Barts Health NHS Trust

Jeremy Lefroy Excerpts

Thursday 19th March 2015 Commons Chamber

[Jane Ellison]

The whole House will have noted that the right hon. Gentleman asked why the report has only just come out. He might reflect on his own time in office, when there were reports that did not come out at all just before the general election. If there is any better example of weaponising the NHS—we have just seen it. Instead of trying to make political capital, should the right hon. Gentleman not admit that the new CQC inspection regime illustrates exactly why transparency is so important, and why this Government were right to implement it?

Under the previous Government, failures of care were swept under the carpet and not acted on, which led to the tragic consequences we know about. Before the last general election, Labour tried to block the publication of a devastating report into Basildon and Thurrock hospital. [Interruption.] These are serious matters, and that is exactly why the CQC inspection has to be taken seriously. As I have said, local management is looking at these important issues, some of which we have debated before in the House, and which need to be addressed very seriously. However, the hospital management are beginning to do that, and they must take such action to ensure that they bring care up to the right standards.

All the things that the CQC has identified have to be addressed. As I have said, this illustrates exactly why the new CQC inspection regime is so important. Even now, a week before Parliament dissolves before the general election, this Government are committed, without fear or favour, to transparency and to bringing out this report. We are committed to ensuring that we put into the public domain the measures that need to be taken to put that hospital back on track and to ensuring that its patients can have confidence in the safety of its operation.

[Jeremy Lefroy (Stafford) (Con)]

This is a very serious matter, and it is extremely important that it should be brought to the House. I am pleased that the Francis report on Mid Staffordshire resulted in the appointment of a chief inspector of hospitals, which has led to the production of reports such as this, but does the Minister agree that this case highlights the vital importance of having proper safety systems within each health and social care provider, as is proposed in the Health and Social Care (Safety and Quality) Bill, which is now going through the House of Lords with the support of the Opposition and the Government? Will she ask the CQC to ensure that each hospital and social and health care provider that it inspects has such safety systems in place and that that includes management systems, to ensure that the providers cannot make cuts that would put patient safety at risk?

[Jane Ellison]

I pay tribute to my hon. Friend’s remarkable work in this Parliament on campaigning for transparency in patient safety. He is exactly right to say that these are important features of the inspection regime. As I have said, work has already begun to strengthen the management arrangements at Whipps Cross, but he is right to say that patient safety must be the predominant concern of the management when they come to address failings such as these.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

I am happy to look into that issue and get back to the hon. Lady.

[Jeremy Lefroy (Stafford) (Con)]

In addition to the work that Monitor does on tariffs for individual pathways, what work has it done to assess the base funding that acute hospitals need to maintain core services, which are so interdependent?

[Mr Hunt]

Monitor has done extensive work on this issue, but my hon. Friend is absolutely right to talk about it. If we are to meet the financial challenge that the NHS faces over the next five years, we need to have a very sensible discussion about what realistic efficiency gains need to be made, and I am sure that he will engage in those discussions.

National Health Service

Jeremy Lefroy Excerpts

Wednesday 21st January 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is a pleasure to follow such thoughtful speeches, in general, on this subject. I thank all the staff at the accident and emergency departments that serve my constituents, whether at County hospital in Stafford, Royal Stoke University hospital, New Cross hospital in Wolverhampton, or Manor hospital in Walsall.

On many occasions in the House over the past few years, the tragic events in my constituency have been referred to. Whenever they are referred to from now on, I would like people to acknowledge the enormous progress to improve health services that has been made in Stafford at what is now County hospital and throughout my constituency. It is absolutely vital that we remember what is happening now as well as where we have come from. Let us not forget that out of the Francis report has come the tremendous emphasis on patient safety and compassionate care that is vital for all our constituents. I do not want Mid Staffs to be used just as shorthand for something that was clearly very poor care; it should also be shorthand for the huge improvements that have been made by the people working there and the NHS staff in many other hospitals throughout the country.

I would like to look in a bit more detail at what this motion proposes and the reasons we are currently suffering from the huge demand on accident and emergency services, particularly in relation to out-of-hours GP services and delayed discharges. Regarding the pressures on A and Es, it has rightly been said that there are 600,000 more attendances every year, but we are finding that there are 4,000 more admissions every week—some 200,000 a year. That indicates the seriousness of the situation, because people are not admitted to hospital unless they are in a fairly serious state or seriously unwell. It shows that we are now entering a phase in which the baby boomer generation needs more acute care. We welcome the fact that people now live a lot longer, but the fact is that when people get ill in later life, they tend to be acutely ill and to have complex needs, and that results in their admission to hospital.

The right hon. Member for Holborn and St Pancras (Frank Dobson) mentioned the ratio of beds to population in the UK. We have one of the lowest ratios in Europe—we have a very efficient health service—but the idea that we can get an even lower figure is pie in the sky. In fact, we ought to go marginally in the opposite direction. We should certainly consider increasing the number of beds. Let us not forget that our patient stays in hospital are shorter than most comparable figures across Europe.

We need to bear in mind that we will get more and more admissions, and we need to have the capacity for that. As I remember only too well, I argued a few years ago that the design for the new hospital in Stoke-on-Trent would make it too small; indeed, it is too small, and we are now increasing the number of beds there.

The King’s Fund has said that only 55.4% of patients say that they know whom to contact for out-of-hours services, and such a lack of information or lack of clarity has already been mentioned. We need something straightforward and simple, and frankly, it must be available 24/7, because emergencies happen 24/7. That is why I have pushed for my A and E to reintroduce 24/7 care, rather than its current 14/7 care. People have to look at the clock to check whether it is nearly 10 pm, and then ask themselves whether the A and E will still be open or whether they will need to go elsewhere. They avoid going to another hospital because our A and E is so good, so they delay going until 8 am, by which time they may be in a worse condition. If the facility is for emergencies, it needs to be open 24/7. I welcome the fact that we will soon get an overnight doctor service. A and E needs to return to 24/7 not only in my case, but in other centres that do not offer a full-time service.

[Steve Baker]

Does my hon. Friend agree that putting GPs into such centres provides the possibility not only of having integrated care, but of treating most people who present overnight, when an A and E consultant might not be available?

[Jeremy Lefroy]

I entirely agree, which is why I welcome the introduction of an overnight doctor-led service at the County hospital in Stafford, even though I would like such services to go further. A parent whose child is sick with a temperature may not want to be a burden on the ambulance service by calling one out but will still want to be seen at that time, rather than having to wait until morning, so being able to go to such a service gives them reassurance. If the child is particularly unwell, they can then be referred to a specialist centre, but otherwise the parent can be reassured that they can wait until the morning. Such matters are vital for our constituents.

It is, indeed, a problem to get GP appointments, and it is vital that the issue is sorted out. There are wide discrepancies. In the practice I attend, I can get an appointment the next day not just because they want the local MP to be seen, but because they are very well organised and their patient load is not huge. That is simply not the case in other practices, and some people in my constituency have to wait two or three weeks for an appointment. The problem must be sorted out, and there must be evenness across the country.

GP surgeries put an additional pressure on A and Es. The statistics show that the patients of some GP surgeries attend A and E far less often than those of other surgeries, because such GPs take the time to have longer appointments and take the trouble to go through problems and deal with them on the spot, whereas others are more inclined to say, “I haven’t got the time, so you had better go to A and E.” The statistics show that for some GP surgeries the ratio of patients attending A and E is almost twice that of others in the same area and with the same demographic.

Delayed discharges have often been referred to in this debate. The figure was relatively stable until the start of 2014-15, but since then the total number of delays has risen by 19%. The King’s Fund analysis suggests that delays attributable to NHS services have risen from 60% to 68%, whereas those attributable to social care have fallen from 35% to 26%. It states:

“This suggests that capacity and workforce issues, particularly in nursing homes and non-acute services”

—within the NHS—

“are becoming more important than social care funding”.

I find that very interesting. I do not know on what evidence it is based, but the King’s Fund is a respected institution and we must look at what it says. It implies that there is an issue with integration not just between the NHS and social care, but between acute NHS services and non-acute NHS services.

So what should we do? First, we have to recognise that there will be increasing demand for complex acute care and, hence, for accident and emergency services. A and E departments therefore need to remain open and to expand. I welcome the fact that the A and E in Stafford will double under the investment plans. Secondly, we need clear pathways for out-of-hours care, rather than complicated pathways that are difficult to understand. Thirdly, we need clear information relating to those pathways. Fourthly, we need to do much more work on access to GPs and must look much more closely at the results of GPs in avoiding A and E admissions among their patients. Finally, we need to make integration a reality, not just between health and social care, but within all NHS services and social care.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I am very happy to look at that issue.

[Jeremy Lefroy (Stafford) (Con)]

T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I have been in contact with the NHS Trust Development Authority. I have been reassured that the safety of patients in Stafford is the primary concern and that the transfer of services should help to ease pressure on local services and improve patient care.

Health and Social Care (Safety and Quality) Bill

Jeremy Lefroy 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.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The new clause relates to clauses 2, 3 and 4. Clause 2 will place a duty on providers and commissioners of publicly funded health and adult social care to use a consistent identifier in a person’s health and care records and correspondence. The consistent identifier must be specified in regulations, and the Government’s intention is that the NHS number will be specified. It is important to note, as my hon. Friend the Member for Stafford (Jeremy Lefroy) outlined, that the duty to use the NHS number would apply only in the direct provision of care and when it was in the individual’s best interests. As he articulately said, this matter is very different from the issues with care.data that we have discussed. There is a duty on professionals to share information in the best interests of patients in respect of the provision of direct care.

Clause 3 will introduce a duty to share information that is held by providers and commissioners when it is in an individual’s best interests and will support their direct care and treatment. As we discussed in Committee, that is an essential part of the delivery of safe, effective and high-quality care.

Clause 4 defines health or adult social care commissioners or providers. Its effect will be that the duties imposed by clauses 2 and 3 will apply only to relevant health or adult social care commissioners or providers. They are defined as public bodies exercising health or adult social care in England and any person, other than an employee, who provides such services or care under arrangements within a public body.

I welcome the constructive support of the shadow Minister, the hon. Member for Copeland (Mr Reed), throughout the passage of the Bill. There has been a great deal of consensus, and rightly so. I am grateful for his support for the role of the national data guardian. As was discussed in Committee, the Government are committed to consulting on the role of the national data guardian and the Secretary of State has given his unequivocal support to the consultation. We believe that having a data guardian is an important additional safeguard in the system.

As the House will be aware, Dame Fiona Caldicott has been appointed as the first national data guardian and has already built up significant credibility in her role of challenging and scrutinising the way in which information is shared across the health and social care system. Strengthening and broadening the role of the national data guardian will further enhance the confidence of patients and the public that there is a strong voice for their rights and protections in this area.

Even without a legislative basis, Dame Fiona’s panel, which was previously known as the independent information governance oversight panel, has built its reputation as an effective and authoritative voice. It has helped to ensure that data and information are shared in a way that allows the health and care system to access what it needs to improve outcomes for patients, while protecting against their inappropriate use. Having made significant progress, there is now clear agreement across the House that it is important to embed the national data guardian in the health and care system as a powerful independent voice, and to put that role on a statutory footing.

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I offer sincere thanks to my hon. Friend, to Ken Lownds, the Minister and all the officials who have played such an active part in ensuring the Bill’s success. I wish it well on its way. It will make an enormous difference to health care throughout the entire national health service.

[Jeremy Lefroy]

I would like to speak to new clauses 2 and 3 together. The new clauses tabled by my hon. Friend the Member for Stone (Sir William Cash) seek to embed safety as the central component of the CQC’s inspection regime. My hon. Friend is not only a supporter of the Bill but a major inspiration behind it. His determination in this place to establish what went wrong in the care of his constituents and mine, and to ensure that our NHS was improved as a result, is a major reason for us being here today.

