Health and Social Care (Safety and Quality) Bill

Lord Young of Norwood Green Excerpts

Friday 6th February 2015 Lords Chamber

[Lord Young of Norwood Green (Lab)]

My Lords, I do not usually enter these debates because I do not necessarily feel that I have the knowledge to do so. I was impelled to do so—I must admit that it was a fairly late impulse—by the Bill’s title and then having a cursory glance at its substance. I was not expecting much humour in this debate but I am indebted to the noble Lord, Lord Willis, for the idea of chipping at birth. I have recently had that done to a cocker spaniel; I never thought of introducing it to my children when they arrived. It might not be a bad idea to keep track of them but I doubt that it will get through.

I wanted to speak in this debate because, apart from the matter of my own personal interaction with the NHS—I say to the noble Lord, Lord McColl, that I do not know whether they used indelible ink, but thank goodness they got the hip implant on the correct side, the left—whether or not the Bill goes through, there are still fundamental changes that all of us want to see take place in the health service, and which have been touched upon throughout the debate. To return to the noble Lord, Lord McColl, it strikes me as important to identify best practice, and I cannot help wondering why it takes so long for it to permeate. The noble Lord gave his example of how to ensure that accidents do not happen in the operating theatre. One that I have heard about recently is a tick-list system, rather like the one that they use when flying aircraft. It says that everyone in the operating theatre identifies who they are—I think that probably helps—and knows the nature of the operation, and so on; I shall not go through all of it.

Why is best practice not being extended at a more rapid rate throughout the health service? After all, we know where some of the best hospitals are; we can identify their performance. When I as a lay person enter hospital, perhaps because, as I have been recently, I am looking after an aged relative, I can see best practice. I can see when they are paying attention to whether their patient is eating his food or getting enough liquids. I can see whether they attempt to get a patient who has been immobile out of bed and exercised regularly, so that he or she does not leave hospital in a worse state than when they entered it. There is a danger of that, after all: they go into hospital still in control of their bodily functions but sometimes leave with a catheter and, if they are really unlucky, with double incontinence. It is so difficult to get this right.

I also have experience of some hospitals where one ward is operating to perfection but in another you wonder whether you are in the same hospital. Why does that come about? My view, and I think that my noble friend Lord Turnberg identified some of the issues, is that, apart from the intrinsic dedication of staff, which we hope we will experience, training and supervision are key. If the people in charge are just talking the talk and not walking the walk—if the ward sister or matron is not actively engaged in going around their ward, talking to patients and observing the culture—it will not happen.

Someone talked about changing culture. Anyone who has studied organisations knows that changing culture is the hardest thing to achieve, and in an institution as large as the NHS it is doubly so. I hope that the Minister will give us some assurance on the inculcation of best practice. The noble Lord, Lord Ribeiro, talked about wrong sites and wrong implants. The thing that I reflected on was not only the poor patients but the sheer cost to the NHS of such claims. We dealt with that recently in an Oral Question. I hope that the Minister will consider that.

I could not help but identify with my noble friend Lord Turnberg when he talked about the non-inclusion of children. I had not carefully looked at that measure before I realised that that was the case; I was thinking about NI numbers as an identifier when I suddenly thought, “Well, that won’t apply to children anyway, unless I’m mistaken”. I think that he is right about that criticism.

I do not feel qualified enough to say whether the overall impact of the Bill would be either negative or positive; I can see the positive points in it, but do not want to get caught up in the semantics of whether there was zero harm or reduction of harm because I do not feel qualified to be able to distinguish between them. We all share the same common objective that is in the Hippocratic oath: “Do no harm”. As a general dictum, if you like, I embrace the point made by the noble Lord, Lord Elton, about the perfect being the enemy of the good. As a trade union negotiator I have embraced more compromises, which sometimes I have described as “shoddy”, than have most of us—although most of us here have engaged in that. However, I never really regarded them as shoddy but as a natural part of any negotiation. Therefore I will leave it up to the experts to determine that.

I will say only one thing to the Minister: it is a worry that somehow, despite the excellent intentions of the Bill, we have not created enough time to ensure some amendment that might make it much more acceptable to the whole House.