The department is already working with its national partners to offer practical support to local provider and commissioner organisations on information governance and sharing. For example, the department is partner to the Information Governance Alliance, a group of national health and care organisations which has been established to provide a single authoritative source of guidance and support on information sharing. I confirm to the noble Lord that the guidance will include specific examples and will be prepared in consultation with our key stakeholders.
Turning to Amendment 6, the NHS number helps to ensure that an individual’s health and adult social care history is readily accessible when they move along their care pathway. This will improve safety and the experience of care. The adoption of the use of the NHS number as a consistent identifier has been a long-standing government objective.
It may help if I explain a little about the purpose and use of the NHS number. An individual does not need to know their NHS number to get treatment. Conversely, having an NHS number does not imply entitlement to the free use of all NHS services. The NHS number helps to confirm the identity of patients and link health records. There are some electronically based services for which an NHS number is essential and from which a patient who objects to the number being shared may not be able to benefit—for example, as the noble Baroness said, screening programmes, choose and book referrals, and electronic prescriptions in primary care. In these instances, the implications of objecting may be serious, which underlines why the decision to opt out should always be considered carefully and discussed with professionals.
That said, there is an important principle at stake here. The Government are committed to empowering the individual. In the future, it will increasingly be the citizen who determines who has access to their data, with care professionals respecting their preferences. For that reason, the Bill provides that if an individual objects, or is considered likely to object, then no duty to share information will arise under these new provisions. I hope that that is a useful explanation for the noble Baroness.
I am pleased to reassure her also that the Bill will not have any effect on the existing systems to protect victims of abuse. The Care Act 2014 sets out clear duties on adult safeguarding. Under the Act, local authorities must make inquiries, or cause others to do so, if they reasonably suspect that an adult who has needs for care and support is, or is at risk of, being abused or neglected.
Statutory guidance will provide that the early sharing of information is key to providing an effective response where there are emerging concerns. Where an adult has refused to consent to information being disclosed, practitioners must consider whether there is an overriding public interest that would justify information sharing.
There are equally robust mechanisms in place to protect children. The Department for Education has produced statutory guidance entitled Working Together to Safeguard Children, which clearly sets out that professionals should share information with local authority children’s social care where they believe that a child is at risk of abuse or neglect. It states:
“Fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children”.
Existing guidance on information sharing for practitioners and managers states that if a child is suffering or is likely to suffer significant harm, professionals should share information even if consent is refused or withdrawn. The interests of the child are paramount.
I agree wholeheartedly with the sentiment behind the amendment in the name of the noble Baroness, Lady Hollins. It is critical that an individual’s communication needs are identified and shared appropriately with those responsible for providing and commissioning care and services. This Bill requires the sharing of information where this information is,
“likely to facilitate the provision to the individual of health services or adult social care in England, and … in the individual’s best interests”.
An individual’s particular communication needs would be a good example of such information. This will be made clear in guidance.
The concerns that the amendment seeks to address reflect those Mencap has recently raised with the Department of Health. I am pleased to say that my officials have had constructive discussions with Mencap and we welcome its offer to help shape the guidance. Mencap welcomes the Bill as it has the potential not only to improve information sharing between health and social care, especially for people with a learning disability, but also has, in its words, the potential to “save lives”. I would add that, provided the patient or his or her attorney have consented to its inclusion, any information from a GP record that can be coded can be included on a summary care record. Work is already under way to expand the summary care record inclusion data set to include specific communication needs items.
Lord Ribeiro: My Lords, I thank the Minister for clarifying the issues around the consistent identifier. It is interesting that the use of the consistent identifier and the sharing of information was welcomed at Second Reading by the noble Lords, Lord Turnberg, Lord Willis of Knaresborough and Lord Hunt of Kings Heath. The noble Lord, Lord Hunt, confirmed that the Opposition were very supportive of sharing a patient’s information, which, as he said, was,
“clearly in the best interests of their patients”.—[
Official Report
, 6/2/15; col. 961.]
That slides me very easily and comfortably into Amendment 5 and the question of best interests, which, again, has been addressed. I must confess that I have always used, and continue to use, the term “best interest” without assuming that this can be used only about those without mental capacity, as defined by the Mental Capacity Act 2005. It is my understanding that in these clauses the phrase “best interests” assumes its general meaning and provides a relevant person
with a duty to act in the individual’s best interest when providing information for direct patient care. That is my understanding of the term.
As regards Amendment 6, patient control and choice about how their information is used is the subject of wider government policy. I believe that what needs to be done in that respect has already been illustrated. It is about empowerment of the individual and giving them control over their own information. I also welcome the intervention of the noble Baroness, Lady Hollins, in highlighting a key piece of information in patient care. Her description of a patient who died after surgery for want of the right word when asked a question—the patient answered incorrectly, which led to a fatal outcome—was truly revealing. In my experience, it is critical that if an individual has particular communication needs, those who provide care or treatment should know about them beforehand.
