Health and Social Care (Safety and Quality) Bill

Debate between Jeremy Lefroy and Jamie Reed

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.

Health and Social Care (Safety and Quality) Bill

Debate between Jeremy Lefroy and Jamie Reed

Friday 7th November 2014 Commons Chamber

[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.