Public Interest Disclosure (Protection) Bill

Debate between Philippa Whitford and Kevin Hollinrake

2nd reading & 2nd reading: House of Commons
Friday 25th September 2020 Commons Chamber

[Dr Whitford]

Absolutely; I thank the hon. Gentleman for his intervention, and I will come to some of those issues later. This issue, as has been said, is in part one of culture, of being open, of realising that it should be about learning and fixing rather than trying to shut someone up. The more that downward pressure is put on people—like a pressure cooker—the more that builds, and there is more and more unhappiness. The problem is that in something such as health and social care, it actually affects patients.

That is why I am proposing the Public Interest Disclosure (Protection) Bill. The key thing that I seek to achieve is to remove whistleblowing from employment law and create free-standing protection legislation. If we really value whistleblowing, it should not be tucked away in some corner. It should be something that stands by itself—that sends the message that, in whatever sector, if someone sees wrongdoing and damage, they should come forward.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I pledge my support on a cross-party basis, and I am delighted to associate my name with the Bill. The hon. Member talks about valuing whistleblowers. Does she agree that we should value them not only for the risk they take and the individual issues they raise, but for the wider cultural issues they raise within a system—particularly, as she says, in financial services—which allows this House to put the measures in place to clamp down on that adverse culture?

[Dr Whitford]

I welcome that intervention, but whistleblowing should not have to be a risk. It should be a normal part of someone’s work or their duty as a citizen to come forward and report something.

The Bill defines whistleblowing disclosures, but it also widens the definition of “relevant authorities” to include not just employers, but public authorities and regulators, as many whistleblowers report that when they have involved regulators, they have been intimidated in exactly the same way and have made no progress. It places a duty on all relevant authorities not to subject whistleblowers to any form of detriment, and indeed, to protect them from detriment, but particularly—I cannot reiterate this more strongly—to investigate the concern and take action to prevent a recurrence.

The Bill widens the list of professions in which a disclosure may be made to include those previously excluded, such as religious ministers and police officers. Let us consider the cases of child abuse that might have been prevented had priests and ministers been able to speak up, or how much earlier the families of the Hillsborough victims could have been told the truth and given closure.

The Bill also includes those who were not previously defined as employees, such as trainees, interns and volunteers. I am sure that all of us who have taken an interest in this topic are well aware of the four-year persecution of Dr Chris Day, who warned about unsafe staffing in his intensive care unit, only to be told that junior doctors were not classed as NHS employees and that he had no protection. Although that anomaly has been resolved, it highlights the traps that unsuspecting whistleblowers can fall into.

The Bill seeks to establish an independent body with statutory powers to oversee whistleblowing. I have called it a commission in the Bill, but I do not care what it is called. After his report into the deaths in Mid Staffordshire NHS Foundation Trust, Sir Robert Francis established the “freedom to speak up system”, but the national guardian is not a statutory role and the local guardians are trust employees who themselves may be put under pressure when investigating a case. That comes back to the point raised in an intervention earlier: there needs to be absolute objectivity and a determination to deal with an issue locally, rather than it becoming a festering sore. By contrast, the Scottish Independent National Whistleblowing Office was established as a statutory body in 2018. It published its draft standards for the NHS and social care last year.

Devolved Governments will develop whistleblower-support systems for their public services, but PIDA is the underpinning legislation for all sectors—including businesses and financial services—and it no longer serves its purpose. The commission’s duty would be to protect whistleblowers and promote the principle of whistleblowing in the public interest. Such a body would develop standards of practice for whistleblowing policies and procedures and monitor the compliance of organisations with those standards. Such standards would include how issues should be investigated, and organisations would be expected to show what action they had taken to address cases. The standards would stipulate prospective protection of the whistleblower from detriment, from the point of their making a disclosure, including by preserving their anonymity and confidentiality—many whistleblowers suddenly find themselves splattered across the local paper.

The commission would also seek to resolve cases and reduce litigation, which is wasteful of public funds and both expensive and traumatic for the whistleblower. It could provide advice to whistleblowers who do not have any other route to report an issue or who are not making progress locally. It would be able to issue redress orders to try to repair detriment suffered by a whistleblower, rather than just making financial awards, and it would include the banning of non-disclosure agreements, which whistleblowers are often intimidated into signing. When staff have been subject to deliberate detriment, there would be the ability for civil action. As in Australia, criminal charges would be available for the most egregious cases of whistleblower persecution.