I am confident that the requirements to share information in support of direct care in the Bill already encompass communication needs. The Minister commented that Mencap has sought reassurances that health professionals should become more aware of the ways in which people can communicate their health and care needs. I am sure that, from his statement earlier, work on this will take place to ensure that those concerns are met. With those comments, I hope the noble Baroness will be happy to withdraw her amendment.
Baroness Finlay of Llandaff: My Lords, I am grateful to the Minister for being so clear in addressing the issues that I have raised and for the supportive further clarification sought by the noble Lord, Lord Hunt, of Kings Heath. It will ensure that the term “best interests” is attributed only its ordinary meaning and not misinterpreted for the purposes of this Bill as meaning “best interests tests” as outlined in the Mental Capacity Act. I am also grateful that the guidance and the Explanatory Notes will be amended as both noble Lords have outlined. I appreciate the welcome of the noble Lord, Lord Ribeiro, for how the debate has gone and what has happened. I therefore beg leave to withdraw my amendment.
Clause 3: Duty to share information
(1) The Secretary of State shall, as soon as practicable, make regulations to apply the provisions of sections 2 and 3 to services for children that benefit their health and wellbeing and protect them from abuse.
(2) Such regulations shall be applicable in the first instance to relevant health and children’s social care commissioners and providers.
(3) These regulations may be extended to other public bodies by order where there is an established body of evidence that such extension would improve the health and wellbeing or protection of children.
(4) All such regulations shall be approved by resolution of both Houses of Parliament.”
Lord Warner: My Lords, Amendment 8 follows the slightly unsatisfactory debate at Second Reading on 6 February on the issue of a common identifier for children. As I said then, I welcome the provisions in the Bill for consistent identifiers for adults across health and social care, but I still cannot see why the same considerations do not apply in this Bill to children. Indeed, I would go even further and say that the absence of a common identifier for children poses even greater risk than that for adults.
I declare an interest as the Children’s Commissioner for Birmingham, appointed by the Secretary of State for Education. I do not intend to speak about my work there except to tell the House that Birmingham, like many other parts of the country, is experiencing huge rises in the numbers of children at risk and in need.
A key element of tackling this problem is all agencies speedily sharing information about individual children. To do this means a common identifier. It is not only me saying this. As far back as 2003 the noble Lord, Lord Laming, in his excellent report on the tragic case of Victoria Climbié, called for a common identifier database for all children under 16. This Government halted work on it. Nevertheless, professionals working in the area have battled on, trying to improve information sharing in order to reduce risks to children.
The child protection information sharing project is being implemented to allow—I emphasise “allow”, not “require”—healthcare staff in unscheduled care settings to be alerted to the existence of a child protection plan. However, this is a long way short of using the NHS number, given to all individuals at birth and a lifelong identifier, to link data sets for the protection of children. All these professionals cannot understand why politicians across the parties—I am not making a party-political point—simply will not commit to doing the same for children as they do for adults on interagency information sharing and to making it easier to share information through a common identifier.
I am not going to detain the House today with various attempts to patch up children’s data sharing. I simply suggest that all Front Benches read the 2014-15 report on information sharing from the Children and Young People’s Health Outcomes Forum. This makes it clear why the NHS number should be used as the link identifier and provides a process map for doing so.
Amendment 8 attempts to build on all the hard work that I have mentioned by an army of committed professionals to improve the lot of vulnerable children.
Instead of the almost endless bureaucratic dithering and squabbling by various public bodies both nationally and locally, we need to put children on the same basis as adults in terms of information sharing and linked identifiers. My amendment provides that a Secretary of State—frankly, I do not care which one, and anyway they may all have different functions after 7 May—should have the responsibility to make regulations to apply the provisions of Sections 2 and 3 of the Act to services for children that benefit their health and well-being and protect them from abuse. It is a deliberately broad remit, but I believe that it is within the scope of the Long Title of the Bill. If the Minister wants to argue that it is not within scope, I would like to hear the legal arguments for that. I have gone through the Long Title and I cannot see that it states anywhere that the Bill is limited to adults.
The amendment does not tie the hands of any Government in terms of detail or precise timing. Initially, it restricts the scope to children’s commissioners and providers in the health and social care sectors, but it provides for later extension where there is a body of evidence to show that doing so could improve the health and well-being of children—something which I suspect all noble Lords in the House support.
I recognise that my amendment will not have improved my popularity rating in government departments, among the Bill’s sponsors, and probably on the Front Benches as well at this stage of the electoral cycle. However, if people want this Bill speedily, I want to see some movement from the Front Benches—not just the Minister; this is also a matter for our Benches. I do not intend to press matters further today, but I would like to hear whether the Front Benches can demonstrate a willingness to commit to act on this issue at the earliest legislative opportunity if they are part of the next Government. I know that no one can commit the next Government, but it is possible for all the main parties to take a view on the issue going into an election. I hope that we can bring a bit more positivity to this issue and I beg to move.