I agree entirely with the principles contained in the new clauses. New clause 2 would place a duty on the CQC to include safety in its annual performance assessment and ratings, while new clause 3 would require the CQC to consider safety in its annual state of care report. I believe that clause 1 of my Bill would already ensure that the CQC has a duty to do all that is contained in new clauses 2 and 3. I will try to explain why.

Clause 1 states that the requirements for registration with the CQC will always cover safety by securing that registered providers of health and social care “cause no avoidable harm”. The CQC will therefore be under a duty both to consider safety in its inspections and ratings and to cover this area in its state of care report. Indeed, it already does so, and here I pay tribute to the previous Government for introducing this annual state of health and social care report through the 2008 Act.

The foreword to this year’s report, to which my hon. Friend the Member for Stone has already referred, is hard hitting about safety and indeed quality. It states:

“The variation in the quality and safety of care in England is too wide and unacceptable. The public is being failed by numerous hospitals, care homes and GP practices that are unable to meet the standards that their peers achieve and exceed.”

I welcome this candour. This is what we expect from the CQC—to hold the NHS and indeed the Government to account, and to ensure that action is taken.

Let me mention an article that appeared in The Times yesterday, showing the huge variability of standards within the NHS and praised some outstanding trusts, specifically mentioning one in Birmingham and a couple of others. What we want to see is those standards being uniform across the NHS. I know that all those working within the NHS and social care want to see that. Nobody goes into work wanting to fail; they want to succeed for their patients to whom they have a duty of care. For our part, it is our responsibility to ensure that they have the environment in which that can happen. That is a small part of what this Bill is designed to bring about.

[Sir William Cash]

I recall the extraordinary experience of discovering that in order for the original trust in Mid Staffordshire to achieve trust status, an interview was necessary. In that interview, I believe 48 questions were put, 35 or so of which were about finance—not about care and safety. That demonstrated why everything went wrong. Now, however, under these arrangements, the whole situation is completely reversed, which is a thoroughly good idea.

[Jeremy Lefroy]

I entirely agree. There were moves towards that when the Healthcare Commission, which was responsible at that stage and manifestly failed in the case of Mid Staffordshire, was replaced by the Care Quality Commission—an understanding by the previous Government that progress needed to be made in ensuring the quality and safety of care. That progress has been maintained and accelerated under the present Government.

I was referring to the 2013-14 report. One of my hon. Friend’s new clauses specifically provides that safety should be a part of such reports. Indeed, the report goes into detail over the way in which the CQC has inspected for safety. On page 12, for instance, it gives an example of a wide variation in the ratings on safety and four other measures—effective, caring, responsive and well led—for each department in a particular hospital. The ratings for safety range from inadequate to good, which shows that even within a trust or a hospital, there is a wide range of safety performance. The CQC is therefore already fulfilling what my hon. Friend is seeking in these two new clauses.

Of course, the same might be argued for clause 1 itself: why is it necessary when the CQC is now implementing the Secretary of State’s requirement to ensure that providers “cause no avoidable harm”? The reason is that, without clause 1, a Secretary of State would not have that obligation. While I cannot imagine a Secretary of State who would not consider safety and “no avoidable harm” as top priorities, experience and indeed the CQC’s own report from which I have quoted show that some of the organisations for which the CQC has the responsibility for regulation have not, and might still not, take safety seriously enough.

[Sir William Cash]

I distinctly remember insisting over and over again during the debates on the whole question of Mid Staffordshire that were taking place until the last general election that it was the Secretary of State who had to take the final responsibility for these matters, and that the duties imposed on him and the functions that he had to perform had ultimately to be his and must not be transferred to some other agency, however worthy it might be and however hard it might work to achieve objectives which, as we now know, were not being complied with satisfactorily, but which are being complied with satisfactorily now, under the Care Quality Commission. The argument that my hon. Friend is advancing comes straight from the history of the experience of Mid Staffordshire, and there is no one better to put the case than him.

[Jeremy Lefroy]

I thank my hon. Friend for what he has said. I entirely agree that this is an extremely important matter. Clause 1 will ensure that there is no slippage in the future, because the Secretary of State cannot get out of her or his responsibility, and the Care Quality Commission’s annual state of care report will be part of the process of holding the Secretary of State to account. I encourage, indeed challenge, this or any future Government to hold a proper annual debate on the report, because it is a vital report. Indeed, I should welcome a debate on the 2013-14 report, uncomfortable thought it might be for certain people.

I believe that new clauses 2 and 3 are unnecessary, because what they prescribe flows from clause 1. However, I am most grateful to my hon. Friend the Member for Stone for tabling them.

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[Sir William Cash]

I see him nodding and I am glad that I managed to pass that test. I am always grateful to my hon. Friend, who ensures that we all keep up to the mark.

On this occasion, I think we would have the capacity to make the change in the first place, but, if not, perhaps we can take a belt-and-braces approach in the House of Lords and use the notwithstanding formula. We shall see.

[Jeremy Lefroy]

Again, I am most grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling this new clause, which covers an important subject—the language skills of doctors—although of course the language skills of all involved in clinical care are vital.

Clear and understandable communication is essential to safety and the quality of care of patients. Language skills are a necessary condition for good communication, but not a sufficient condition. They must be accompanied by good communication skills, with which not all of us are automatically blessed, however good our language skills. Communication skills teaching is now an essential part of training in medical and nursing schools and it is to the credit of the previous Government that they ensured that it was embedded in the curriculum of new medical schools and was taken forward in existing schools. I welcome the Government’s support for that important approach.

I understand that regulations have been in place for a short while to ensure that all doctors, whether from within or from outside the European Union, have appropriate language skills before being granted a licence to practise. I want to hear from the Minister what the effect of those important regulations has been and whether he believes that new clause 4 is necessary. I would also like him to consider whether the assessment of language skills should include communication skills within that language.

[Jacob Rees-Mogg]

I want to speak in support of my hon. Friend the Member for Stone (Sir William Cash). This is an important new clause on a matter that it would be wise to have clearly set forth in primary legislation.

The heart of the matter is, unfortunately, the European Union and the mutual recognition of qualifications within the EU, and there are good reasons for that. The only way to open up service industries generally is if mutual recognition of qualifications takes place, so if we are to have a single market in services that is an important basis for it. However, above and beyond that there must be a fundamental principle of patient safety, which is embodied in this excellent Bill, and a lack of good language skills and of understanding of a language is a danger in both directions. It is a danger for the doctor who is listening to the patient explain his or her symptoms and it is also a danger when the doctor explains to the patient what steps the patient needs to take for better health. If there is confusion, it can have a seriously deleterious effect on the patient’s health.

We must be clear that this is not about restrictive practice or protecting the market for British doctors but about ensuring that there can never be such confusion. As my hon. Friend the Member for Stone says, if this provision runs into trouble with the European Union, we need to state clearly that it is of such fundamental importance that it must override international treaty obligations. It was Disraeli who said in his speech in the Manchester free trade hall in 1872, “Sanitas sanitatum, omnia sanitas”—that the first duty of Minister is the health of his people. That statement has underlined and guided Conservative policy for nearly a century and a half.

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[Philip Davies (Shipley) (Con)]

I apologise for not being here when my hon. Friend the Member for Stone (Sir William Cash) opened the batting on this new clause.

I very strongly support the sentiment behind the new clause. It should go without saying that people who are practising medicine should be able to communicate properly in English. It is a sad state of affairs when we have got to a point where we feel the need to introduce legislation in this regard. Whatever the rights and wrongs of the matter, sufficient examples have been reported around the country to indicate that we do have a problem. It may not be widespread—it may only occur in pockets—but it is perfectly clear that in some areas there is a problem that needs to be addressed. If the Government do not intend to accept the new clause, I would like to know what they intend to do about this genuine problem that people have identified.

My hon. Friend the Member for Stafford (Jeremy Lefroy) made a reasonable point about the measures that were put in place, partly by the previous Government, relating to new doctors and people who are currently going through training. The problem with that, however, is that it does not deal with the people who are already practising.

[Jeremy Lefroy]

My hon. Friend makes an extremely important point. Does he accept—perhaps the Minister will comment on this as well—that the revalidation process that doctors now have to go through should include, if it does not already, as I am sure that it must, language and, indeed, communication skills?

[Philip Davies]

I take my hon. Friend’s point. I am not entirely sure, though, how robust that process is or whether the same test is applied for people who are currently practising as for those who are starting out on their training. I suspect that there may well be a slight difference in the standard that is expected. I hope that I am wrong and he is right; it will be interesting to hear what the Minister says. I would be interested to know how many people have been struck off because they are unable to communicate effectively—if it is hardly any, or none, that would indicate that the current regime is not working effectively—and how often the measures that my hon. Friend mentions have been invoked.

As ever, my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) made an interesting point about the European Union. I do not intend to get bogged down in that today, but it would be interesting to know what the Minister’s understanding of this is. If he will not accept the new clause, is my hon. Friend’s point a factor in that, or is it his position, and that of the Government, that nothing in EU law would prevent such a provision from being introduced?

Although I agree with the sentiment behind the new clause, I wonder whether its wording is deficient and could lead to some unintended consequences. My hon. Friend the Member for Stone made great play of the need for people to be able to communicate effectively in English, and he is absolutely right, but unfortunately there is no mention of English in his new clause. That seems to be a rather glaring omission that could lead to unintended consequences at a later date. The new clause merely says that people who practise medicine should

“have appropriate language skills to communicate effectively with their colleagues and patients.”

I think what he is really trying to say is that they should have appropriate English language skills to communicate effectively with their colleagues and patients. As drafted, the new clause would place an onus on people practising medicine to have appropriate language skills in general to communicate effectively with their patients. In the case of a patient who speaks no English whatsoever and speaks Urdu, for example, would the new clause insist, in effect, that their doctor must be able to communicate effectively with them in the only language that they are capable of speaking? That would seem to be a possibility, because the crucial word that has been omitted is “English”.

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[Jeremy Lefroy]

I beg to move, That the Bill be now read the Third time.

I thank all those who have worked with and supported me in bringing the Bill to this stage. I especially thank my hon. Friend the Member for Stone (Sir William Cash), who, as I mentioned on Report, has been an inspiration, as have Julie Bailey, Ken Lownds and many others who campaigned for the Francis inquiry. My hon. Friend the Member for Mid Norfolk (George Freeman), who is now a Minister, was also a driving force—clauses 2 and 3 are substantially based on a Bill that he had previously introduced—and I thank him for his work and support. I also thank all hon. and right hon. Members who served in Committee and who sponsored the Bill.

I thank the Clerks in the Public Bill Office for all their help, advice and skill, as well as the Bill team and others in the Department of Health, who worked extremely hard, for all their skill and advice. Finally, I thank the hon. Member for Copeland (Mr Reed) and his Front-Bench colleagues, and my hon. Friend the Minister and his Front-Bench colleagues for supporting measures that I believe will assist us to get what we all want—higher-quality, safer and more integrated health and social care.

That is the purpose of the Bill: if it does not help in some important ways to achieve that, it will serve no purpose. I believe that it will do so for several reasons. First, it will ensure that every Secretary of State makes patient safety a priority at all times. Would that have prevented the tragic events at Mid Staffordshire or in other hospitals, surgeries or care homes? It would certainly not have done so in every case, but I am convinced that the attention given to safety would have done precisely that—prevented much avoidable harm to patients. In the important words of the Prime Minister in response to the Francis report on 6 February 2013:

“Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means.—[Official Report, 6 February 2013; Vol. 558, c. 281.]

Secondly, the Bill will put in place another of the necessary building blocks for the integration of health and social care that we all desire. A consistent identifier is not sufficient to bring about integration, but it is most certainly necessary and will help in some way.