There are different ways to improve the quality of a service, and whistleblowing should not be the main method of detecting poor practice, the squandering of public funds or fraud. Just as audit is critical to ensure probity in the financial sector, it is also essential to detect poor clinical practice. In Scotland, we have had regular reporting against quality improvement standards for the most common cancers for many years. In the case of my specialty, breast cancer, I was involved in leading the development of the standards almost 20 years ago. The process identifies outliers, who can then be supported to update their practice, but it also creates peer pressure to drive clinical improvement, as people know that their performance is going to be shared at a conference, openly and transparently, every single year.

It is important to normalise incident reporting and encourage a culture of routinely raising issues without the sense of conflict and pressure associated with whistleblowing. That is the aim of systems such as Datix in the NHS, through which staff record, review and seek to learn from all incidents, from minor to major, including near misses. There will, however, always be cases that cannot be detected by audit, such as alcohol or drug misuse, bullying or racism. For that, whistleblowers are essential.

For whistleblowers to speak up early and reduce harm, they must be valued, supported and protected. In the NHS, that is about patient safety, which is literally a matter of life and death.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I will be brief, to let the Front-Bench spokespeople conclude. In the parliamentary briefing for this debate, there is a question posed to the Minister: do sufficient protections for whistleblowers already exist in current legislation? I hope his answer to that will be no. I hope that the Bill is successful today, but if not, it will be passed on a future occasion. My hon. Friend the Member for Cheadle (Mary Robinson) and I are meeting the Minister on Monday to discuss this, because we need reform. The proper protections are not in place at the moment.

I want to give one example, which I have spoken about before in this place, and that is the case of Sally Masterton. She was not a whistleblower. In 2013, she worked for HBOS, and she wrote a report about a fairly low-level fraud in the company. She was discredited by Lloyds to the regulator—it simply said that she was not a credible witness. The Financial Conduct Authority did not investigate. She was effectively suspended by Lloyds, through constructive dismissal. Five years later, the FCA decided that she actually was a cogent witness and said to Lloyds, “You need to do something about this. You need to compensate her and apologise,” which it did. The terrible fact about the case is that nobody at Lloyds or HBOS has been sanctioned for that disgraceful mistreatment of a whistleblower for five years. This was part of a disgraceful 13-year fraud of small and medium-sized enterprises within the bank, and still to this day that scandal has not been resolved.

[Dr Whitford]

The hon. Member highlights that the regulator—the FCA—also let that whistleblower down, and that is another thing that needs change.

[Kevin Hollinrake]

The hon. Lady is absolutely right. As I said in my earlier intervention, it is not just about the relatively small issues that the whistleblowers highlight. It is about the wider cultural issue. It shows the mismatch of power between the whistleblower, these big, powerful organisations and their customers, which we know we need to tackle, but we would not know that without people like Sally Masterton. I commend the hon. Lady for bringing forward this legislation. I hope she is successful; she will be sooner or later.

European Union (Withdrawal Agreement) Bill

Debate between Philippa Whitford and Kevin Hollinrake

Committee stage & Committee: 1st sitting: House of Commons & Committee: 1st sitting
Tuesday 7th January 2020 Commons Chamber

[Dr Whitford]

No one has ever negotiated a trade deal in just 11 months, so is it not likely that we will end up with something incredibly primitive? As for casting up that people voted for this in the election, what they voted for was the Government party saying, “We will achieve that by the end of the year.” They did not vote for it saying, “Well, never mind—we will crash out with no deal if we fail.”

[Kevin Hollinrake]

The hon. Lady makes a very good point, and I do not want to do that either. However, if she reads the comments from Michel Barnier that I quoted earlier, from the Financial Times of 26 November 2019, she will see that he said that normally such a period would be far too short, but that Brussels would strive to have a deal in place. Clearly, he thinks that he is capable of doing that. He talks about how he would sequence negotiations. For some things, we would have to kick the can down the road a bit and put some contingencies in place to deal with those. Clearly, he thinks that it is possible that we can do that deal.

[Dr Whitford]

The political declaration has a huge wish list of aspirations. Are they going to be negotiated later, or does the hon. Gentleman really think that including the European Medicines Agency, the European Chemicals Agency and all the various things that are in the wish list will be achieved by the end of the year?