1.30 pm
Baroness Masham of Ilton: My Lords, I would like to ask a question of the noble Lord, Lord Warner. Would Amendment 8 help to protect children such as Baby P, who suffered around 50 abuses, including a broken back, which had been neglected? Many other children have suffered abuse and neglect since then. Children need extra shared protection.
Lord Warner: I know of the commitment of the noble Baroness in this area. The answer is that a linked identifier would have helped in many of these cases. We have to move beyond exhortation in central government guidance for people to share information across the agencies to providing them with the practical tools that will make it easier for these data systems actually to share information and make it readily accessible. That means providing a common linked identifier for the agencies to use in matching their data sets. So, yes, in all probability Baby P might have been protected, as well as the many others we have seen since Victoria Climbié.
Lord Elton: My Lords, given the undertaking that we are not going to divide on this, I am tempted on to my feet to remind your Lordships that, although we have talked about the Climbié case, this goes back to the case of Maria Colwell in 1975, when Lord Goronwy-Roberts, the Labour Minister for Health in this House, was successful in beginning the setting up of at-risk registers. That was a long time ago and yet we still have not solved the issue of the breakdown of information sharing between agencies, voluntary and otherwise. I encourage my noble friend to leave a note on his desk, to which we all hope he will return after the election, reminding himself to get on with this.
Lord Hunt of Kings Heath: My Lords, I am not sure about the noble Lord’s latter point. I think my noble friend has done us a great service in raising this issue. Since we are talking about unique personal identifiers again, perhaps I may first remind the House of my presidency of the bar-coding association, GS1.
As a resident of Birmingham, I thank my noble friend for his work as the Children’s Commissioner, which has been invaluable. Your Lordships will have a great opportunity to discuss these matters further on Monday night after we debate standardised packaging of cigarettes, because I have a Motion to Take Note on the Birmingham electoral order, which changes the electoral cycle in Birmingham following the work of the three commissions and the Permanent Secretary at the DCLG.
On the substantive point, my noble friend raised the case of Victoria Climbié, on which I well remember making the Statement to this House a long time ago now. What was so striking in that report was that she went through, I think, at least eight or nine public agencies. If any one of them had talked to another, it is likely that she would still be alive today. It was a shocking report, because there were so many failures by so many different organisations. Although, inevitably, the local authority always tends to be the focus of concern, neither the health service nor the police covered themselves in glory. I am not really in a position to commit the Opposition in exactly the way that my noble friend wants, but if the noble Earl would like to institute some urgent cross-party discussions with my noble friend, we would certainly be very happy to take part.
Earl Howe: My Lords, to start with a given, I am sure I speak for the whole Committee when I say that we are all committed to taking whatever steps are necessary to protect children from abuse and neglect. Clauses 2 and 3 are, as they stand, based on long-standing policy intentions. They have real buy-in and support from those who will need to deliver them.
As regards children’s social care and wider children’s services, the difficulty with proceeding without delay in the direction that the noble Lord, Lord Warner, is advocating is that we do not yet have robust evidence on the impact of the potential burdens and risks of an extension of these duties. Moving to the use of a common identifier for the education and children’s social care sector would represent a substantial change.
In the discussions that I have had on this, I have been persuaded that it is only right that we fully understand and assess the impact before considering legislation.
However, I can give the noble Lord, Lord Warner, some hopeful news. I am pleased to inform him that the Department for Education has committed to undertake an evidence-gathering exercise to understand fully the impact of adopting a consistent identifier for these types of provision. That exercise is expected to report before the end of the year. I hope the noble Lord will understand that we would not want to pre-empt the outcome of that or make decisions now on behalf of Ministers in the next Government, who will wish to consider the evidence once it is available.
The amendment would also have the effect of creating a power to extend Clauses 2 and 3 to other public bodies where there was evidence that this would benefit the health and well-being or protection of children. I recognise and welcome the sentiment and reasoning behind the desire to extend the information-sharing duty under this Bill to encompass child protection issues. As I have already assured the noble Baroness, Lady Finlay, there are clear requirements on professionals to share information to protect children. I hope that reassurance is helpful.
Lord Elton: In fact, Reg Wells-Pestell, not Goronwy Roberts, was the Minister. I want to get that right for anyone who is old enough to remember and reads Hansard.
Lord Ribeiro: My Lords, the amendment tabled by the noble Lord, Lord Warner, seeks to extend the use of the NHS number to services that benefit children, particularly those in social care, and which protect them from abuse. The Minister addressed the amendments in some detail and I was pleased to hear the assurances he gave, which I hope will have an effect. But I also note that the noble Lord, Lord Warner, was pretty impartial in his criticism of both Front Benches, and the suggestion that they come together and provide some movement is something that perhaps could happen when we have the report from the Department for Education at the end of the year. I will leave it to the noble Lord to decide. He has already intimated that he will not be pressing his amendment.
