Health and Social Care (Safety and Quality) Bill

Lord Hunt of Kings Heath Excerpts

Friday 6th February 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as president of GS1, which is the bar-coding association of the United Kingdom. I am sure that the suggestion made by the noble Lord, Lord Willis, will be given every consideration it deserves. I, too, congratulate the noble Lord, Lord Ribeiro, on bringing the Bill to your Lordships’ House. He knows that the Opposition support the Bill, and we will adopt a constructive approach to it.

However, I would like the noble Lord and the noble Earl, Lord Howe, to clear up this point about the remaining stages of the Bill in your Lordships’ House. My noble friend Lady Pitkeathley made a very important point. I do not understand why there is not time to give the Bill proper scrutiny. This is essentially a government Bill; it is therefore up to the Government to find the time. We know that this House has plenty of time until Prorogation on 26 March. At the moment, the noble Earl and I are enjoying many Questions for Short Debate, and I understand that there are many more to come. That is because there is virtually no legislation left. The Government say there is not time, but that is not so. I offer our good offices through the usual channels to see whether we cannot find time for a proper Committee and Report stage. That would be the right path. I understand what the noble Lord, Lord Elton, said—that in the past he has been very strong about the role of the House of Lords in the scrutiny of legislation, and has criticised the way in which Governments have tried to get legislation through. We have to be cautious about this. I want to see the noble Lord get his Bill by the end of this Parliament, and we will do everything we can to help, but the evidence that has come particularly from the Berwick committee shows that there should at least be some debate, especially on Clause 1, although there are other issues as well.

Some debate on Clause 1 would be helpful. Although we support the clause, it would be helpful to hear a little more from the noble Lord about what is meant by “zero harm”. The noble Lord, Lord Willis, says that those words are not actually used in the Bill. The problem is that those words were used in the briefing on the Bill, and now it has come to be known as “zero harm” in the health service. It may be that that is part of the issue around Clause 1—not so much what it contains as how it is perceived. I hope that we can clear that up as well as we go through the Bill.

I have one question for the noble Earl. As he knows, I and the noble Lord, Lord Patel—he cannot be here today but will be for later stages—have both chaired the National Patient Safety Agency. We encouraged NHS bodies to report near misses and patient safety incidents. I assume that many of those incidents would come within the definition of “avoidable harm”. Given that, can the noble Earl say whether that means that, once the legislation is passed, almost every NHS body in this country would fall foul of the provision? If that is so—and it might be argued that it should be so—does he think that there is a potential perversity in that people will try to hide these incidents in the future, whereas our whole learning experience, which came from the airline industry, is to encourage people to own up to mistakes? It is a very important point. I think it lies at the heart of what the noble Lord, Lord McColl, said earlier and, indeed, the evidence which we have received from the Berwick advisory group.

My noble friend Lord Young made a very important point about good practice, and I am not sure whether the Bill helps one way or another. He mentioned the WHO checklist in dealing with wrong-site surgery, which has a lot of support from various institutions, including the Royal College of Surgeons. We know that not every surgeon is prepared to do it; there is no question but that some surgeons refuse to take part in those checklists and that sometimes, if they do, they do not take part with wholehearted enthusiasm. Whether this Bill helps that or not, I would be interested in hearing from the Minister how he thinks we can encourage very powerful clinicians who, I suspect, think that it is beneath them to take part in what they call a box-ticking exercise. How can we encourage them to do so? My noble friend is absolutely right—one of the besetting sins of the health service is its inability to spread good practice quickly. That is why we invented NICE.

I find it really disappointing that, in relation to NICE technology appraisals, as an example, even now many clinical commissioning groups refuse to implement them, despite a legal requirement to do so, and have set up their own silly little committees to try to second-guess what NICE is doing. I know that that goes outside the Bill, but it does answer my noble friend on a really important issue that we need to tackle. We all know that we have excellence and we have problems in the health service, and the scale of transfer of excellence to the health service is just too slow.

On the subject of data-sharing, as the Minister knows, the Opposition are very supportive of the sharing of patient information, which is clearly in the best interests of patients. Indeed, we took through the original provision in, I think, the 2003 health Act, although there were many others that we might have taken it through in, to allow for this to happen. The care.data project ran into a few problems, as we know, and has now been rolled out in a kind of pilot way in order to secure public confidence. But I think that it would be fair to say that there are still concerns about whether, in the end, the public and GPs are going to be prepared to sign up to this. As he will know, we think that the National Data Guardian must be made a statutory post. It was the subject of amendments in the other place. I am delighted that Dame Fiona Caldicott has become the National Data Guardian; that is an excellent appointment, and the Government should be congratulated on making it. We know that the Secretary of State for Health has said that her appointment would be put on a legal footing at the earliest opportunity—and this is the earliest opportunity. Surely, this is the time to do it.

Noble Lords will have received briefing from Mencap —I certainly have—about the information-sharing clauses. Mencap wants Clause 4 amended so that the health information includes the person’s communication needs, which means that professionals are more aware of the ways in which people can communicate their health and care needs. Perhaps the noble Lord, Lord Ribeiro, could give some consideration to that.

On the issue of children and why they are not included in terms of a national identifier in the Bill, I assume this is because of the split in government responsibilities between the Minister’s department and that of another department. Perhaps that is not the case, but it would be interesting to know about that. On national insurance numbers, as my noble friend Lord Young whispered to me, children of course do not have national insurance numbers until I think the age of 16. That may be a problem.

I come back to Clause 5. A number of noble Lords have raised the issue of why provisions have not yet been brought forward relating to the Law Commission’s draft Bill. We all know why the Government was not prepared to bring forward a health Bill in the fifth Session—not even a draft Bill—which is why the noble Lord, Lord Ribeiro, has very kindly taken on a Private Member’s Bill. It has been very disappointing; at the very least we could have had pre-legislative scrutiny, which would have been very helpful. I am not going to suggest that we amend the noble Lord’s Bill with 300 clauses suggested by the Law Commission, but I hope that the noble Earl, Lord Howe, will be able to say something about what the Government are going to do with those clauses.

My noble friend Lady Pitkeathley raised some interesting points on the PSA and the new provisions. I take what the noble Lord, Lord Willis, said, but I hope that the noble Lord, Lord Ribeiro, will answer my noble friend’s point about whether there has been some misunderstanding of the PSA’s role. Next Wednesday we debate the Deregulation Bill. I have tabled an amendment that seeks to take a number of health regulators out of the economic growth provisions because I believe that they will inhibit the effectiveness of those health regulators. From meetings we have had with the Department of Health it has been made clear that the PSA is included, but not the regulators—the GMC, the NMC et cetera. I wonder whether there is some confusion in the noble Earl’s department about what the role of the PSA is. My noble friend Lady Pitkeathley pointed that out very well.

We support the principle of the Bill. I congratulate the noble Lord, Lord Ribeiro, on bringing it to your Lordships’ House. I wish to see it make progress, but we need to have proper scrutiny as well.