Thirdly, the Bill will help the sharing of information, which is vital for a person’s care. Almost everyone with whom I have discussed this matter has told me of times when they or their loved ones have had to repeat information about their care on several occasions, or found that vital information—perhaps regarding medication or allergies—was simply not available to the person caring for them.

Finally, the Bill will bring consistency to the objectives of the regulation of the health and social care professions under the overarching objective of the protection of the public.

During the passage of the Bill, a number of important questions have been raised, both within and without the House. I am grateful to those who have raised them, because it is vital that a Bill such as this receives strict scrutiny.

A fear was expressed that the consistent identifier would become an ID card by the backdoor. The identifier could never become an ID card because it will be used only to facilitate the provision of health services or adult social care, and it must only be used in the individual’s best interests.

It has been asserted that there is no need for the duty to share information because the sharing of information is already required as part of the professional duties of health and care professionals. However, Dame Fiona Caldicott’s review in 2013 concluded that such sharing was not always happening as it should as a result of a “culture of anxiety”. The legislative landscape was found to be a contributory factor and a risk-averse attitude to information sharing was cited as a barrier to sharing by staff who deliver care directly to individuals. The Bill seeks to provide a remedy, while setting clear limits on the information that can be shared and the circumstances under which it can be shared.

Others have concerns about the Bill’s introduction of

“public confidence in the professions”

to the objectives of the regulatory bodies. The Law Commission’s report of April 2014 noted:

“It was argued that maintaining confidence in the profession was being used to punish professionals who pose no threat to the public for something which incurred the profession’s, or the public’s, disapproval. Specific examples included a nurse who was disciplined for publishing a work of fiction about euthanasia and an investigation into a doctor’s behaviour at a Parent-Teacher Association meeting. Some argued that the concept of maintaining confidence in the profession was too subjective and difficult to quantify to form the basis of a statutory duty.”

The report concludes that in constructing the draft Bill on which the provisions of the Bill are based, the Law Commission was

“not seeking to change the current legal position or disrupt the relevant case law. The clause restates the existing legislative position that public protection is the regulators’ ‘main’ objective, and recognises that the public interest also consists of promoting and maintaining public confidence and proper standards of conduct and behaviour.”

I have no doubt that, should the Bill receive its Third Reading today, all the matters that I and others have raised will receive further scrutiny in the other place by experts.

No legislation can guarantee that there will be safe, high-quality care. Such care is founded on the capability, commitment and compassion of those who work day and night in our health and care services; no law can bring it about. What legislation can do, and what this Bill seeks in some small way to achieve, is to ensure that the framework within which those people work is sound—that the systems, resources, training and regulation that they need to provide safe, high-quality care are in place. In doing so, this is a Bill for both patients and professionals; for avoidable harm and poor care hurt both, while safe, high-quality care is a blessing for all.

UK Ebola Preparedness

Jeremy Lefroy Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

I thank the right hon. Gentleman for raising that point; he has done so on a number of occasions. It is very important that there is not a weak link in the chain. We have been relatively satisfied with the screening procedures at Casablanca, which we have obviously inquired into in great detail because of the fact that Pauline came through Casablanca, but I will ask Public Health England to reassure me that it is satisfied with those screening procedures, and, if not, if there is any assistance we can provide to the Moroccan authorities.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend for paying tribute not only to the British defence, NHS, Public Health England and DFID workers, but to the immense courage of Sierra Leonean, Liberian, Guinean and Nigerian health workers, as well as many others. As he said, several hundred have paid the ultimate price for their devotion to their patients. The right hon. Member for Leigh (Andy Burnham) mentioned the health system in Sierra Leone. Will the Secretary of State, along with my right hon. Friend the Secretary of State for International Development, ensure that as much help as possible is given to the Sierra Leonean Government to strengthen their health system and avoid a collapse that could pose a great risk to the UK?

[Mr Hunt]

I can reassure my hon. Friend that my right hon. Friend the International Development Secretary has spoken to the President of Sierra Leone about that very issue. One of the big learning points from the relative success of Nigeria, which we discussed earlier, in combating Ebola compared with Sierra Leone has been about the strength of the local health system. One particular challenge is that the entire health system in Sierra Leone is now focused on Ebola, raising the risk of other diseases, such as malaria, tuberculosis and HIV, killing more people even than Ebola. Strong local health care systems are an important long-term insurance policy to ensure that countries can deal with infectious diseases.

A and E and Ambulance Services

Jeremy Lefroy Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

The hon. Lady is right, and there is particular pressure in the ambulance service across the country. We are putting in £50 million of winter-pressures money to help address those issues. Where there are unavoidable delays because of other emergencies at the same time, it is important to get the communication right, and I do not think we do that as well as we should. There are times when we could give more specific information about the likely arrival times of ambulances, according to the algorithms used by 999 and 111 call-handlers. That would keep the public better informed. That is something we are looking at.

[Jeremy Lefroy (Stafford) (Con)]

West midlands ambulance paramedics and staff do a brilliant job under great pressure at the moment, but one thing that the head of the ambulance service has mentioned to me is the difficulty in planning ahead to provide more vehicles and staff because some of the funding—not particularly the winter-pressures funding, but funding around Stafford hospital—is on a short-term recurring, rather than a long-term, basis. Might the Secretary of State look into that and see how it could be made long term, so that instead of paying lots of overtime, we could recruit and train more paramedics?

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to that issue. One issue that has been debated often in this House is the money we waste in the NHS on locum staff, who are much more expensive than full-time staff. One of the ways we can deal with that is through something I announced in my response to the extra money in the autumn statement on our long-term plan for the NHS, which is to give multi-year commissioning contracts and multi-year tariffs to trusts, so that they can have a longer-term horizon. Too often the planning horizon is just for the next year. Indeed, I think there is a discussion to be had about whether this winter pressures money we put in every year to help could be better integrated in NHS core budgets, as a way of making sure we get the best use of that money.

National Health Service (Amended Duties and Powers) Bill

Jeremy Lefroy Excerpts

Friday 21st November 2014 Commons Chamber

[John Pugh]

If the right hon. Gentleman reminds me, I will endeavour to do so. What I am really hoping for, though, is a change in the conversation about the NHS so that we stop talking about the internal market—Labour Front Benchers have in a sense reneged on their involvement in that—and instead talk about how we should organise NHS services that will efficiently deliver the moral entitlements that people expect.

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to my hon. Friend for giving way and to the hon. Member for Eltham (Clive Efford) for introducing this opportune Bill.

Does my hon. Friend agree that one problem with an internal market is the sheer complexity of tendering, which means that smaller organisations such as some in my constituency are simply not capable of matching up with the organisations that decide to tender for some of the contracts that are available?

[John Pugh]

My hon. Friend makes a good point. For those who are unsure about the benefits of the internal market, there is a way of addressing the problem, which is to allow individual health economies, in whatever area—Eltham or wherever—to opt out of the internal market if they can prove that there is a case for doing so. That could be put into legislation in a permissive form, so it would not be a top-down reorganisation, and it would allow people objectively and sensibly to test the benefits of the internal market against a more normal model of public service delivery, which I support, as I hope the hon. Member for Eltham does.

--- Later in debate ---

[Dr Poulter]

I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).

The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.

Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.

[Jeremy Lefroy]

I am glad that my hon. Friend has mentioned Macmillan. At the moment, Macmillan is in the middle of tendering for end-of-life and cancer care in Staffordshire, which hon. Members have mentioned. Although the integration that the tender requires is absolutely vital—I think that it is supported by all Members, including the hon. Member for Stoke-on-Trent Central (Tristram Hunt) in a recent article—one of the real problems involves the mechanism. The fact is that the integration seems to require the tender to be for the entire service, rather than for just a small contract, say, to help with integration. Will my hon. Friend comment on that, because this is one of the problems at the heart of the matter? We do not want large private companies to run our cancer and end-of-life services.

[Dr Poulter]

In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the 2012 Act, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.

--- Later in debate ---

[Barbara Keeley]

Thank you, Mr Deputy Speaker.

The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.

By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.

[Jeremy Lefroy]

As I have already said, I have major concerns about the form of the contract. The hon. Member for Stoke-on-Trent Central (Tristram Hunt) wrote, and I say this in defence of Macmillan:

“This is the context for our new cancer contract and we should not pass knee-jerk judgments upon new ideas which aim for better outcomes and efficiency.”

That is what Macmillan is after.

[Barbara Keeley]

I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

I welcome the Bill and congratulate the hon. Member for Eltham (Clive Efford) on introducing it; I shall be supporting its Second Reading today.

My support derives mainly from my and my constituents’ experiences over several years of some of the workings of the Health Act 2006, introduced by the previous Government, and the 2012 Act, introduced by this Government. In particular, two matters have been, and continue to be, of great significance: first, the two Francis inquiries into cases of dreadful care in my constituency, and secondly, the reports that have had such a major influence on the entire NHS. Just yesterday, my wife was giving a lecture to medical students on aspects of the Francis reports. It is vital that these lessons, particularly on patient safety and zero avoidable harm, are not forgotten, which is why I introduced a Bill on the subject two weeks ago.

The second concerns a more recent matter referred to already today: the review, supported by Macmillan, of cancer and end-of-life services in north Staffordshire, Stoke-on-Trent, Stafford and Cannock, which has resulted in a tender of all these services to be managed through an integrator. Just to correct the record, it is not just private companies on the tender—NHS organisations are also on it—but I still have major concerns. I am looking at this through the eyes of patients everywhere. The NHS must not be about structures or be in thrall to political dogma of any kind; it must be about safety and quality of care for all patients. I hope the Government might see the Bill in that way and use it as an opportunity to make improvements to both the 2006 Act and the 2012 Act.

I welcome clause 1. During the trust special administrator process that we had to go through, the inability of providers and commissioners to speak to one another—in some cases because of so-called commercial confidentiality —was ridiculous and without doubt delayed the process. At certain points, the whole process cried out for someone, if necessary the Secretary of State, to put everyone in a room for a day with instructions not to leave until everything had been sorted out. However, everybody was walking on eggshells in case they did something that might result in a judicial review and a reversion to square one. That was not in the interests of patients. That is not to be critical of those involved: for the most part they tried very hard and we got a better result than at some points we feared.

I want to make a serious point about clause 1 and the desire for the Bill to place the running of the NHS firmly in the hands of the Secretary of State. It is vital that there should not be too much hands-on running of the NHS by the Secretary of State—the British Medical Association, which has some very positive comments about the Bill, says that as well.

I am short of time, so let me conclude by talking about cancer and end-of-life services, which have been raised today. The problem is the way in which the NHS is funded and the fact that the tender is for all services involved in those pathways. It would have been much more sensible for the tender to help the work of integration, which would have involved a much smaller amount, rather than the full amount of services.

[Clive Efford]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

The House proceeded to a Division.

Health and Social Care (Safety and Quality) Bill

Jeremy Lefroy Excerpts

Friday 7th November 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

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

This Bill is all about patients—their care and safety. My commitment to that comes directly out of the findings of the Francis report, particularly the second Francis report, following the public inquiry into the instances of dreadful care at the Mid Staffordshire NHS Foundation Trust in my constituency. The work of Cure the NHS, led by Julie Bailey, who challenged that care, and supported by a group of my constituents and those of my hon. Friend the Member for Stone (Sir William Cash), has brought us to today’s Bill.

Sir Robert Francis, in the letter to the Secretary of State for Health presenting his report, wrote:

“In introducing the first report, I said that it should be patients—not numbers—which counted. That remains my view. The demands for financial control, corporate governance, commissioning and regulatory systems are understandable and in many cases necessary. But it is not the system itself which will ensure that the patient is put first day in and day out. Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows that this cannot be assumed to be happening.”

The Prime Minister, in his reply to the Francis report, said:

“Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means.”—[Official Report, 6 February 2013; Vol. 558, c. 281.]