Lord Warner: I just want to register something with the Minister. I am grateful for what he had to say, but the whole issue of trying to make progress in this area is littered with attempts at reviewing the information that is available on making the world a better place. As the noble Lord opposite has reminded us, we have to go back 40 years for the first really serious child abuse scandal, involving Maria Colwell, which came to light. Since then it has been 40 years of agencies, in case after bad case, failing to share information that would have saved a child’s life. As I said, 12 years ago the noble Lord, Lord Laming, said his piece on one of those cases and made it very clear that a common database was required, with a linked identifier.
It is no good the Department for Education crawling all over the ground again and finding 27 reasons why we should not do anything. We need some action.
There is plenty of evidence about why a common identifier would make things a lot safer for children. They are pretty much the same arguments that you would use in relation to adults; they are not fundamentally different. The Government and the Opposition Front Bench need to understand what is going on around the country—it is happening in Birmingham—where the agencies are coming together in multiagency safeguarding hubs. But when they come together, they find that their data systems cannot talk to each other, even if they are in the same room, because there is no easy linkage between the different databases.
If we wish to make kids safe, we have to progress this issue quickly. Frankly, I am not wildly reassured by a DfE review by the end of this year in an area that is littered with information about the need to make progress. It is not just me; I think that many of those hard-working professionals I have talked about cannot see why the government bureaucracy—whoever is in government—cannot make some progress in this area. Having got that off my chest, I beg leave to withdraw the amendment.
Clause 5: Objectives in relation to the regulation of health and social care professions
Baroness Finlay of Llandaff: My Lords, I will also address Amendment 10 in my name. Amendment 9 seeks to ask how a regulator can, through its fitness to practise panels, judge well-being. I can see how health and safety can be judged objectively but well-being is a subjective judgment and it is very difficult to dispute a person’s view of a professional’s action having adversely impacted on their well-being. I have a concern that, as a sole criterion, it could be used in a vexatious way where there are other issues that somebody wishes to address against a professional, perhaps at a personal level, rather than it being focused on their professional conduct.
Amendment 10 seeks clarification of the prioritisation of the issues to be considered by fitness to practise panels. Such panels should not assess public confidence on the basis of purely personal condemnation of a person or the media’s response to what has happened—the so-called trial by media.
1.45 pm
If progress towards remediation was discounted without the clarification that I seek, it would not appear just. There would be a danger that panels felt biased towards punishing a professional who did not pose a risk to the public on the basis of what might subsequently be said in the media and on what had already been said.
I am concerned that the new paragraph could inhibit valid, open criticism for fear on the part of a regulator of decreasing public confidence in the profession. That might be particularly so in today’s climate, where we are striving to be open, transparent and candid with disclosure of problems.
There is a tension here: to maintain the confidence of the public might mean not being as open and transparent about all the variables, all the unknowns and all the risks that exist in the provision of health and social care, particularly in the provision of complex healthcare. The Bill is trying to address those very issues and, I hope, to be realistic. I hope that the Minister will be able to give me some clarification on both these issues.
Baroness Pitkeathley (Lab): My Lords, I thank the noble Baroness, Lady Finlay, for tabling these amendments to Clause 5 and for her characteristically clear introduction. As noble Lords may remember from Second Reading, I, too have concerns about Clause 5 in my role as chair of the Professional Standards Authority. I said then that there had been a misunderstanding of the role of the authority and that I was afraid that the Bill would make our objectives unclear and narrow the scope of our work. I was also concerned lest the Bill would in any way make it less clear that the primary and overarching role of the Professional Standards Authority is public protection. The Minister said then that his officials were happy to continue discussions, and I am pleased to say that there have been helpful conversations and meetings with the noble Lord promoting the Bill, the Minister and his officials. I am grateful for the care and attention that have been given to our concerns.
None the less, I take the opportunity that the noble Baroness’s amendment gives me to ask the Minister again to clarify that the Professional Standards Authority will never be required to prioritise the objective of promoting public confidence in the professions over its primary purpose of protecting and promoting the health, safety and well-being of patients, service users and other members of the public. In other words, could there ever be circumstances in which public confidence might conflict with public health, safety and well-being? Such circumstances might be where the authority identified a poorly performing regulator. If the Minister could give me this clarification, it would help the authority address any arguments that might in future be raised that it should conceal a regulator’s poor performance or otherwise prioritise the objective in new paragraph (b) over that in new paragraph (a).
The confusion about the hierarchy between the objectives in new paragraphs (a) and (b) may have arisen because of the conflation of the PSA’s role with that of the regulators which it oversees. It may have arisen also because Clause 5 does not follow the Law Commission’s recommendation, which proposed a clear main objective for the authority followed by two general objectives. Although the Minister has acknowledged the role of the authority as an overseer of the regulators, it would be helpful if he could provide an assurance that under Clause 5 the main and primary aim and
focus of the authority will continue to be to promote the health, safety and well-being of patients, service users and other members of the public.