[Kevin Hollinrake]

There may be a staging process; we do not know how the negotiations are going to roll out yet. Michel Barnier said that Brussels could take contingency measures to deal with those kinds of issue, because he does not want economic disruption. There is an appetite on both sides. What the European Union has done far better than the UK Parliament is negotiate as a bloc, together. There has not ever been any difficulty from its side in terms of people wanting different things, whereas clearly the UK Parliament has not behaved like that. As a result, the biggest vulnerability within the European Union from a poor trade deal or no trade deal is with regard to the Republic of Ireland.

The Republic of Ireland’s GDP growth rate is around 5%. Most financial commentators say that if there was a no-deal Brexit, the Republic of Ireland would go into recession. The EU would not want that. It would not leave the Republic of Ireland behind. The UK has imperatives in striking a deal and so has the EU. To my mind, that means we can do a deal in the next 12 months. I urge the Opposition to have more confidence in their position. The remarks from the hon. Member for Sheffield Central (Paul Blomfield), the Opposition Front-Bench spokesman, betrayed a lack of confidence, appetite and enthusiasm for this whole thing.

We cannot deal with Brexit like this—and I voted to remain. We must walk forward with confidence not only about our new relationship with the European Union, but, crucially at this time, about our negotiations on the trade deal.

Privatisation of NHS Services

Debate between Philippa Whitford and Kevin Hollinrake

Monday 23rd April 2018 Westminster Hall

[Kevin Hollinrake]

I am grateful for the hon. Lady’s intervention. I absolutely think that funding needs to be fair. There are certain instances we can look at as to whether the funding for certain CCGs in York and north Yorkshire is unfair. We need to ensure that the funding is got right wherever people are. It is incredible that we have a postcode lottery for healthcare in this country; things differ in different parts of the country, based on many of those issues. They are issues that we absolutely need to resolve.

[Dr Whitford]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

May I make some progress? I have taken three or four interventions in a row.

[Dr Whitford]

It is on the point about a postcode lottery.

[Kevin Hollinrake]

Okay.

[Dr Whitford]

I thank the hon. Gentleman for giving way. During the 33 years that I spent working in the NHS, the main aim was to get rid of postcode prescribing. He must recognise that the CCG system enshrines postcode prescribing.

[Kevin Hollinrake]

As I said, there are concerns. I have concerns: some of my constituents have difficulties. The overall quantum of healthcare funding—I will return to this at the end of my remarks—is putting pressure particularly on rural areas that I represent. We need to tackle a number of different issues. With regard to the future of healthcare funding, my perspective is similar to that of my hon. Friend the Member for Gloucester (Richard Graham): we should be working on a cross-party basis to deliver the solutions.

In terms of private or public, the public are absolutely behind the point that they have no preference. A greater number of people express no preference, in terms of a private sector or public sector provider, as to who provides their healthcare. Yes, of course the public are massively in favour—89% are in favour—of a taxpayer-funded healthcare system, but on the question whether the care should be delivered by private or public providers, it is a very different picture.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is a delight to serve under your chairmanship, Mr Hosie. In the scope of the history of the NHS, I would like to make a little punt for the Highlands and Islands Medical Service—a forerunner of the NHS that was founded in 1913, a long time before the UK NHS.

To make a gentle point to the hon. Member for Gloucester (Richard Graham), I will read the World Health Organisation’s 1995 definition of privatisation. Privatisation means

“a process in which non-government actors…become increasingly involved in the financing and provision of health care, and/or a process in which market forces are introduced into the public sector.”

Patients who attend any of the four UK health services will receive amazing care, but that is predominantly due to the dedication of the people who work in them, some of whom are working against much harder pressures than others. Government Members talked about outsourced cleaning and car parking as a good thing. There was evidence that it was the outsourcing of cleaning, and poor-quality cleaning, that led to the rise of hospital-acquired infections.

[Kevin Hollinrake]

rose—

[Andrew Selous]

Will the hon. Lady give way on that point?

--- Later in debate ---

[Dr Whitford]

I have only just started, and there is not much time left. It is repeatedly mentioned in this House that patients and carers in England have to pay significant car parking charges. That should not be seen as a benefit.