The Prime Minister’s words captured the essence of this issue precisely.

Most of the Francis report recommendations have been accepted, and many have already been implemented. In addition, other very important decisions have been taken by my right hon. Friend the Secretary of State for Health, such as the appointment of chief inspectors of hospitals, general practice and social care. Those are already having a profound effect on improving the safety and quality of care that patients receive.

Our NHS, using the best medical science and skills, combined with professionalism and compassion, delivers extraordinary repair treatment and healing to the vast majority of its patients. Yet, it can also forget that and cause completely avoidable harm to sick patients. The Bill intends to reduce, and, I hope, eliminate, its ability to do that. The Bill arises out of a determination to ensure that what happened at Stafford, and indeed elsewhere, should not be repeated. It seeks to ensure that the focus on safety and quality of care we are seeing is not only maintained, but strengthened, and, most importantly, it seeks to ensure that it cannot be reversed. Of course, legislation on its own will not guarantee safe and high-quality care—leadership, culture and resources are all vital elements—but by making it clear in law what is expected of those providing health care, the Bill will go a long way to doing so.

First, the Bill, in clause 1, changes the Secretary of State’s power to a duty, moving from a “may” to a “must”, to ensure that all those providing health and social care make zero avoidable harm their target. Patient safety is therefore put at the top of the list of what must be inspected for. One important way of ensuring that patients receive the safe and high-quality care we would all wish to see is through better integration between services, both health and social care. That is why clauses 2, 3 and 4 seek to give an impetus to integration through the requirement for a single patient identifier and a responsibility to share information. Professional bodies play a vital role in improving safety and quality of care by setting standards.

[Mr David Nuttall (Bury North) (Con)]

My hon. Friend will be aware of small concerns raised by the British Medical Association about some of the detail of his Bill. Is he confident that those will be able to be dealt with in Committee?

[Jeremy Lefroy]

I thank my hon. Friend who has shown a strong, keen and sincere interest in this Bill. Yes, I have just seen the BMA’s submission, and I recognise the concerns that have been raised. Those concerns should be listened to, addressed, and dealt with in detail in Committee. Perhaps what I am coming on to say will address some of them now. We must take extremely seriously the views of the BMA, which represents doctors.

As I was saying, professional bodies play a vital role in improving safety and quality of care by setting standards of practice and ensuring that high standards of conduct are maintained. Clause 5 and the schedule to it ensure that the professional bodies within the medical, nursing and care professions have the same overarching objectives that will benefit patients.

I propose to set out the context of the Bill and then to go into the detail of each of its three parts. In doing so, I will seek to address points that have been raised with me, especially whether we need legislation to achieve the aim of the Bill—patient safety and quality of care.

I am grateful to the team at the Department of Health that has helped in the preparation of the Bill and to the Minister, whose earlier proposals in his ten-minute rule Bill have informed the measures on the integration of services. I also thank the shadow Secretary of State and the Opposition health team for their interest in the Bill, the Chair of the Health Committee and other colleagues who have taken the time to discuss it with me, and to those in the health and social care professions who have contributed their thoughts.

I am also grateful to Ken Lownds whose work on patient safety has been fundamental to my work on this Bill and to my hon. Friend the Member for Stone who first called for a public inquiry and who has supported this work all along. I wish to thank my staff: James Cantrill, Pauline Ingall, Hetty Bailey, Alex Simpson, and Emily Mills, all of whom, but especially James and Pauline, have contributed in many ways. Above all, I wish to thank my wife, Dr Janet Lefroy, who has patiently discussed with me over many years the theory and reality of patient safety and care.

In 1863, in her preface to her notes on hospitals, Florence Nightingale wrote:

“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do no harm to the sick.”

That principle, extended to all health and social care services, lies behind the whole Bill, but particularly clause 1, to which I will now turn.

We are in a time where, quite rightly, there is increasing scrutiny of the safety and quality of care in our health and social care services. There are no accurate figures of how many people die avoidably while in the care of health or social care services in England. A recent study estimated that perhaps 12,000 people a year die from avoidable causes in hospitals alone. That is more than four times the annual number of deaths on roads in the UK. This is about not just those who die avoidably, but those who live but whose lives are profoundly affected by the avoidable errors—perhaps they are left with disability or mental scars. It is also about those who care for them who may have caused the avoidable harm and for whom it casts a shadow over their entire life.

In many cases, straightforward patient safety concern, procedures and practice would have protected both the patients and the members of staff from the consequences of avoidable harm. No patient wants to be harmed, and no one in the NHS would willingly harm them. The essence of zero avoidable harm is for the professionals and the organisations for which they work to convey to the patients, “We are health care providers because we want to treat and cure people. This is our contribution to humanity. We owe it to you, the patient, when you submit to our treatment not to harm you by being unprofessional, inattentive or negligent and also to have made all possible preparations in case we make an error so that it will not harm you. We will of course advise you of all risk inherent in what we are going to do for you.” When I speak of zero avoidable harm, that is the culture I mean.

These principles, procedures and practices for zero avoidable harm are in place in many hospitals and other care providers across the country, but they are neither universal nor standard. This is about not bureaucracy, but ensuring that health and social care has the same approach to safety as other activities in which safety is critical, such as air travel or the nuclear industry. Just last weekend, I noticed at one of the manufacturing sites in my constituency, which deals in chemicals, a board prominently displayed that said that the site had gone for more than 1,000 days without an accident. I fully acknowledge that health and social care is highly complex, and becoming increasingly so. But to those who use complexity as an excuse not to draw lessons from other professions that have had to make safety a priority, I would simply say: that is not good enough.

There is much excellent work going on in safety science, systematising and standardising many elements of health care, and indeed social care, to ensure that variability can be eliminated. Safety-critical sectors in the UK and elsewhere have for years been using what are called human factors to enable all staff to perform at their best, not only technically but also in communicating with patients and colleagues. Human factors are the key to building a culture of safety, or an open culture in which staff are able to speak up about safety—a just culture, in which blame is absent but fair accountability is the norm.

I shall now explain the detail of clause 1. At the moment regulated activities, which are defined by clause 8(2) of the Health and Social Care Act 2008 as activity involving, or connected with,

“the provision of health and social care”,

are regulated through regulations that are made under section 20 of that Act. That section provides that the Secretary of State

“may impose in relation to regulated activities any requirements which the Secretary of State thinks fit”.

Such regulations

“may in particular make provision with a view to…securing the health, safety and welfare of persons for whom any such service is provided.”

So the Secretary of State has the power—a “may”—but not the duty—a “must”—to impose regulations regarding the safety of patients. The message that this could send out is that patient safety is not essential. Of course, Secretaries of State, and most recently heads of the Care Quality Commission, have made it clear that patient safety is of vital importance, but that did not apply at Stafford hospital or, indeed, in many other places.

Clause 1 of my Bill amends the 2008 Act by substituting the following for subsection (1) and part of subsection (2) of section 20:

“The Secretary of State must by regulations impose requirements that the Secretary of State considers necessary to secure that services provided in the carrying on of regulated activities cause no avoidable harm to the persons for whom the services are provided.”

So it is now incumbent on the Secretary of State specifically to require that those providing health and social care services cause no avoidable harm. The Care Quality Commission will therefore need to assure itself, when inspecting those providers, that they have the policy systems and procedures in place that tackle avoidable harm.

As the explanatory notes to the Bill state, current Care Quality Commission registration requirements, which the Government are introducing, which will introduce new fundamental standards of care, would not be changed as a result of clause 1, as the new regulations satisfy the new duty. But the clause ensures that those regulations could not be watered down in future to reduce the emphasis on patient safety.

The Bill defines harm as being avoidable,

“unless the person providing the service cannot reasonably avoid it (whether because it is an inherent part or risk of a regulated activity or for another reason).”

It may be argued—this is one of the concerns that have been expressed by the BMA—that it is impossible precisely to define avoidable harm in every instance, and therefore that we should not attempt to do so. However, the very fact that so many cases of avoidable harm, sometimes leading to death or other serious consequences, manifestly do occur is a reason to ensure that it receives the highest possible priority, even if there may be arguments over the definition at the very margins.

Some may understandably raise the concern that the desire to tackle avoidable harm might lead to professionals simply not taking any risks. The Bill covers that by excluding from the definition harm that cannot be reasonably avoided. As in many instances, a test of reasonableness, which is included in the Bill, is a sensible way to address that.

Instances of avoidable harm would include, for instance, operations being performed on the wrong limb; patients being left without adequate hydration or nutrition; patients being left alone in A and E for long periods without any attention; poor records resulting in the wrong drugs being administered; and neglect as a result of wards being staffed below safe levels. In my experience, and I am sure in that of other hon. Members, the vast majority of instances of avoidable harm would come under one of those, or similar, categories.

There would be no questioning whether such instances had arisen because professionals were afraid to take risks; they would come from poor clinical skills, faulty record keeping, inefficient administration or a lack of care and compassion. The fact that the instances of avoidable harm vary so much across the health and social care sectors in itself shows that the problem can be tackled. How many lives would be saved if all providers had the same standards as the best in class? That is why it is so important to address avoidable harm through legislation.

I now turn to clauses 2, 3 and 4. These clauses are about continuity of information, which must be used

“to facilitate the provision to the individual of health services or adult social care in England, and…in the individual’s best interests.”

Again, this is all about the patient. There are two provisions: the first is for use of a consistent identifier for a person by the provider of health or social care; the second is to ensure that relevant information is shared in support of people’s direct care by the introduction of a duty to share information. Both provisions are designed to help with the integration of health and social care, which is greatly needed and which the Government and the Opposition have said is essential for the future.

Before I turn to the details, I should like to quote from a letter sent to me by my constituent, Mrs Janet Powell, who was delighted to hear about the Bill. She describes two recent experiences of the lack of integrated information, explaining:

“After breaking her femur in November 2013, my mother was admitted to the Manor Hospital, Walsall. In February 2014, she was admitted to Stafford Hospital suffering from heart failure. In July 2014, she went to New Cross Hospital, Wolverhampton for her cataract operation. For each of these admissions, she has a different hospital number. We have had to repeat vital information about her medical conditions each time she has been dealt with by different teams.”

Mrs Powell’s mother was fortunate to have relatives who were able to be with her on each occasion and give the vital information about her conditions, but for many people that is not the case, and even if it were, the process would still be inefficient and leave open the possibility that vital information regarding the patient and their care would be omitted.

The requirement for the use of a consistent identifier would make the accessing of accurate and timely information about a patient’s condition much easier, but clause 2 stresses in proposed new section 251A(5)(a) to the Health and Social Care Act 2012 that the requirement to use a consistent identifier would apply only if it was

“likely to facilitate the provision to the individual of health services or adult social care in England, and…in the individual’s best interests.”

As one would expect, the Bill contains provisions for the identifier not to be used in certain circumstances, including when the individual objects or would be likely to object and when the information concerns the provision of services by an anonymous access provider—for instance, sexual health services. The Bill makes it clear that the professional must still comply with the Data Protection Act 1998 and with any common law duty of care or confidence.

The introduction of a duty to share information for an individual’s care and treatment—again, only if in the person’s best interests—is aimed at ensuring that medical records are shared appropriately between the professionals in the NHS and care sectors who are responsible for the care of the patient. That is especially important when patients move between organisations along their care pathway.

The 2013 Caldicott review of information governance, “To Share or not to Share”, found that a culture of anxiety prevents information from being shared between organisations and that the legislative landscape contributed to this, with staff saying that a risk-averse attitude to sharing was a barrier to sharing in caring for people. The review said that the duty to share information in such circumstances can be as important as the duty to protect patient confidentiality. Dame Fiona concluded that health and social care organisations should have the confidence to share information in the best interests of patients within the essential broader framework of protecting personal patient data. Again, the Bill will provide the same important safeguards as those in respect of the consistent identifier.