Lord Hunt of Kings Heath: My Lords, some very important points have been raised by the noble Baroness, Lady Finlay, and my noble friend Lady Pitkeathley. My regret is that we are dealing with these regulatory matters in this Bill. A number of statutory instruments will also come through your Lordships’ House, one from the GMC, in the next few days.
We had a Law Commission draft Bill which should have been a fifth Session Bill and would have enabled your Lordships to look at the statutory regulation provisions in the round. However, because of the Government’s decision not to proceed with that Bill, not even in pre-legislative scrutiny, we now have to look at this matter in a piecemeal way. It is wholly unsatisfactory. I am very sorry that we are having to deal with these issues in this way without enough time to focus on them properly. I am worried about Clause 5; I think that we are going to let it through without understanding its implications. We would be very grateful for anything that the noble Earl can do to clear this up.
Earl Howe: My Lords, I very much hope that I can allay the concerns of both noble Baronesses and the noble Lord. In its report, the Law Commission recommended a consistent main objective for professional regulators and the PSA around patient safety. It also recommended two subsidiary objectives: maintaining confidence in the profession and proper professional standards and conduct. The Law Commission’s report describes this proposal as restating the existing legislative position that public protection is the regulators’ main objective. The Government’s view is that public protection is sufficiently important that it should be expressly adopted in the legislation.
The noble Baroness, Lady Pitkeathley, asked whether public confidence might conflict with public health, safety and well-being. In the example of the Professional Standards Authority identifying a poorly performing regulator, it is clear that the interests of public protection and public health, safety and well-being would require the PSA to take action. In this example, any argument that the objective of promoting and maintaining public confidence in the professions would require the PSA to conceal poor performance would clearly run counter to public protection. The objective of promoting and maintaining public confidence in the professions does not mean that the PSA or the regulatory bodies should be promoting the reputation of the professions generally. Rather, it is about taking action where there is a risk that confidence in the profession as a whole is undermined to the extent that it may deter people from seeking the treatment or care that they need and impact on public protection. This example highlights the fact that while the objectives are all linked to public protection, in practice they may not always necessarily be relevant, or relevant to the same extent in particular cases. It is not a case of one objective overriding another or preventing it being considered but ensuring that they are pursued only where they are relevant to public protection.
The Bill does not prioritise or weight one element of public protection over another. It is for the PSA to determine how it applies those elements in carrying out its functions in relation to the regulators and considering the issues of the case. My view is that health, safety and well-being will always be relevant to public protection when the PSA is carrying out its functions in relation to the regulators. It will be for the PSA to determine how to apply the objectives appropriately.
The noble Baroness asked whether the objective to promote and maintain public confidence might inadvertently lead the regulators to be less transparent in highlighting bad practice. Equally, that might lead to regulatory committees and panels punishing professionals who do not pose any threat to the public. If the actions of a doctor appear likely to reduce confidence in the medical profession and influence the decision of individuals as to whether to seek medical help at all, it may be right to take action. However, panels and committees will be asked to reach their own objective judgment as to whether particular acts or omissions would affect public confidence if no action were taken. A subjective view, uncritically influenced by public opinion or the media, would be an unacceptable basis for a decision.
Turning to the term “well-being”, the BMA has raised concerns with my ministerial colleague Dr Dan Poulter about how it would be interpreted by fitness to practise panels and committees. Well-being has been a long-standing and established feature of the legislation for three of the regulators. It encompasses those aspects of a professional’s role that may have an impact on individual patients but not directly impact on their health or safety. Dignity, compassion and respect are all important in delivering care, and it would not be right to disregard them.
It will be for the regulators to formulate and issue guidance for fitness to practise panels on interpreting and applying the objectives in practice, including the term well-being. The legislation makes clear that those objectives are considered only under the umbrella of public protection.
My officials will draw the regulators’ attention to those concerns should the overarching objective become law. That is in order to inform any guidance that will be needed to implement both this Bill and the secondary legislation for the GMC.
The noble Baroness, Lady Finlay, also asked about how we view the definition of “public” in the Bill. It of course includes patients and service users, as well as other parts of the collective public. I hope that that reassures the noble Baroness that the objectives in relation to well-being and public confidence will not be pursued outside the regulators’ objective to protect the public.
Lord Ribeiro: In following the Minister, perhaps I may deal, first, with “well-being”. At paragraph 3.20, the Law Commission’s report states:
“We disagree with the criticism of ‘well-being’. This term has already been incorporated without difficulty into the main duties or objectives of many of the regulators”.
Within that context, it feels strongly that that term cannot be misinterpreted.
The Bill introduces consistent objectives for the PSA and the regulators based on the proposals of the Law Commission’s review last year. Most of the professional regulators have some form of main objective. Although they are not consistently expressed they are generally to protect, promote and maintain the health and safety of the public. It is the health aspect with which the noble Baroness, Lady Pitkeathley, was particularly concerned at Second Reading. I think that that concern has been allayed today.
