Health and Social Care Leadership Review

Lord Lilley Excerpts

Thursday 9th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness is absolutely right that there should be a duty of candour. Noble Lords will remember that during the Health and Care Bill debates there was the debate around the openness of HSIB process. Here we have a difficult balance. On one hand, if someone has acted inappropriately or caused damage, you would want them to be brought to justice but, on the other hand, we know that the NHS has a culture of cover-up when things go wrong. It is great that we praise the NHS when things go well but I have heard too many stories of when things go wrong and clinicians close ranks and cover up.

Sometimes, they gaslight. I was talking about this the other day to a young official in the department and she told me about her friend, a young Afro-Caribbean female, whose baby died during birth. When she complained, the papers suddenly, magically disappeared. How can that happen? We have to make sure that there is real justice, but we have to get the right balance. HSIB makes sure that there is a safe space so people can feel free to come forward, so that we learn from that. Sometimes there may not be justice for the individual, but we can make sure that we avoid a repeat of these incidents. The Ockenden report clearly showed the role that the culture of the organisation played. We must be careful: there should not always be a focus just on numbers; we do not want to train people within the wrong culture and do more damage. We have to tackle all these issues at the same time.

[Lord Lilley (Con)]

My Lords, I would congratulate the Secretary of State Sajid Javid on presenting this report if it called for fewer full-time equality, diversity and inclusion officers and devoting resources, intention and focus to patients. Sadly, on reading the report, it does not; quite the reverse. It is totally obsessed with EDI. EDI is mentioned three times as frequently as patients. There is no mention of waiting lists, whistleblowers, cover-ups or value for money, and only one reference to efficiency. There is nothing about the lessons of Staffordshire or the failures in the health service—nothing at all. It is about EDI only. Worst of all, it states that demonstrating a commitment to EDI is more important than just technical skills.

It is important that we eliminate discrimination from the health service, but when I am treated, it is the technical skills of the medical staff I am worried about, as it is when those whom I love are being treated. The report sets goals for increasing the representation of underrepresented groups, but no goals for improving outcomes for patients. Worst of all, it proposes using the everyday discrimination scale as an objective tool of management, yet it is entirely subjective and all the academic literature I have found suggests it is completely worthless. Will my noble friend commission another report that will deal with people’s real concerns about the NHS?

[Lord Kamall (Con)]

I thank my noble friend for the question. It is important that we recognise that not only do we have more doctors and nurses than ever before, but we need staff to be good leaders. That includes understanding diverse workforces and, as I said earlier, making sure that we have good leaders at the top. Why do we have a diverse workforce? In fact, that diversity is not represented right at the top, in the leadership. Sometimes, when you want to change an organisation—I am sorry, but I did an PhD in organisational change—there are a number of aspects and one of them is the culture and the leadership. Sometimes a new leadership comes in that can drive that change in the organisation. It is not just about structures but about making sure that we improve the standard of care we give to people. This issue came up in the report, because we have to have the right leadership and focus on patient care and on making sure that we have a proper integrated health and social care system for patients all the way through their lives.