I do not for one moment pretend that these provisions alone will make fully integrated health and social care a reality, but I believe that they will certainly help to remove some of the obstacles.

The final part of the Bill—clause 5 and schedule 1 —sets out three objectives of regulation: public protection, maintaining public confidence in the professions and upholding standards. Again, the driver for this is the safety and care of patients.

The long title of the Bill states that it would

“make provision about the disposal of cases concerning a person’s fitness to practise a health or social care profession”.

That was indeed my intention. Some of the regulatory bodies have been frustrated by the limitations on their ability to deal with a person’s fitness to practise. However, I have subsequently learned that such was the level of detail required to introduce the provisions that they would have made the legislation too long and complex for a private Member’s Bill. This Bill therefore concentrates on the vital overarching duty to protect the health, safety and well-being of the public.

When the serious failures set out in the second Francis report were debated in the other place, the noble Lord Hill, then Leader of the House, said:

“the regulatory bodies in particular have difficult questions to answer. The Nursing and Midwifery Council and the General Medical Council need to explain why, so far, no one has been struck off. The Secretary of State for Health has today invited them to explain what steps they will take to strengthen their systems of accountability in the light of this report, and we will ask the Law Commission to advise on sweeping away the Nursing and Midwifery Council’s outdated and inflexible decision-making processes.”—[Official Report, House of Lords, 6 February 2013; Vol. 743, c. 320.]

The Law Commission, to which we are greatly indebted, has produced an excellent draft Bill with an accompanying report, “Regulation of Health and Social Care Professionals”, dealing with these matters. It states:

“Given the importance of health and social care professionals regulation, it is a matter of some concern that its UK legal framework is fragmented, inconsistent and poorly understood.”

It describes the piecemeal growth of that regulation since the establishment of the General Medical Council in 1858, which has become a framework that

“is neither systematic nor coherent and contains a wide range of inconsistencies and idiosyncrasies.”

As part of its work, the Law Commission therefore proposed in recommendation 13 that an overarching duty to protect the public should be established in a single statute for all the regulatory bodies. The recommendation states:

“The main objective of each regulator and the Professional Standards Authority should be to protect, promote and maintain the health, safety and well-being of the public. The regulators and the Authority also have the following general objectives: to promote and maintain public confidence in the profession and to promote and maintain proper professional standards and conduct for individual registrants.”

It is that recommendation that will be given effect by clause 5 of my Bill.

It might reasonably be asked why we do not simply wait for the entire Bill, with all the details of changes to regulatory body powers, and introduce the overarching duty then. Let me be clear that I am a very strong advocate of introducing the Law Commission’s entire Bill at the earliest opportunity; indeed, I would urge the next Government to do so. However, I believe—this is supported by regulators who have written to me—that introducing the overarching duty to protect the public, together with maintaining public confidence in the professions and promoting and maintaining proper professional standards and conduct, is a very important matter. It should not be left any longer. The commission’s report explains why:

“fitness to practise panels have, in some cases, adopted an overly restrictive approach to the test of fitness to practise impairment… In particular, the concern is that in cases of clinical misconduct or deficient professional performance they 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 the public confidence in the profession.”

It concludes:

“If this concern is correct, then we think that the panels in question have misunderstood the correct legal position—namely that regard must be had to all of the factors reflected in the objectives when deciding impairment, irrespective of the particular grounds being considered. Our intention is that the wording of the general objectives in the draft Bill and duties to have regard to them should help to clarify the existing legal position.”

I have enormous respect for the health care professions—in fact, three members of my closest family work in or are training for them. These professions have led the world in many ways. Indeed, hundreds of health care professionals are at this very moment showing their courage and commitment by volunteering to tackle the Ebola epidemic in west Africa. One of the most important things that we as legislators can do is to provide them with the framework they need so that poor practice will not be tolerated and the public will have the highest degree of confidence in them. Clause 5 will help to achieve this.

I said at the beginning that this Bill is all about patients. It will put safety at the heart of health care by making the Secretary of State responsible for bearing down on avoidable harm. It will help the vital integration of health and social care services, thereby improving both quality and safety by introducing a consistent identifier and a duty to share information. It will make it clear that the main objective of each regulator of the health care professions is the promotion, protection and maintenance of the health, safety and well-being of the public.

None of this will absolutely guarantee that the failure of safety and care described in Sir Robert Francis’s first report, and the failure of the NHS and regulators set out in his second, will not happen again. That depends on other things that cannot be legislated for, such as culture and leadership, and those that can, such as the commitment of resources. However, it is my belief and hope that it will make a recurrence much less likely. My constituents in Stafford, and those of my hon. Friends the Member for Stone, for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson) will then know that all they have gone through over so many years will not have been in vain.

--- Later in debate ---

[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.

[Mr Jamie Reed (Copeland) (Lab)]

The House has a lot of business to attend to today. That said, this Bill deserves consideration in some detail. It clearly has widespread support across the House, including on the Opposition Benches, and from medical professionals across the NHS. Some groups have raised a number of concerns. I know that the hon. Member for Stafford (Jeremy Lefroy) will want to address them.

The Bill is made up of three key areas. Part one relates to provision of care that avoids harm. It requires the Secretary of State to bring forward regulations setting out the requirements on providers registered with the Care Quality Commission to ensure that the services they provide do not cause avoidable harm. Clearly, that is a principle we all support. All of us have learnt the lessons of what happened in the hon. Gentleman’s constituency and none of us wants to see that repeated in any part of our health economy or anywhere in our country. We want the very best care for our family and friends. Harm-free care should be something we all strive for at all times. We know that our doctors, nurses and other medical staff work incredibly hard, as Government Members have said, often in exceptionally trying circumstances. The Government—any Government—must do everything within their power at all times to support those professionals. That is surely beyond question.

The second part of the Bill relates to the continuity of information and how it is shared between providers of care. For effective health care to be provided in the 21st century, data must be utilised as effectively as possible. I am sure the Minister shares that viewpoint. Macmillan Cancer Support has shown in north Trent that local data, when used effectively, can be used to redesign the follow-up care that colorectal cancer patients receive. On analysing the data, it discovered that more than a third of people who survived for more than five years had an additional, non-cancer complication such as type 2 diabetes or heart problems. By using these data—and, by extension, knowledge—it could better plan the future care of those patients. The principle of using complete data to identify patients’ needs must be applied more often to ensure that patients get the care they require. There are some tremendous examples of GPs in Salford deploying this care model. I urge Members to take a look at the innovative techniques being developed there.

I ask the House to indulge me for a moment. Like everyone, I understand how such data can lead to better patient outcomes. Two weeks before the last general election, as an undiagnosed type 1 diabetic, I was rushed to hospital—once again, I place on the record my gratitude to the West Cumberland hospital for saving my life—and now every day my life is governed by data: blood glucose readings, insulin ratios and so on. I want such data to be easily available to me: I want them on my smartphone, and I want them provided to pharmacists and GPs, to help me and others in my situation better to control the condition. Incidentally, such a huge innovation would also save the NHS a lot of money and improve outcomes for patients with a variety of long-term conditions. In that regard, the Bill is doing exactly the right thing.

I would be grateful if the hon. Gentleman could set out again how the Bill would make data sharing more consistent across the whole health service, because this is a challenge. Where individuals’ personal data are concerned, there are clearly issues of privacy to address. That debate rages across many sectors and is routinely discussed on and offline and in the House. I have been here almost a decade now—it is hard to believe—and issues of individual personal data have been discussed throughout that time. Nowhere is that felt more sharply than with medical data.

It was regrettable—and avoidable—that the Government failed with the care.data scheme, as it severely eroded public trust in how data protection matters are dealt with. I do not think that anybody would take issue with the principle that medical confidentiality should always be respected and protected. I hope the hon. Gentleman will outline what safeguards are in the Bill to ensure that only relevant patient data are shared. Sharing unnecessary information could undermine patient trust, particularly regarding the use of personal data, and, critically, could slow down treatment, which we do not want.

[Jeremy Lefroy]

I am grateful to the hon. Gentleman for setting out from personal experience how important this matter is. I can assure him that the aim of these provisions is to ensure that data are shared only for the care of individual patients. This is not about data collection, but about patient care and safety, for which, as he rightly says, data are often so important.

[Mr Reed]

I thank the hon. Gentleman for that response. We will drill down into this in Committee because it is important that we get the details absolutely right.

This is about the efficacy of the care provided, and if we do not get it right, we will be storing up trouble for the future. The sharing of relevant health information is already governed by professional obligation, as the hon. Gentleman will know from his marital circumstances, and the British Medical Association has said it would be unnecessary to replace that with a statutory framework without clear justification. I hope to hear some justification for a new framework. One of the lessons of my party’s time in office, and one of the lessons that should be learned by this Government, is that we need to take medical professionals with us. If we do not, we will put ourselves and patients in a difficult position. We can devise all the statutory and regulatory frameworks we want, but if we do not take medical professionals with us when we apply those strategies, we will be in difficulty.

The third part of the Bill relates to objectives for the regulation of health and social care professions. This part, and the draft order on the objective of the General Medical Council, amends the objectives of health and social care regulators and the Professional Standards Authority. Professional bodies such as the GMC and the BMA have differing views on the impact this will have in practice. The GMC states that while this Bill will not impact on the GMC per se,

“The newly worded statutory objectives in the draft order address the aim of protecting the public and set out clearly the importance of public confidence issues when deciding on appropriate action in the public interest.”

The GMC also believes that the Bill will align other regulators’ statutory purpose with their own. The BMA, however, believes that the now separate role of protecting the public while maintaining public confidence in the professions could lead to regulatory committees and panels punishing professionals who do not pose any threat to the public.

The details of this part will be subject to further scrutiny in Committee, but I would be grateful if either the hon. Member for Stafford or the Minister explained how this scenario articulated by the BMA could be avoided. Let me repeat that it is essential to take the medical professions with us on this, in view of the lack of appetite for the application of the Francis recommendations with regard to the individual duty of candour. I think this has been dropped because the medical profession did not believe it to be enforceable. The Government listened, but we should explore those concerns in greater detail.

It was disappointing that the Government did not bring forward in the Queen’s Speech a Bill to deal with the wider reform and regulation of health care professionals. An opportunity was missed, and I hope the Minister will explain why. Wider reform is clearly needed. The Nursing and Midwifery Council was disappointed not to see such a Bill in the Queen’s Speech and still says that wider legislative reform is needed. We must remember that this Bill is an essential component of the implementation of the Francis recommendations and that, without it, some of the important changes recommended by Robert Francis simply cannot take place. We support the superb efforts of the hon. Member for Stafford principally in that context. This is an issue that many in the professions wanted to see addressed by the Government in the Queen’s Speech. They should have brought forward a Bill, and it clearly cannot be through a lack of parliamentary time or because of a packed legislative agenda that no Bill has been introduced. I hope an explanation for that will be forthcoming.

Other issues need to be addressed. The principle of the Bill is one that we support and we will not divide the House on it. The details will be scrutinised further in Committee, and I hope that both the Minister and the hon. Member for Stafford will be able to deal with some of the issues I have raised.

Finally, although the Bill is an important step, cultural change in any organisation or profession is difficult and takes a long time to achieve. There is no magic bullet, as has been said, and we should always recognise that. I was grateful to the hon. Member for Stafford for mentioning the regulation of the nuclear industry, of which I have a lot of experience. I think I was the first person to introduce this regulatory example into this whole debate, and it is a very important comparison.

