(2) For subsection (3) substitute—

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”’—(Sir William Cash.)

Brought up, and read the First time.

[Sir William Cash (Stone) (Con)]

I beg to move, That the clause be read a Second time.

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[Mr Jamie Reed]

I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.

A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.

Section 3 of the 2008 Act states:

“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”

Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.

New clause 2 requires the CQC to

“include indicators of the safety of health and social care services.”

We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.

As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.

[Dr Poulter]

I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.

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[Mr Jamie Reed]

Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.

I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.

In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes

“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”

Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.

Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.

These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that

“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.

So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.

I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.

We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.

[Dr Poulter]

I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

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[Mr Jamie Reed]

I, too, pay tribute to the work of the hon. Member for Stafford (Jeremy Lefroy). The diligence and tenacity with which he has pursued the Bill, and the collegiate nature in which he has done so, are to his eternal credit.

Members across the House, many professional bodies outside this place and others support the principles and aims of the Bill. Harm-free care is something to which everybody in our NHS aspires. Although it is something that, frankly, we should take for granted, it is something that any health care system in any part of the world must work tirelessly to achieve. Credit must go to the NHS staff, both clinical and non-clinical, who work tirelessly, often in very trying circumstances, to deliver high-quality care. I am sure that Members from all parties will echo that sentiment.

I do not wish to repeat what I said on Second Reading, in Committee or on Report, so I will keep my remarks relatively brief. The key principles of harm-free care, data sharing, and consistent objectives for regulatory authorities have been welcomed by the Opposition, and I will touch briefly on the why those things are important.

I have already mentioned harm-free care, and the Bill will give power to the Secretary of State to bring forward regulations to ensure that high-quality, safe care can be delivered. A wide-ranging power is being granted to the Secretary of State, and I welcome the Government’s assurances that any measures introduced will be subject to full parliamentary scrutiny, as is proper with such issues.

We have already debated the benefits and risks of data-sharing, and Third Reading is not the place to do so again. I have been clear about the benefits that can be realised through effective data-sharing, although there are still concerns, many of which I raised on Second Reading. It is important that the national data guardian is put on a legal footing to ensure that any issues that arise can be dealt with effectively and swiftly.

On the regulation of health and social care professions, it is logical to have a consistent overarching objective for regulatory bodies, and right that that objective is patient safety. A number of bodies continue to express concerns about a possible conflict between the practical implications of a number of those objectives, and I ask the Government to keep that under review to ensure that the Bill is effective.

The issue of public confidence runs through the entire Bill, and the hon. Member for Stafford touched on that in some detail. We all want to have confidence that the care we receive is of the highest quality, and to have confidence in the integrity and security of the data and private information that the NHS holds about us. We need to know that our data are used only with our permission and for the betterment of health and social care provision. Finally, we want confidence that doctors, nurses and others are properly supported and regulated to ensure that best practice is always followed. The Bill should help to ensure public confidence in those areas, which is why Labour will support it today.