It is clear that public protection—by “public” I of course include patients—is sufficiently important that it should be adopted expressly in legislation. Defining public protection in terms of these three elements to be pursued by the regulators and the PSA as their overarching objective enables public protection to be considered in its fullest sense. That should give comfort and reassurance to the noble Baronesses who have spoken. With that, I hope that the noble Baroness will agree to withdraw the amendment.
Baroness Finlay of Llandaff: My Lords, I am most grateful to the noble Baroness, Lady Pitkeathley, for having expanded on and brought better definition to the points that I was trying to make on the amendments and for the clarification that we have had from the Minister and the noble Lord, Lord Ribeiro. I therefore beg leave to withdraw the amendment.
Bill reported without amendment.
Health Service Commissioner for England (Complaint Handling) Bill
Second Reading
1.59 pm
Moved by Baroness Finlay of Llandaff
That the Bill be read a second time.
Baroness Finlay of Llandaff (CB): My Lords, I should like to express my gratitude to the right honourable Member David Davis, MP for Haltemprice and Howden, for inviting me to sponsor his Private Member’s Bill in this House. The Bill has the support of the Government and the Opposition, as I understand it. As noble Lords may be aware, the Bill was motivated by the tragic death of Sam Morrish and subsequent events. Sam died of septic shock at the age of three, on
23 December 2010. In June 2014, the health service ombudsman published a report on an investigation into a complaint made by Mr and Mrs Morrish about the care and treatment provided to their son Sam. Mr and Mrs Morrish also complained about the way in which the NHS investigated the circumstances surrounding Sam’s death.
Sam Morrish and his family came into contact with a number of NHS organisations in the days before he died: the Cricketfield surgery, Devon Doctors Ltd, NHS Direct and the South Devon Healthcare NHS Foundation Trust. In her investigation, the ombudsman found that each of these organisations had in some way failed Sam. In the ombudsman’s report into Sam’s death, Dame Julie Mellor, the health service ombudsman makes reference to her report on sepsis, Time to Act—Severe Sepsis: Rapid Diagnosis and Treatment Saves Lives. This report highlighted the lack of action being taken to save the lives of people with sepsis because a failure rapidly to diagnose and treat can have tragic consequences. Indeed, the tragedy is that the ombudsman found that had Sam received appropriate care and treatment, he would have survived.
However, it took the ombudsman more than two years to investigate and report on the NHS’s handling of Sam’s case. During that time there was a series of factual errors, which Mr and Mrs Morrish repeatedly had to correct. The Patients Association, which supported the Morrish family in its complaints, said that the ombudsman was not fit for purpose. Dame Julie personally apologised to the family and offered to meet to discuss the case. Importantly for this Bill, she said:
“We took too long to investigate this case and made errors in the draft report. I recognise the family’s experience of us has contributed to their distress”.
I agree. Any unreasonable delay in investigating cases adds to the distress of those involved. As David Davis explained in the other place, delay impacts adversely on those grieving and also means that it takes more time to act to correct failings. Reducing unnecessary delay in investigating cases also reduces the distress of those involved, and the Bill seeks to do just that.
This is a simple Bill. Clause 1 is the important part. In summary, it makes provision about the handling of complaints by the Health Service Commissioner for England, which is the legal name for the health service ombudsman. It requires the ombudsman to notify a person making a complaint of the reason for the delay if the investigation of the complaint is not concluded within a 12-month period, and to include in her annual report to Parliament details of how long investigations of complaints have taken to be concluded and action taken, with a view to concluding all investigations within a 12-month period.
As noble Lords will be aware, the health service ombudsman carries out independent investigations about unfair, improper or poor service by the NHS in England. This is the second and final stage of the NHS complaints process. The ombudsman is independent of government and accountable directly to Parliament through the Public Administration Select Committee. She annually lays before each House of Parliament a general report on the performance of her functions. Having looked at her annual reports, I commend
Dame Julie for modernising the way that her office works. In challenging circumstances, and across both its parliamentary and health service functions, she has increased the number of cases investigated from 421 in 2011-12 and 384 in 2012-13, to 2,199 in 2013-14, with that figure expected to rise further in 2014-15.
The majority of complaints are reviewed and assessed with strong judgment and in a timely fashion, but certain high-profile cases, particularly that of Sam Morrish, suggest that the ombudsman might benefit from legislative backing to reduce the number of investigations that take longer than 12 months to complete.
I am glad to see the noble Lord, Lord Colwyn, in his place. It is worth noting that concern over NHS complaints is long-standing. Some years ago, he introduced a Bill to try to address this, long before the ombudsman was in place. It was also long before we had the excellent review of NHS hospitals’ complaints systems by the right honourable Ann Clwyd MP and Professor Tricia Hart. They made a number of recommendations to improve the way NHS complaints are handled. I know that from her loss Ann Clwyd MP has put her heart and soul into trying to tackle the system and to raise awareness of the right way to complain about the NHS and the right of people to make such complaints. It is important for all involved in the NHS complaints process to get it right at every stage.