What is the point of the comparison? Effective regulation is an iterative process that relies on an effective partnership between the regulator and the regulated. Too often, regulatory bodies in a number of sectors can play cat and mouse or hide and seek with respect to those they regulate, which can have a serious, damaging and counter-productive effect. We are beginning to see that with Ofsted—the comparator often used nowadays for the Care Quality Commission. Of course we want to see education standards driven up; of course we want to see pupils receiving the best education in the world; and of course the pursuit of excellence must be constant and consistent. We must, however, consider what happens when regulators begin to damage the cause they exist to support. None of us wants to see the medical profession becoming as beleaguered as those other essential public servants in the teaching profession.

That said, public services exist first and foremost for the benefit of the public, not for the public servants—an essential principle. Iterative regulation is undoubtedly the way forward, as is demonstrated by the safety and performance improvements that have taken place in the nuclear industry over the past decade and a half. Those changes accompanied a major regulatory recalibration in the early part of this century. Cat-and-mouse, hide-and-seek regulations were actually making performance in the industry worse. Regulators should not wait for failure to occur and then seek to punish; they should work to prevent failure from occurring in the first place, and that requires a partnership between the regulator and the regulated.

There is a great deal in the principle of the Bill that unites the House. I am exceptionally grateful to the hon. Member for Stafford for all the work that he has done, and his Bill has the Opposition’s support.

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I am delighted that this important Bill appears to have cross-party support. I strongly support it, as do the Government, and I pay tribute to the tireless commitment shown by my hon. Friend the Member for Stafford (Jeremy Lefroy) to the cause of public safety. I think that I speak for the whole House—although many Members are not present this morning—when I say that he has commanded all our respect in campaigning so tirelessly, with such good grace and diligence, and with cross-party support to ensure that the lessons of the appalling tragedy at Mid-Staffs are properly learned. He has demonstrated the integrity of that work again today, which is reflected in the degree of support for the Bill.

Let me begin by echoing the support that my hon. Friend expressed for Julie Bailey, my hon. Friend the Member for Stone (Sir William Cash) and Ken Lownds, all of whom have done a huge amount of work behind the schemes in support of the Bill and the wider cause of patient safety. My hon. Friend spoke extremely powerfully about the 4,000 unavoidable deaths and the many thousands more unavoidable incidents of harm. Such incidents will, of course, be avoidable if we are better equipped to track, monitor and collect data in the way that is proposed in the Bill, and to develop the culture of transparency and accountability for which it provides.

My hon. Friend spoke about the concept of zero avoidable harm, which sits at the heart of the Bill, and spoke particularly powerfully about the culture of health and safety. In the aviation and nuclear industries, as we heard from the hon. Member for Copeland (Mr Reed), it is a culture that involves actively looking out for near misses, and actively welcoming the reporting of problems by staff members from top to bottom of an organisation as soon as they have been identified, that has enabled those industries to develop such exemplary health and safety records. One of the great lessons that emerges, loud and clear, from the Francis report is the need for a change of culture.

My hon. Friend referred to the science of safety and the elimination of variability from the system, and to the good work that is being done in this country, not least as a result of the Francis report. That is another example of an area in which the NHS is leading in global medicine. He also spoke of the importance of integrating information and data. His account of the journey made by his constituent Janet Powell as she helped to escort her mother across the health and care landscape will have resonated with many Members. It certainly resonated with me, because over the last 18 months I have been in a similar position, supporting my own mother through a journey from primary care to hospital care to community care in Norfolk. As many Members and many millions of carers outside will know from experience, it is often the carers, parents and loved ones of patients who are carrying the best information about the patient through the system. That information is often too slow and does not keep up with the patient on their journey.

My hon. Friend spoke very powerfully about the risk-averse attitude to sharing information. That is a problem, and the Government are committed to trying to tackle it. That is another reason why we are supporting this Bill. Key to that, as my hon. Friend touched on, are the recommendations of Dame Fiona Caldicott, and I am delighted that she has agreed to take a lead role and to accept the invitation of the Secretary of State to look at the safeguards we need to be putting in place across the whole of the NHS and Department of Health care and data provisions. That will help provide a strong degree of reassurance to both Members in the House and people outside that patient concerns about confidentiality are being met.

My hon. Friend also spoke very powerfully about his support for health care professionals, and I would like to put on record my support for his comments about the NHS staff who are in Africa on the front line of the fight against Ebola. We owe them all a huge debt of gratitude.

We also heard from a number of other Members who spoke very powerfully. My hon. Friend the Member for Bury North (Mr Nuttall) was kind enough to congratulate me on my role in managing to get the data-sharing measures included in this Bill. They were raised before this House in my ten-minute rule Bill, which fell, but I am delighted to see those measures picked up in this Bill.

My hon. Friend also spoke very powerfully about the NHS as a bedrock of British society, and I could not agree more. He made some interesting points, too, about the difference between the science of health care and the human and compassionate and cultural side of health care, which this Bill goes right to the heart of. That has always been a great strength of the NHS, which in its founding charter is a scientific and research-led organisation, and which has always put compassionate care at the very top of its mission.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke very powerfully and again paid tribute to both the NHS and its staff. She also spoke about the importance of transparency and of there being public confidence in the data confidentiality aspects of this Bill and more generally across the health care system.

I was pleased by the tone and spirit of the speech of the hon. Member for Copeland and to hear that there is cross-party support for this Bill. Although parliamentary time is short in this Session, I think that with that support this Bill has every chance of reaching the statute book.

I was particularly pleased to hear the hon. Gentleman’s powerful—and personal—support for the importance of data sharing in 21st-century health care. He rightly highlighted Salford as a beacon of what can be achieved, and that stands as a tribute to the NHS in the north-west, which is leading the way in the use of informatics and medical data for both research and treatment.

The hon. Gentleman also spoke powerfully about his personal experience as a diabetic patient, and about his reliance now on data as a patient and his active embrace of telehealth and the use of smartphones. He also spoke very powerfully about how that is allowing him to have better control of his condition. Patient empowerment, through data and electronic health records and putting in place a landscape so that patient medical information flows with the patient and reflects the patient journey across the system, is key to both this Bill and the Government’s wider proposals for building the integration of health and care and a 21st-century model of the NHS in which health care moves from being something done to patients when the system is able to do it to a system in which active health citizens are empowered and enabled and encouraged to take more responsibility for their health care so they can drive through the system in the way that suits them.

We might not have a packed House here on this Friday morning, but we have certainly packed in the arguments. We have heard a lot of high-quality contributions. I want to talk about the thinking behind the Bill and answer some of the key questions that have been raised.

The need to maintain minimum levels of quality much more consistently was put into sharp focus by the landmark public inquiry report, published in February 2013, on the terrible, shocking and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust. I think everyone in the House would accept that the subsequent Francis report shook the health system to its core. Francis’s call for a fundamental culture change across the entire health and social care system that would put patients first at all times still resonates loudly in this Chamber and throughout the health and care debate.

Sir Robert Francis QC, the chair of the inquiry, made a compelling call for action across six core themes: culture; compassionate care; leadership; standards; information; and openness, transparency and candour. That is a checklist that all of us who are involved in health care need to keep close at hand. The inquiry represented a watershed in our thinking on safe and better care. That in turn is driving a culture change across the NHS as we resolve never again to allow the system to fail patients and service users in the shocking way that it did.

The Government published their response to Robert Francis’s public inquiry on 19 November 2013. That response, “Hard Truths: The Journey to Putting Patients First”, demonstrates the Government’s commitment to creating a culture of openness, with greater accountability and a relentless focus on safety in an NHS that puts compassion at its heart. In response to the events at Mid Staffs, to Robert Francis’s recommendations and to Don Berwick’s excellent review of improving patient safety, the Government have already introduced a number of measures to improve safety. First, a new statutory of candour on providers will help to ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation. This new duty will be overseen by the Care Quality Commission. It will come into force for all NHS bodies soon and for other registered providers by April 2015. We expect staff to reflect the duty in their everyday activity.

An organisation is made up of its staff, and providers will be expected to implement the new duty through staff across their organisation. Training and education of staff will also support the establishment of an open culture. The General Medical Council, the Nursing and Midwifery Council and the other professional regulators will introduce a new explicit and consistent professional duty of candour, making clear a requirement to be open, whether the incident is serious or not.

Secondly, the Secretary of State announced in March a new Sign Up to Safety campaign, a platform on which all NHS organisations and patients can share, learn and improve ideas for reducing harm and saving lives. It was launched in June, and health care leaders have been invited to set out what their organisations will do to strengthen patient safety, including by producing a safety improvement plan. Sign Up to Safety aims to achieve much more than just the numbers of NHS organisations joining; it is about motivating participants actively to get involved. The campaign will go beyond institutions and seek to sign up as many individual NHS staff as possible, and everyone who chooses to join will commit to the new patient safety ambition.

In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality have established a new national patient safety collaborative programme. This will spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country. The safety collaboratives will be supported systematically to tackle the leading causes of harm to patients. The programme will include establishing a patient safety improvement fellowship scheme to develop 5,000 fellows in a national faculty within five years.

We are absolutely committed to changing the culture of patient safety through investment in leadership. NHS England is now working with The Health Foundation to help develop proposals for a safety fellowship initiative. The NHS is on a transparency journey, through the NHS Choices patient safety section, to become completely open and transparent. More information about our local health services is now more publicly available than ever before. As well as using the information to drive improvements, it is vital that a patient or member of the public can easily find and understand what it says about their local health services.

In June, NHS Choices began publishing new and existing information in a new safety section, complementing the wealth of information available about our hospitals and wards. It specifically provides information on: nurse staffing levels, including at ward level; infection control and cleanliness; CQC national standards; whether the unit is recommended by staff to their relatives and friends; patients assessed for risk of blood clots; the response to patient safety alerts; and open and honest reporting. The NHS is one of the safest health care systems in the world but there is always scope to improve health care standards universally and reduce avoidable harm further. That is why the Secretary of State for Health set the ambition to reduce avoidable harm by half and save 6,000 lives over the next three years.

As well as the devastating effect that health harms can have upon patients, service users and, as hon. Members have mentioned, their carers and families, a recent report by Frontier Economics has estimated that poor care could be costing the NHS up to £2.5 billion every year. That is why the Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients.

[Jeremy Lefroy]

I am grateful to the Minister for the argument he is developing. Does he agree that the Bill is vital for staff? They do not want to be involved in instances of avoidable harm; it preys on their minds and can blight their careers. If the institutions to which they belong are not seeking to avoid harm, it is often the professionals, rather than the institution, who carry the can, and that is not right.

[George Freeman]

As ever, my hon. Friend makes an incredibly powerful point. An institution is only as strong as the staff within it, and when an institution is not taking seriously an issue that the staff confront as a daily reality, it puts them in an impossible position. He rightly says that by changing the culture of the institution, NHS staff will be able to do their jobs more easily and with more confidence, safe in the knowledge that when they raise issues that may be of concern, whether or not there is in fact a risk, they will be welcomed and supported. That culture change is vital if we are going to turn things around in the way that we are committed to doing.

There are three key sets of provisions in the Bill: the ones that will mandate patient safety as a key requirement of CQC registration; the provisions ensuring the integration of data across the health and care pathway; and the provisions dealing with the regulation of professional standards. They represent real and significant steps to support and develop patient safety in the NHS, and we are delighted to support them. Let me deal with each of the three in turn.

On the CQC requirements to include safety, clause 1 is central to the Bill’s focus on safety and quality, and, in particular, the elimination of the avoidable harm that flows from the provision of poor care in health and adult social care services. Safety is paramount and must be the focus of care providers at all times. The experience at Mid Staffs underlines the importance of that and of what can happen when providers put other priorities before safety. The CQC’s role in protecting patients is vital, and safety and the avoidance of harm are key elements of the CQC’s regulation of providers, in two key ways. First, monitoring registered providers against safety requirements and taking enforcement action when the requirements are not met is central to the CQC’s objective to protect and promote the health, safety and welfare of people who use services.

