Health and Social Care (Safety and Quality) Bill

Lord Turnberg Excerpts

Friday 6th February 2015 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I, too, congratulate the noble Lord, Lord Ribeiro, on introducing this Bill in a characteristically clear and balanced way. I very much enjoyed hearing him. I find myself in the odd position of being extremely enthusiastic about the provisions of one part of the Bill and rather less than enthusiastic about other provisions, where I feel that there is a desperate need for amendment. I hope that the suggestion that we will lose the Bill if we think about amendments is not true and that we can see our way through that.

I shall begin with the bad news and say straightaway that I do not think it a good idea to try to avoid harm to patients by legislating for it. Of course, few can argue against the idea that we should do all that we can to avoid harm to patients by poor practice, neglect or abuse, least of all me, after a life in clinical practice. Certainly, after the Mid Staffs scandal, I can well understand the desire of the noble Lord, Lord Ribeiro, and the Government to be seen to be taking action, but there are three questions to be asked first. Is it necessary to enshrine this in law? Would such a law be effective? Would it have a negative effect on harm reduction?

The Health Foundation believes that the Bill might have a negative effect. It points out that if we want to avoid harm, which everyone does, the best way is through the intrinsic motivation and dedication of staff and senior leaders rather than through legal or regulatory levers. It prays in aid the Berwick advisory group, headed by Don Berwick, a significant figure in this field in anyone’s book. His group included extremely well qualified individuals whose views should at least give us reason to pause before going ahead with this legislation. It says that “zero harm”—its expression—is an impossible aspiration and to try to legislate for it is too simplistic.

Reduction in harm requires a continuing progressive process involving education, training and motivation from the top permeating through every part of an institution. Bringing the law into that at this stage is not terribly relevant and seems to be a knee-jerk response to the Mid Staffs inquiry, which is never a good basis for attempts at quick resolution. What we should be aiming at is better education and training and better supervision by those in charge. That at least has been shown to be effective in reducing harm. The Bill also talks of excluding harm that cannot be reasonably avoided, but we are then into the whole difficult business of trying to define reasonable avoidance. That needs time and expertise that is not readily available. We need to think that through more carefully.

Now for the good news: the part of the Bill that is very welcome is the desire to see a single identifier introduced for all patients in the NHS. I agree entirely with the noble Lord, Lord Willis, on this. The idea that the identifier will be used across the service so that information about a patient can be shared between all those in the NHS and social care who have to deal with that patient makes enormous sense. It makes for increased safety, too, if Doctor A knows what Doctor B has been treating his patient with. It is a common good. For example, when someone turns up in the accident and emergency department, doctors can find out rapidly what illnesses they have had and what treatment they have been given. However, there is a question about how we can include patients treated in the private sector. I hope that we will hear more about that at some point. I strongly urge that the national insurance number be used as the identifier. It makes more sense to use an existing number for the great majority of the population rather than dreaming up a new numbering system. However, of course, that does not have to be in the Bill itself.

It is of interest that the new National Information Board’s framework for action, which was published last November, states that the use of the NHS number as the primary identifier in clinical correspondence and for identifying all patient activities will be mandated in healthcare. The Independent Information Governance Oversight Panel will play a key role as national data guardian for health and care. This will ensure that proper scrutiny and challenge can be seen to be operating and will reassure those who feel that patient confidentiality will be threatened. A single patient identifier will also be extremely valuable as, hopefully, we move forward with care.data. As that gets off the ground, with the robust safeguards that we hope will be in it on patient confidentiality, the use of those data for medical research and clinical trials will be essential.

Here I declare my interest as scientific adviser to the Association of Medical Research Charities, of which my friend, the noble Lord, Lord Willis, is chairman. Our members are desperate to see research into advances in the treatment of the many diseases that they cover being aided by the use of patient data. As the noble Earl has stressed on many occasions, research is a key and central role for the NHS. There is little doubt that a single identifier, the NHS number, will be a valuable tool in achieving that desirable aim.

Returning to my concern about the difficulties of allowing the Bill to pass without amendment, I should say—in case I am seen as a maverick spoiler—that I am not alone in my view. Apart from the Health Foundation, I know that the Academy of Medical Royal Colleges, the BMA, the Medical Protection Society and, I fear, the Royal College of Surgeons have all raised aspects where amendments may be required. I know that the noble Baroness, Lady Masham, who cannot be here today, is unhappy with the Bill as it stands. I hope that we will be able to look at the Bill again and that the Government will come up with a mechanism by which we can consider amendments to the Bill. I have suggested one possible mechanism to the powers that be, but of course it is not up to me.