Likewise, when the ombudsman makes mistakes it is important that she takes an open and transparent approach both to the person making the complaint and to Parliament through the Public Administration Committee. In Committee in another place, Bernard Jenkin, who chairs the Public Administration Committee, gave his support to the Bill. He stated that it was important for his committee to see cases that had gone wrong. He referred to the wider programme of public service ombudsman reform taking place. Last year, the committee produced the report Time for a People’s Ombudsman Service, and I understand that the Cabinet Office is conducting a review into the reform of ombudsmen.
The Bill is therefore deliberately limited in its aims. It seeks to make small but important changes to the way the health service ombudsman operates. It recognises that a future Administration will determine how to proceed on wider, more general reform, while acknowledging that some changes made in the shorter term will significantly improve the experience of people taking their complaints to the health service ombudsman and better enable Parliament to hold the ombudsman to account. I thank David Davis MP for introducing this important Private Member’s Bill. I feel quite honoured to have been asked to do this, particularly because I know in some depth about the inquiry that Ann Clwyd MP conducted. I beg to move.
2.07 pm
Baroness Hayter of Kentish Town (Lab): My Lords, I congratulate the noble Baroness, Lady Finlay, on bringing the Bill to the House. I welcome it and the changes, which she outlined, that the ombudsman has
already been making internally. I shall comment on the general complaints environment within which this falls.
As we know, public service delivery has become much more complex since the office of the ombudsman was established nearly 50 years ago. Many services are now delivered through a combination of public, private and third-sector providers, particularly in health and social care, where the boundaries between treatment and care and between providers are becoming blurred. Indeed, consumers often do not know whether they are patients or service users, who is providing the care, who has responsibility for the handover between health and social care when things go wrong or even whether their local authority retains responsibility for a care service provided by an independent organisation, albeit funded by the authority. Incidentally, the answer to the latter question is yes, the local authority retains responsibility.
Are we surprised when users or their families are confused about whom to complain to in the first instance or to which ombudsman to appeal should matters not be resolved? Social care is dealt with by the Local Government Ombudsman whereas health is dealt with by the Parliamentary and Health Service Ombudsman. The Public Administration Select Committee in the other place has helpfully explored these challenges. In April last year, it published a report whose very title tells a tale: Time for a People’s Ombudsman Service. It recommended the creation of a new, unified public ombudsman, which the current Parliamentary and Health Service Ombudsman and the Local Government Ombudsman welcomed. Those two ombudsmen—actually, women in both cases, which is perhaps why they co-operate so well—share the Select Committee’s ambitious vision for reforming the landscape.
A unified ombudsman would provide a streamlined and seamless service for users, covering all public services delivered both locally and nationally in England, and all the UK non-devolved services. That is an exciting possibility, which could not only empower consumers, but also—by the gathering of all complaint data—enable trends and persistent faults and shortcomings to be identified, so that preventive rather than just restitutive action can often be taken.
The Government have commissioned Robert Gordon to carry out a review of the ombudsman landscape in the light of this report, and I look forward to reading his recommendations. Can the Minister tell the House when he anticipates receiving that report, and whether the Government favour the Select Committee’s approach?
There is a real impetus for change, which could benefit consumers as well as the health service and social care. I hope I might be in a position to urge a new Labour Government to consider legislation to create a modern, single public ombudsman service. Failing that, however, I will be back, urging the Minister to do so, for the sake of citizens but also to achieve better value for money.
2.11 pm
Lord Hunt of Kings Heath (Lab): My Lords, the Opposition support the Bill and we are very grateful to the noble Baroness, Lady Finlay, for sponsoring it
in your Lordships’ House. Obviously, it is important that investigations are completed as quickly as possible and that those who complain are kept fully informed of their complaints.
My noble friend Lady Hayter raised a very interesting question about the landscape, as she described it, of the ombudsmen. She was so right to talk about the complexity of health and social care provision. It is clear that there is a general movement towards integration of health and social care, as regards both service provision but also governance—the Manchester example last week is but one example of that. It would therefore be interesting to hear what the Government think about whether we should have a more integrated approach to the role of the ombudsmen.
I also wanted to raise again with the noble Earl the report of the Morecambe Bay investigation, on which he reported to the House last week. He will know that there was criticism of the Parliamentary and Health Service Ombudsman in that report. That was with regard to a complaint from James Titcombe, the father of Joshua, who died in 2008 as a result of an infection that was missed for almost 24 hours despite clear signs. A series of failed communications followed between the Parliamentary and Health Service Ombudsman and the CQC, and, more significantly, within the CQC itself. That led the parliamentary ombudsman to believe that the CQC would take robust action and that a parliamentary ombudsman investigation of the complaint would add nothing significant.