The Conservatives introduced the internal market in 1990. That introduced competition between NHS hospitals, and even at that point created an “us and them” mentality in my local area. It created divisions between the GPs and the hospital through the purchaser-provider split. Sometimes, if a patient was sent to me but had a problem that I diagnosed as pertaining to a different department, I could not refer them on, because the GP would not fund it. They had to go back to the GP and start again. That was both inefficient and, at times, dangerous.

Unfortunately, I have to criticise official Opposition Members, because I remember in 1997 when Labour got in and talked about going back to one NHS. Those of us who worked in the NHS were delighted. Sadly, we soon started to hear about foundation trusts and, in essence, we were back to the same policy. It was Labour that introduced independent treatment centres, initially with block contracts for common operations such as those on hips and knees. Most of those contracts were not met, and were therefore of incredibly poor value. GPs were being pushed to refer their patients to the ITCs. That was eventually recognised, and the move was made towards payment by results, which eventually led to the tariff. Capital funding was also kept off the books, leading to the private finance initiative, which we have discussed many times in this place. PFI has been shown to result in between £150 million and £200 million of profit per year for the companies that hold the contracts. That is putting a huge strain on many trusts.

In the 2010 election, the Conservatives promised no top-down reorganisation. Unfortunately, just a couple of years later, with the introduction of the Health and Social Care Act 2012, we saw that that was not true. The Act came into force in April 2013, and section 75 in particular pushed commissioning groups to put contracts out for tender. That has created relentless pressure to bring independent sector providers into the NHS. As the hon. Member for Thirsk and Malton (Kevin Hollinrake) mentioned, it has risen from £2.2 billion in 2006 to £9 billion in 2016-17, more than 10 years later. That is approximately the same cost as providing all GP services, so it is not a minor cost; it is significant. The independent treatment sector in 2015-16 won approximately 34% of contracts—a figure that rose to 43% in 2016-17. However, as the independent treatment sector has moved towards more community services, it is now winning approximately 60% of contracts. There is no question but that there is greater involvement of private companies in providing healthcare.

We hear all the time about waste in the NHS, but we have had circular reorganisation throughout my career—from 100 health authorities to 300 primary care trusts, to 150 primary care trusts and to a little more than 200 clinical commissioning groups. CCGs were described as putting power into GPs’ hands, but less than half of CCGs have a majority of clinicians on them, and less than 18% have a majority of GPs. We are now going to go through another change, with the introduction of 44 sustainability and transformation plans or accountable care organisations. The costs associated with the redesign, the redundancies, the new organisations, the external consultants and the change managers are all described as one-offs, but this has been repeated relentlessly over the past 30 years and has resulted in huge waste. Much smaller organisations, such as hospital trust and ambulance trusts, are now run by very senior managers with six-figure salaries—the same size as those received by the people who ran health authorities at the start of all this. That is a waste.

Then there are the running costs of the market itself—the contracting design, the tendering, the bid teams, the corporate lawyers, the billing and the profits. The costs of the system are utterly opaque. It is not possible to penetrate the veil of commercial sensitivity, and the Department of Health does absolutely nothing to show where public money is spent. It is estimated that the cost of the English healthcare market is between £5 billion and £20 billion—no one really knows. We have no evidence of precisely how high the costs are, and there is absolutely no evidence of a benefit, so it is not possible to do a cost-benefit analysis.

[Kevin Hollinrake]

The hon. Lady is talking about the efficiency of the system, but is she aware that the Commonwealth Fund report, which addresses some of the issues she is talking about, described the NHS as the most efficient healthcare system in the world?

[Dr Whitford]

The 2014 “Mirror, Mirror” report was actually based on the years before the Health and Social Care Act 2012 came into force—2010 to 2013—and at that time the NHS was No. 1 in eight out of 11 markers. That was due not to privatisation, but to easy accessibility. One of the key things is that patients can access the NHS quickly and easily. That ranking is not based on the system of reform that the Health and Social Care Act introduced.

[Kevin Hollinrake]

The hon. Lady seems to be implying that the internal market is a problem, but it has been in place since my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) was the Chancellor. Efficiencies have been driven, and she must take into account the internal market reforms that are in play.

[Dr Whitford]

The difference is that the original market was an internal market; what we have at the moment is an external market, which means that money is leaving the NHS and going to external companies. That is quite different from competition among hospitals.

To tackle waste, we should start with the cost of the market. Even if it is at the lowest end—£5 billion—it would help to clear the debt and pay for the hole in social care. It would make a significant difference.

