Health and Social Care (Safety and Quality) Bill

Lord Willis of Knaresborough Excerpts

Friday 6th February 2015 Lords Chamber

[Lord Willis of Knaresborough (LD)]

My Lords, I am conscious of the late hour and will try to keep my remarks to a minimum. The noble Baroness, Lady Pitkeathley, raised a number of issues that I should like to deal with but was not going to. I should like to thank Jeremy Lefroy for bringing the Bill into the Commons, and my noble friend Lord Ribeiro for the excellent way in which he introduced it. He introduced a number of the issues in a very balanced way, particularly those relating to Clause 1, which are clearly going to cause some concern.

I fundamentally disagree, however, with the noble Baroness. One of the things that has bedevilled us, and which Clause 5 tries to deal with, is that our regulators in particular have operated in individual silos, as indeed has the PSA. To say that the regulator—particularly, the one that I know best, the Nursing and Midwifery Council—does not have as its first priority protecting the public is to underplay not only that regulator but every other regulator. She is quite right to say that we have moved away from that mark and that the professions themselves have been the main source of the regulators’ work. I have a great deal of sympathy for that view but, as my noble friend said in his opening remarks—indeed, what was said in the other place on Clause 5 —it is clear that, following Francis, Winterbourne View et al, we have to get this back in balance and that throughout our health and care system it is the patient who comes first, second and, indeed, last. The professionals and the regulator are there to serve that interest. I hope that my noble friend the Minister will say that from the Government’s point of view that is the case. I am pretty sure that that has been the case from the Labour Front Bench. In particular, during the passage of the Health and Social Care Bill and the Care Bill, which are now Acts, in our arguments, it was very strongly the role of the Front Bench constantly to put the patients at the heart of the agenda.

I should declare some interests. I am chairman of the Association of Medical Research Charities, and our interests interface. Not one of our members has given a notification that they are unhappy with this Bill. As the noble Baroness quite rightly said, that is not to say that they would not have liked a different Bill or a government Bill or a Bill which came in on the back of the Law Commission report in 2014. Having said all that, we are not getting a particular difficulty from that. I also declare an interest as the independent chair of Shape of Caring, which has been set up by Health Education England to shape the nursing and care workforce over the next 10 to 15 years. A lot of what is in this Bill will directly affect the work of nurses and care assistants, in particular, and I will come back to that.

I do not regard this Bill as perfect. It is far from perfect. I share the concerns that we are rushing through at the fag-end of this Parliament a Bill which has significant importance in terms of patient care and public safety. Having said that, when I decided late yesterday to speak in this debate, my argument is “Is the Bill worth the effort?”. I think that it is worth the effort. Members of this House will know full well, and established Members of the other House with us today will also understand, that to try to get this sort of legislation at the beginning of any Parliament and in the first Queen’s Speech is very difficult. If there is to be a strange coalition and perhaps then another Government, we may not see legislation of this sort for some considerable time. It is better to get something on the statute book and to start working on it. There are elements of this which are very important.

The Bill has the backing of the Government and the Labour Front Bench, which I hope is still the same. I am pretty sure that it has the backing of many Cross-Benchers. The purpose of the Bill is quite simple and clear. Its first priority is to link registrations with the CQC to a statutory body to prevent avoidable harm where there are regulated health and social care services. Secondly, it has to establish a consistent identifier for patients or clients through the whole of their healthcare journey, allowing information relevant to their care or treatment to be shared appropriately. Thirdly, it has to ensure greater consistency across and between regulators of health and social care with the primary objective of public safety. I do not think that there is anyone in this House or in the broad public who would not agree that it is right and proper that Parliament addresses those three priorities.

My only questions are: does this Bill say that? Does it do what it says on the tin? Is there a reality that those three objectives can be met? I am a layman in these matters but someone who works with the nursing and care sector at the moment. I believe that the answer is yes. The Bill is proportionate, logical and deliverable but it is only one step forward. It is part of a journey to create a more dynamic rather than a stationary regulatory system. The trouble with our regulatory systems is that they are stuck in time and do not move with the times. They need to be far more dynamic.

Clause 1 appears to have caused some problems with the BMA, certainly with the Berwick advisory group—or some members of it—and with the Health Foundation. I know that the noble Lord, Lord Turnberg, will address some of those concerns in his contribution so I will leave him to do it. While I fully accept the concerns which have been raised about Clause 1, there is, as the noble Lord, Lord Ribeiro, said, some exaggeration of what the Bill is trying to do.

The Bill, rightly in my view, seeks to make it a duty of the Secretary of State to require the CQC to impose regulations which cause no avoidable harm to patients. The Bill states just that; what it does not state, nor do the Explanatory Notes, is that we are trying to go for a legalisation of zero harm. There is no healthcare system in the world that could have zero harm framed within legislation—that is impossible. I hope that my noble friend will make it clear that that is not the intention. I hope, too, that he will go on to say that the current regulations from the CQC, which if I am not mistaken are about to come before the House—perhaps they have already gone through the House and I have missed them—have already put into statute exactly what we want to see happen in this Bill. So I do not think that there is a problem from the CQC either.

Clauses 2, 3 and 4, although again eminently sensible in their changes, cause one or two issues which I hope the Minister will be able to respond to. The idea of a common identifier is so obvious that you wonder why we did not put it into the Health and Social Care Act in the form that it is in. The idea of using of one’s national insurance number to deliver that seems sensible, but I am delighted that the Bill does not have it on its face because modern technology is moving so fast that there may well be within a very short time a totally different concept of a common identifier. The Bill will allow that to come in very effectively. Who knows? In future, babies might be chipped at birth so that there is a way of barcoding them as they go along their journey. Before the noble Lord, Lord Hunt, puts out a tweet somewhere, I should say that that is not a Liberal Democrat idea for the next election.

On data sharing, the latest response from Fiona Caldicott is right. The duty to share important information is as important as the duty to protect it. Getting that balance right is important. The fiasco over our attempts to share research data, which nearly derailed that important initiative, is in our minds. The fact that we constantly hear reports of data being lost or put in the post to somebody is something else that we have to take care of.

The area of the Bill that I am particularly concerned about and want to see through is Clause 5. I want to devote the last few moments of my speech to the work of the Nursing and Midwifery Council, which is faced with an impossible task at the moment. It spends an inordinate amount of its time dealing with disputes about people who have reported nurses or midwives for unprofessional conduct; it is mired in a morass of cases. The difference is this: the GMC has roughly 10,000 complaints about doctors each year. In 2013-14, 2,371 of them were investigated, and only 241—about 2.4%—were brought to full hearings. Compare that with the NMC where there were roughly 4,000 referrals last year, 75% of which have gone to full hearings. The NMC is spending an inordinate amount of time dealing with hearings, no matter how important or trivial they are, simply because that is the way the legislation is formed. Clause 5 allows us not only to have a comprehensive framework across all the regulators but gives them powers to streamline the way in which they deal with complaints. It is far more important to deal with the key point of keeping patients safe than with the huge amount of trivia which comes through the regulators.

All in all, this is not a perfect Bill, but is a Bill well worth putting on the statute book, and I hope that noble Lords will support it and give it a Second Reading.