I would be interested to know whether the noble Earl thinks that the ombudsman’s office has learnt lessons from what happened there, and—it is entirely within the context of the Bill—whether he is satisfied that currently and in the future there will be a much more integrated approach between the health ombudsman and the CQC, as well as, of course, in areas where you have an integrated health and care service for the local ombudsman, to take the point my noble friend raises.
2.14 pm
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con): My Lords, I very much welcome the debate on this important Bill. I thank my right honourable friend in another place, David Davis, and the noble Baroness, Lady Finlay, for their stewardship of the Bill, which makes the health service ombudsman more accountable to people taking their complaints to her and, more generally, to Parliament. A productive debate was had in the other place, with support for the Bill from all sides. Speaking for the Government, I hope that we can get the Bill on to the statute book as soon as possible, although I understand that parliamentary time is limited.
The Government very much support the principles that lie behind the Bill. It is a good Bill, and an important one. We are committed to continuing to improve the way in which complaints are handled across the health and social care systems and are actively encouraging the NHS to be more open and receptive to complaints. We remain committed to putting patients first.
Rightly, our focus on giving patients a stronger voice, coupled with reviews such as those by Sir Robert Francis QC and Ann Clwyd MP with Professor Tricia Hart,
have raised people’s awareness of their right to complain. If someone is dissatisfied with the NHS services that they have received, it must be right for them to expect that their complaint will be investigated efficiently and effectively. The health service ombudsman investigates, and makes final adjudications on, complaints that individuals have been treated unfairly or have received poor service from the NHS in England. She is the second, independent stage of the NHS complaints arrangements, being independent of both government and the NHS, accountable directly to Parliament. An efficient ombudsman service is therefore vital if we are to deliver the effective complaints service to which NHS patients are entitled.
In response to the noble Baroness, Lady Hayter, and the noble Lord, Lord Hunt, who asked about the prospects for having a more unified and integrated ombudsman service, I would add that the Cabinet Office is reviewing way in which the public services ombudsmen currently operate. We take complaints about the public services, including the NHS, very seriously. We consider that there is a continuing need to improve the handling of these complaints—in particular, to use information obtained from them to improve service delivery. As part of that work, we have been looking at reform of the public services ombudsmen. Noble Lords will be aware that Robert Gordon, a former director-general in the Scottish Government, has been asked to undertake this review, and the Cabinet Office is hoping to go out to consultation on reform before the end of this Parliament.
Dame Julie Mellor, the Parliamentary and Health Service Ombudsman, has transformed the way her office works. The noble Baroness, Lady Finlay, was absolutely right about that. The circumstances have been challenging, but she has done a good job. There is more openness and transparency in how the office works. The number of complaints investigated by her office has recently greatly increased, and we expect a further rise to be recorded in her 2014-15 annual report. Complaints are generally efficiently reviewed and assessed in a timely manner.
However, certain cases suggest that the ombudsman might benefit from legislative reinforcement in the difficult task of working towards further improvement. The noble Baroness has made reference to the Sam Morrish case. I shall not repeat what she has said; suffice it to say that the family’s experience of the NHS fell well below, and tragically below, an acceptable standard and, unfortunately, so, too, did their experience of taking their complaint to the health service ombudsman. Dame Julie rightly apologised to Mr and Mrs Morrish. In answer to the noble Lord, Lord Hunt, I think lessons have been learnt from that case. At the
very least, I hope that the health service ombudsman would consider carefully and learn from the Morecambe Bay report where appropriate. It is not possible for me to say more than that; as noble Lords are aware, the ombudsman is independent of government, and it would not be proper for me to do so.
It is still true to say that any unnecessary delay in investigating cases adds to the distress of those involved. NHS complaints often raise personal or sensitive issues. It is important to respond to the person making the complaint as quickly as possible. Reducing unnecessary delay in completing the investigation of a case will reduce the distress of those involved. However, where there are considerable delays of more than 12 months, even if seemingly unavoidable, it is surely right for individual complainants to be told why an investigation has taken so long to conclude. We also think it right for Parliament to be informed, in the ombudsman’s annual report, of how many complainants are kept waiting longer than 12 months for their case to be concluded and, equally importantly, the action being taken to reduce that number.
In summary, this Bill will improve the accountability of the Health Service Commissioner for England to people making a complaint, and to Parliament. The Government fully support these aims, and we fully support the Bill.
2.20 pm
Baroness Finlay of Llandaff: My Lords, I thank all noble Lords who have taken part in this short but important debate. I appreciate the support of all noble Lords who have spoken.
This is a simple Bill that seeks to reduce unnecessary delay in investigating cases and, in so doing, reduce the distress of those making a complaint to the health service ombudsman. I have corresponded with Mr Morrish and am aware that he gains comfort from knowing that this issue is being addressed.
I thank everyone involved with the Bill, particularly David Davis MP, who originally brought it forward.
Bill read a second time and committed to a Committee of the Whole House.