In the five years leading up to 2013, the NHS always somehow managed to find money down the back of the sofa, and it scraped out with about £500 million at the end of each year. In 2013-14, it was overdrawn by £100 million. The next year, the figure was £800 million, and in 2015-16, it was £2.5 billion. People sometimes say, “There’s this little bit of efficiency, and this little bit has been saved”, but when I started the UK spent 4.5% of its GDP on health, and the highest it reached was 9%. Imagine if all that money had gone to frontline care, as the hon. Member for Thirsk and Malton talked about, and was used to pay nurses properly, get rid of bureaucracy and actually deliver care. We can do that only if we have a planned single system; we cannot do it if we create an entire bureaucracy.

Scotland diverged in 1999 when we got devolution. We abolished hospital trusts in 2004 and primary care trusts in 2008. We have place-based planning in the form of health boards, which have led to the integration of primary and secondary care. We now face the difficult challenge of the integrated joint boards for integrating health and social care. Look at our success: in-patient satisfaction is up to 90%, delayed discharges have been down every single year and Scotland has had the best accident and emergency performance since March 2015. In February, emergency department performance in Scotland was 90.3% in four hours; in England, it was 76.9%. Look at how the challenge evolved: it literally started in April 2013, when the NHS in England came under pressure.

I have frequently welcomed the plan to move to place-based planning. I agree that the term “accountable care organisations” is unfortunate, but the model contracts put out in August still make it clear that independent sector providers could bid to run an entire accountable care organisation. There is no statutory structure. The basis must be that there absolutely has to be accountability and a statutory responsibility. I believe there should be a presumption of a return to the NHS.

It is crucial that we reform the perverse incentives. Hon. Members have mentioned the tariff. Hospitals earn money only if people are admitted. They make money out of those who are not that sick and lose money on people who are incredibly sick. How will a hospital take part in this if keeping people in the community, which we all want, means that they lose money? That should be reformed in this place. Section 75 of the Health and Social Care Act caused the Nottingham University Hospitals NHS Trust to waste £500,000 preparing a bid for the Nottingham Treatment Centre against Circle, which then just pulled out. Hon. Members have mentioned that Virgin has sued six Surrey CCGs, one of which leaked that it is paying £328,000. Multiply that by six, and we are talking £2 million. The idea that outsourcing to private companies has brought benefits simply does not stack up. We are putting money into care. Get rid of outsourcing and fragmentation. I support the idea of place-based planning, but patients, not budgets, have got to be in the middle of it.

Housing Benefit and Supported Housing

Debate between Philippa Whitford and Kevin Hollinrake

Wednesday 27th January 2016 Commons Chamber

[Kevin Hollinrake]

There is no doubt that we need to house vulnerable people in supported and specialist accommodation, and that our homes, hostels, refuges and sheltered housing need such support. They constitute a much more labour-intensive part of the market, involving personal care, supervision and maintenance.

[Dr Philippa Whitford]

May I take up the point made by the hon. Member for Redcar (Anna Turley)? It costs an extra £18,500 to house those with the most complex needs, and most users of supported living are over 70. In our health debates, we talk about trying to get people into the community. As a result of this measure, people will end up in expensive alternatives.

[Kevin Hollinrake]

I accept the hon. Lady’s point. We need to ensure that we protect our most vulnerable people, and that is what I believe we will do.

Many of the providers of supported housing and specialist accommodation are part of much larger organisations which are able to blend reductions across their estates, but we want to ensure that specialist providers continue to supply accommodation. This policy is in its early stages, and is currently the subject of consultation. I welcome the Minister’s announcement of a one-year delay, or interruption, so that we can get it right. However, it has been referred to before. In September last year, my hon. Friend the Minister for homelessness—the Under-Secretary of State for Communities and Local Government, the hon. Member for Nuneaton (Mr Jones)—said that specialised supported accommodation was likely to be exempted. I do not think that there is any need for Opposition Members to frighten residents and make them fear that they will lose their homes. That is irresponsible.

It should also be borne in mind that, during the current Parliament, there will be £800 million in discretionary housing payments for the most vulnerable tenants, and £40 million for those who suffer domestic violence.

I suggest that Opposition Members should wait to see the results of a policy which I believe will provide a fair deal for the most vulnerable people.