[Jeremy Lefroy]

Does the Minister also agree that the Bill’s provisions, in seeking to get that focus right to the top and make it the responsibility of the Secretary of State, ensure that, right here in this House, patient safety is of the essence?

[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—

--- Later in debate ---

[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.

[Jeremy Lefroy]

Should this Bill command the support of this House on Second Reading, does the Minister agree that one thing we would need to consider in Committee is this real issue of the mixing up of personal information and patient information within records? How best that can be addressed will require quite a lot of discussion.

[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—

--- Later in debate ---

[Jeremy Lefroy]

With the leave of the House, Madam Deputy Speaker.

Should my Bill receive a Second Reading today, I shall take very clearly from this important debate the points raised by my hon. Friends the Members for Bury North (Mr Nuttall) and for Congleton (Fiona Bruce), the hon. Member for Copeland (Mr Reed) and the Minister, and I am grateful to them.

There are two things that we must discuss very seriously in Committee. The first is justification of all the clauses. I believe they are justified, for the reasons that I set out in my earlier remarks; I will not rehearse them again. Secondly, we must discuss the details, particularly around privacy. With that, Madam Deputy Speaker, I thank you very much for your indulgence.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. I am sorry to detain the House briefly. You may be aware that the shadow Home Secretary has asked the Home Secretary to make a statement on the publication of the Wanless report on whether the Home Office misplaced files relating to child sex abuse allegations, and yet the Home Secretary has so far declined to say that she will. This morning the media are reporting details from the Wanless report. Madam Deputy Speaker, I wanted to ask you whether, after the bungling of the child sex abuse inquiry, you think it would be appropriate and wise, given the seriousness of this, for the Home Secretary to make an oral statement on Monday, so that the House is able to have complete transparency on the important issues around the Wanless report?

Stafford Hospital

Jeremy Lefroy Excerpts

Friday 7th November 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is a great pleasure to see the Under-Secretary of State for Health, my hon. Friend the Member for Mid Norfolk (George Freeman) back in his place this afternoon. I apologise for bringing him back to the House. In fact, I do not apologise, because this is a matter of great importance and I know that he shares my interest in it and my concerns.

On the first day of this month, Stafford hospital, now the County hospital, became part of the University Hospitals of North Midlands Trust together with the Royal Stoke University Hospital. The Mid Staffordshire Trust which had run Stafford and Cannock Chase hospitals was dissolved. I wish to speak first about the new arrangements, secondly about the transition and finally about the services that I and my constituents strongly contend are needed in Stafford. I welcome the coming together of our hospital into the larger university trust. I am also very pleased that Cannock Chase hospital will continue to offer an important service as part of the Royal Wolverhampton Hospitals NHS Trust.

[Mr Aidan Burley (Cannock Chase) (Con)]

I congratulate my hon. Friend on securing the debate and on his herculean efforts to support his local hospital. I have no doubt that those efforts will be rewarded at the next general election by his constituents. He has mentioned Cannock Chase hospital. Does he agree that it is important, in this transition phase, that all the services currently provided at Cannock should remain there and be increased and improved as we move towards the new model of ownership under the Royal Wolverhampton Hospitals NHS Trust? Will he also join me in congratulating the new Conservative candidate for Cannock Chase, Amanda Milling, on all her campaigning efforts to ensure that those services stay at Cannock?

[Jeremy Lefroy]

I am most grateful to my hon. Friend for fighting alongside me for the preservation of the Stafford and Cannock hospitals. We said at the time that there was not a cigarette paper between us because, when people were saying that one or other of the hospitals should close, we said, “Absolutely not. Both are essential for our communities.” I thank him for that work.

Stafford becoming part of a university hospitals trust brings many opportunities for patient services, for staff training and development and for the NHS in my constituency. The same opportunities will now be available to Cannock Chase hospital under its new arrangements in the Royal Wolverhampton Hospitals NHS Trust. Our hospital will receive substantial capital investment, resulting in refurbished theatres and wards, chemotherapy and dialysis wards and a larger accident and emergency department.

After the tragic events examined by Sir Robert Francis in his two reports, there has been a great deal of improvement at Stafford. That is not in any way to be complacent, but it is a measure of the hard work of the staff, under Antony Sumara, Lyn Hill-Tout and Maggie Oldham as chief executives, and the chairs, Sir Stephen Moss and Professor John Caldwell. I also pay tribute to the governors and directors of the trust, who have put in so much time and effort in these difficult times. However, the staff must receive the most credit. They have worked tirelessly, under great strain and tremendous scrutiny, to provide excellent care. With so much focus, and rightly so, on our NHS, it would be easy for people to walk away from serving in difficult situations, but most in Stafford have not done so. They wish to serve our community through thick and thin, without much recognition and sometimes facing criticism.

In the past few years, I have heard several predictions about Stafford hospital: that it would close; that it would be privatised; and that it would become a “cottage” hospital. None of those has come to pass. Through the determined efforts of staff and the local community, in particular, through the hard work of the Support Stafford Hospital group and others, and their representatives, we have shown the Government and the NHS that a district general hospital can and must thrive in Stafford, retaining accident and emergency and acute services. As a result, we will see unprecedented investment in Stafford, funded not through an expensive private finance initiative, but directly by the NHS, with refurbished theatres and many other things that I have already described. That is in addition to the new endoscopy unit, which I visited just two weeks ago. It is three times the size of the old one, which I experienced as a patient, with state-of-the-art equipment, and it was designed in full co-operation with the staff.

The investment we are receiving is much greater than was originally proposed; and I wish to pay tribute to the work of all involved in making the case: the University hospital of north Staffordshire, the trust special administrators and Mid Staffs. I have gone on record before, and will continue to do so, about the grave shortcomings of the TSA process, which I would wish on no one in its current form, but the TSAs did fight the corner for Stafford and Cannock, and achieved more than at one stage had seemed possible. The Prime Minister, the Secretary of State and Ministers at the Department of Health have also been extraordinarily supportive, even when being bombarded by e-mails, letters and demands for meetings from me, my hon. Friend the Member for Cannock Chase (Mr Burley) and other parliamentary and council colleagues from around Staffordshire.

The transition period is critical and presents many risks. We have been assured that no service will be moved from the County hospital, Stafford to the Royal Stoke, or indeed from Cannock to Wolverhampton, until it is safe to do so. That means that there should be not just sufficient capacity at the Royal Stoke or Royal Wolverhampton to receive patients, but adequate ambulance capacity to deal with many more patient journeys. I understand that emergency surgery and consultant-led maternity services are likely to be transferred early in 2015, possibly in January. In order for that to happen, we need firm assurances from the hospitals that the capacity is in place and from the West Midlands ambulance service that it will be able to cope with the additional journeys. We have been assured by the University Hospitals of North Midlands NHS Trust that a “double lock” will be put in place to ensure that, first, staff and management and, secondly, an outside independent body, including the clinical commissioning groups, approve any transfer of services and say it is safe for patients. The double lock is essential to public confidence in the process, especially the independence of the independent review—it is vital that we get it right.

The Royal Stoke university hospital’s A and E department has been at level 4— the highest alert—because of bed shortages, several times in the past few weeks. The main reason is that patients cannot be transferred out as there are insufficient step-down and community beds, or social care places. The additional acute beds being added at Stoke are welcome; but they will need to be operating before any service transfer happens. The problems with transfers out will also have to be dealt with. The board papers for the Stafford & Surrounds CCG meeting on 21 October show that the ambulance red 2 indicator—category A calls resulting in an emergency response within eight minutes—for the year to date is at 69.7% against the standard of 75%, and has been below the standard in each month since September 2013. The red 1 indicator has improved in August, but is at 66.7% for the year to date—again, that is against a standard of 75%. Will the Minister confirm what additional vehicles and paramedics the West Midlands ambulance service will have to ensure not only that it can bring its performance up to standard, but that it will be able to deal with extra journeys arising from the transfer of some services away from Stafford? Will he also confirm how closely the Trust Development Authority, to which the University Hospitals of North Midlands NHS Trust is accountable, is monitoring the transition period as County hospital, Stafford becomes part of the expanded trust? What support is the TDA giving to the University Hospitals of North Midlands to cope with any unexpected eventualities in the transition?

Finally, will the Minister also confirm that all the clinical commissioning groups in the area served by UHNM will be supported, too? Some of them, including Stafford and Cannock, face substantial underlying deficits of several million pounds per annum arising from what can only be described as unfair funding formulae. They are working hard to become ever more efficient, but what has been asked of them is almost impossible.

The transition period, which will last up to three years, is therefore extremely challenging. We have a newly expanded trust that is in deficit, an ambulance service that is failing to meet its current red 1 and red 2 targets, and CCGs that are underfunded. I firmly believe that we will succeed in seeing a stronger acute trust in Stoke and Stafford at the end of this, but the problems that I have set out must be addressed.

Finally, I turn to future services at the County hospital, Stafford. As a result of the campaign that we have all fought locally, the vast majority of services will remain. It is estimated that 91% of patient attendances will still take place there, as there will be an A and E department and in-patient beds for acute medical patients. But there are areas in which I will continue to make the case for improved services. The first is to return the A and E department to a 24/7 operation. Even now, staff are attending to patients up until the early hours of the morning. It would not take a great deal to extend the cover so that the A and E can remain open between 10 pm and 8 am.

I have heard of a number of cases of elderly patients who are so concerned about travelling what they see as a long distance, away from their friends and family, that even in emergencies they resist travelling, preferring to wait until the A and E in Stafford opens at 8 am. One such case in particular had tragic consequences.

There is welcome news that a doctor-led overnight service is likely to open early in 2015 at the County hospital, Stafford. That should enable those with non-999 emergencies, including those involving children, to receive advice and some treatment locally. But I see it as a stepping stone back to the service that my constituents need, which is a 24/7 A and E department.

I will also continue to argue for A and E services for children, with the ability to keep them in hospital for a period until they are ready either to return home or to be transferred to a specialist unit. It is vital that, wherever possible, children above all are treated near to or at home—close to their family and friends. It cannot make sense for a parent, who has other children and possibly no private transport, to have to arrange child care and undertake a round trip of perhaps three to four hours by public transport to visit a child who is in hospital but who does not need the most specialist care. I urge the Department of Health and the Royal College of Paediatricians and Child Health to look closely at that matter.

The in-patient paediatrics department in Stafford is not one of the smallest in the country, yet it will go next year, despite the fact that the cost per child is significantly lower than that at surrounding hospitals where they will now be sent. Will that really be the way forward for many other such departments? Surely there is a way to rethink in-patient care for children who do not need specialist treatment and who are likely to be in hospital for only a short period. At the very least, a 24/7 A and E department with a paediatric assessment unit staffed by paediatrically trained consultants would make sense.

Finally, there is the question of consultant-led maternity services. Originally the TSA proposed removing all births from Stafford. As a result of our campaign, it changed that proposal, and our hospital will remain with a midwife-led unit. When the Secretary of State announced that there would also be an NHS England-led review into the possibility of retaining consultant-led services at Stafford, we welcomed it. Stafford’s unit is small, but it is by no means the smallest in England. We contend that, in a network with the larger unit at Royal Stoke university hospital, it should be possible to maintain our unit and thus offer women who need obstetrician-led care the choice of giving birth in a smaller unit, as they do in most other European countries. When it comes to maternity services, I will continue to argue that big is not always better.

The review that was promised has not yet started, although I understand it will happen soon, but it will report after our consultant-led unit has closed. I would like an undertaking from the Minister that if the review recommends that smaller units such as ours should remain, it will reopen at Stafford and the resources will be made available for that.

I should also like the Minister to confirm when the review will begin, who will be doing it and how long it is likely to take. It is also essential that the review of Stafford and surrounding services only takes place first, and as soon as possible, to be followed by a national review coming later. The last thing that the expectant mothers of Stafford need is a long drawn-out process. I was promised a review, as were we all, of Stafford’s maternity in this House, and I should be grateful for the Minister’s confirmation that the commitment stands.

Maternity services, I believe, need to be commissioned more widely than just by CCGs. Government policy is to give women a good choice as to where they have their baby, and I welcome that, but CCGs in places like Stafford are too small to support the commissioning of a local unit. The original intention, I believe, in the run-up to the Health and Social Care Act 2012, was for maternity services to be commissioned by NHS England, not CCGs. That would allow the development of a proper national policy of choice for women, and I would ask the Minister to consider that very carefully.

In Stafford, great progress has been made in recent years. I am determined to do all I can to ensure that we, together with the Royal Stoke university hospital, have one of the finest acute trusts in the country. The retention of the County hospital, Stafford as a district general hospital with acute services and accident and emergency gives us the chance to show that a local acute hospital is not an outmoded institution which, as it was predicted only a few years ago, would soon be extinct. Instead, we can become a prime example of a thriving local acute hospital for the future.

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is an absolute pleasure to be back at the Dispatch Box this afternoon. It is a tribute to the tireless commitment of my hon. Friend the Member for Stafford (Jeremy Lefroy) that, not content with successfully piloting the Health and Social Care (Safety and Quality) Bill through its Second Reading this morning, he has called me back this afternoon for a debate on services at Stafford hospital. I think I speak for the whole House, including Members not present today, when I pay tribute to his tireless commitment, both to his constituency and to the local NHS in his area. The way in which he has gone about it has commanded respect across the House.

My hon. Friend raised many important points, as did my hon. Friend the Member for Cannock Chase (Mr Burley), in support of new investment, importantly paying tribute to the work of the staff as well as the directors and governors. On behalf of the Department, I would echo his comments. He also raised important points about the transition period, the specific needs of children, the ambulance service and the review of maternity services, and the significant point that Stafford appears to be demonstrating that it is perfectly possible to be a thriving local acute hospital. I shall try to deal with all my hon. Friend’s points, but If I do not, perhaps he will be good enough to allow me to write to him and deal with them properly that way.

The configuration of health services is an important issue for many hon. Members across the House and their constituents, particularly those who have previously experienced poor care from local health services. We all agree that all patients should receive high-quality, compassionate care. That is why the Secretary of State has made care a crusade in his leadership at the Department. We are all aware of the appalling lapses of care that were all too often received by patients at Stafford hospital in that terrible period.

The first of November marked a new beginning for local health services, with the dissolving of the Mid Staffordshire NHS Foundation Trust and the launch of the new University Hospitals of North Midlands NHS Trust. Over £250 million of investment is being put into health services in Staffordshire, including significant investment into County hospital.

Past events at Mid Staffordshire will not be allowed to cast a shadow over the future of health services in Stafford. Thanks to the hard work of many, not least my hon. Friend the Member for Stafford, County hospital has a bright future and will offer modern, safe, sustainable services for local people now and in the future. As my hon. Friend has said, much progress has already been made and significant investment is being made in health services in Staffordshire to ensure that that progress continues. The current service specification at University Hospitals of North Midlands NHS Trust is that recommended by the trust special administrator and has been subject to consultation and endorsed by the Secretary of State for Health. Changes to the service specification will only occur on the grounds of patient safety.

Let me reply to the specific points made by my hon. Friend the Member for Stafford. Accident and emergency departments are often the most visible hospital service, and local people therefore often focus on A and E services when looking at changes to their local hospital. Local protests have been held on the grounds of County hospital against the transfer of services. There has been some speculation that A and E at County hospital will be downgraded. Let me take this opportunity to say that that is not the case.

The A and E service will continue to operate 14 hours a day, seven days a week. In fact, thanks to significant investment, the A and E department at County hospital will double in size and have a dedicated space for treating children. That expansion will address overcrowding. The number of staff working in A and E will increase and all consultants working in the department will be trained in paediatrics.

I understand that my hon. Friend and some of his constituents would like County hospital to operate a 24-hour A and E service. It is important to note that the A and E in Stafford has operated 14 hours a day since overnight services were removed in 2011. Of course the decision to close A and E overnight was taken in the interests of patient safety.

Work by the trust special administrators has confirmed that a 24-hour consultant-led A and E remains unsustainable at this time. However, a GP-led service is planned to operate overnight in County hospital from April 2015. Therefore, those patients with conditions that are not life-threatening but that require medical treatment or advice will not need to travel outside of Stafford, no matter the time of day or night. I understand that work by local commissioners is under way to look at the possibility of an interim solution until 2015.

Investment is being made to improve A and E performance across the University Hospitals of North Midlands NHS Trust. Indeed, £80,000 of winter money has been allocated to an improvement plan that aims to have the trust consistently meeting the A and E target by March 2015. In total, £4.5 million will be invested in supporting A and E performance at the trust and a further £4 million across Staffordshire.

My hon. Friend mentioned the West Midlands ambulance service. The continued good performance of that service will be important to ensure success in both service transitions and to improve A and E performance. WMAS has been thoroughly involved in planning, and my hon. Friend has had regular and productive meetings with Dr Anthony Marsh, the trust’s chief executive.

Of course, as with all other ambulance services, WMAS is dealing with increasing demand, but I can assure my hon. Friend and his constituents that WMAS is fully engaged in the changes across Staffordshire. As he knows, A and E hours were reduced in 2011 in the knowledge that the ambulance service could and would ensure that patients were taken to neighbouring hospitals.

[Jeremy Lefroy]

I am grateful to the Minister for that reassurance. I pay great tribute to the staff, paramedics and everyone at WMAS—they do a fantastic job—but sometimes what is said at the top of the service and what is actually going on at the bottom are slightly different. I am not trying to point the finger at anyone. Everyone is trying to do their best. People do not want to admit sometimes that there are real capacity problems, because they want to be seen to be getting on with the job. I ask the Minister to look at this case quite closely, particularly as the indicators have been red for so long.

[George Freeman]

My hon. Friend makes a really important point, and I shall be happy to look at it, as he suggests.

Ambulance diversion from Stafford to larger hospitals for life-threatening conditions—stroke, cardiac arrest or serious trauma—had been in place for some time before the overnight suspension, as my hon. Friend will know. In other words, the ambulance service already has a number of years’ experience of these arrangements. The local clinical commissioning group commissioned additional ambulance service provision to cover both overnight and daily divert activity. That extra provision will remain in place.

Stafford & Surrounds CCG reports that the ambulance service’s performance on the red 1 target in its local area has shown a general upward trend. The target was met in six of the eight months between January and August 2014, and the figure was 77.8%, against a 75% standard, in August 2014. The red 1 target measures performance on the most critical calls that the ambulance service receives: calls to patients in immediately life-threatening situations where a rapid response is vital.

Across the whole trust area, the service met all three performance targets in September 2014, the latest month for which centrally verified data are available. Its performance on red 1 calls was 83%, against a 75% standard. It also met the red 1 and category A19 standards in the six months between April and September.

As I know from my Norfolk constituency, rural areas, such as those served by large parts of Stafford & Surrounds CCG, present challenges to ambulance services across the country. West Midlands ambulance service and local commissioners are working together to ensure that the ambulance service continues to cope with the changes in Stafford and the wider challenges of serving a rural region at a time of increased ambulance pressures across England.

I will touch on the transfer of maternity services. Early next year, in line with best practice guidelines, some services will transfer from County hospital to the Royal Stoke University hospital. That will begin on 16 January 2015 with the temporary transfer of consultant-led maternity services. A stand-alone, midwife-led maternity service will open at County hospital.

[Jeremy Lefroy]

We were given assurances that no services would be transferred without the double lock, which assures that the capacity and safety of the services would be guaranteed in the case of transfer. We now have a specific date for the transfer of services. When can we see the evidence of the double lock for safety and capacity?

[George Freeman]

My hon. Friend makes a good point. I will undertake to look into that and get back to him.

Women who require care provided by an obstetrician or anaesthetist will be cared for in Stoke, and transport between the two hospital sites will be improved. Those changes to maternity services are temporary, as I have stressed, pending the outcome of the review, which is due to report in June 2015. Other services will transfer permanently to Stoke, including acute and emergency surgery, which will move in February 2015. In-patient paediatrics, including in-patient paediatric surgery, will move by the end of March 2015.

These decisions are made in the interests of patient safety. Let us not forget that the root of past problems was unsafe services at Stafford. The local NHS, led by local doctors, has therefore made the decision to transfer services based on clinical evidence, with patient safety rightly at the forefront of all decision making.

Consideration has also been given to patients’ wider needs and travel distances. For example, the movement of in-patient paediatric services will create access to high-dependency services and intensive care and to tertiary specialist opinions, reducing the need for patients to travel to Birmingham. Provision will also be made for parents to accompany their children to Stoke when travel is required out of hours, including supplying accommodation if needed.

It is understandable that people have concerns when change is proposed. I have no time for those who want to frighten patients in the face of change. It is important to remember that change is sometimes needed to ensure the best outcomes for patients. We know that there were serious failings at Stafford, and it is important that the University Hospitals of North Midlands NHS Trust is able to make changes to services where they will benefit patients and ensure that County hospital provides the high-quality, safe care that local people deserve.

Turning to the future of County hospital, over £250 million is being invested in health services in the years ahead. The hospital’s A and E department will double in size and see an increase in its staff numbers. Out-patient facilities will be expanded, particularly for emergency access clinics. Wards and operating theatres will be refurbished and upgraded to be fit for 21st century medical care. There will also be new services, including a £1.2 million MRI scanner that will offer advanced diagnostic services in Stafford for the first time, which means that more than 6,000 patients who currently travel to Cannock and Stoke will be treated closer to home. Eye surgery, orthopaedics, dermatology and a new assessment unit for frail elderly people are also services that County hospital will begin to offer.

Progress is already well under way. On 1 November the Mid-Staffordshire NHS Foundation Trust was dissolved and County hospital joined the Royal Stoke University hospital under the new University Hospitals of North Midlands NHS Trust. Thanks to the hard work of many people, the process of transferring County hospital to the new trust has gone smoothly. A number of assurance processes were in place leading up to the transfer, including oversight and scrutiny of the quality and safety handover documents. That process has been overseen by the local transition board, chaired by Sir Neil McKay, an independent chair who is accountable to the CEO of the NHS Trust Development Authority. The local transition board will continue to provide oversight to ensure the safe implementation of the new service model at the new trust.

Finally, turning to CCG funding, in December 2013 NHS England adopted a revised funding formula for local health commissioners that more accurately reflects population changes. The new funding formula is based on up-to-date and detailed information and takes into account the three main factors in health care needs: population growth, deprivation and the impact of an ageing population. All CCGs have received a funding increase matching inflation for 2014-15.

The people of Staffordshire were badly let down by the local NHS in the past. The appalling difficulties that were too often uncovered gave people in the area reason to fear for the future of the hospital and to be very disappointed, rightly, at the level of service that was provided. The local NHS has worked hard to address the failings in care and to bring about substantial improvements. I pay tribute to the work it is doing. The opening of the new trust on 1 November marked a new beginning for the NHS in Staffordshire. I want to put on record the debt we owe to all those who have worked so hard to get the hospital turned around.

There is still work to be done to ensure that services in Staffordshire are of high quality and sustainable. My hon. Friend has encouraged his constituents to support County hospital and to access local treatments where appropriate, and I give the same message here today. Local engagement and support are key to the development of local services. I assure him that if his constituents are anxious about the quality of services, they can be sure that County hospital in Stafford will be under a level of public scrutiny that nowhere else in the NHS has seen. In my hon. Friend, the people and patients of Stafford could have no more doughty a champion.

Question put and agreed to.