Yesterday also saw the first discussion of the role of HealthWatch during the Committee Stage of the Health and Social Care Bill.  HealthWatch is the proposed new structure to represent the interests of patients and the public in the new NHS.  It is potentially hugely important, as patients will need a strong voice to protect their interests.  However, the Government is proposing that the national body, HealthWatch England, should be constituted as a sub-committee of the regulator, the Care Quality Commission, and that local HealthWatch organisations should be run by local authorities (even though they will be responsible for some of the social care services that HealthWatch will be monitoring) without any protection of their budgets.

This is what I said on the subject:

“My Lords, I apologise to my noble friend Lord Patel if he in any sense felt beaten up by me. I absolve my noble friend Lady Wheeler from any involvement in that process. I also apologise to the long-suffering officials in the Government Whips Office. If my robust style is mistaken, they should really see what I am like when I am angry.*

I added my name to a number of amendments in the various versions of this group. I also proposed Amendment 305. If the noble Baroness whom I believe is replying to this debate is planning to highlight any technical flaws in that amendment, I should point out that I drafted it myself. Therefore, it no doubt does contain a number of technical flaws. But the purpose of the amendment is to assess the feeling within the House and the strength of feeling in the department about the extent to which it is important that HealthWatch England and healthwatch organisations at local level should be independent.

The principle underlying this group of amendments is straightforward-the centrality of the voices of patients and users in the NHS. That voice must be, and must be seen to be, independent of the various provider and regulatory interests. That is what underpins all of the different amendments.

I find it difficult to understand how the Government will oppose the amendments. They keep telling us that the voice of the patient and the user will be central to all these arrangements. They say that that is their intention. But they must be aware, because everybody else is, of the cynicism and doubt that is being expressed around the country about this whole package of NHS changes. Therefore, they should be able to reassure patients and users that their voices will be heard at every level within this complicated restructuring that will take place. That is extremely important.

What is more, it will be important for that voice to be seen to be independent. Members of the public will be concerned about what is happening. They will worry whether their doctors, who that they do not fully understand as being part of commissioning groups, will somehow be making judgments about their care, influenced by financial interests. They will want to be assured that they can go somewhere for proper advice and support, and that that place will genuinely be independent of all of those interests.

A huge expectation is now being placed on local healthwatch organisations. They are expected to provide that independent advice and information, to be able to monitor the nature of the service at local level and to be able to comment on the various changes that are taking place and on the proposals that are coming from the plethora of commissioning groups, senates and goodness knows what else we are going to have. They are going to be there to make recommendations. So, there will be enormous expectations on behalf of the public as to what these groups are going to do. Similarly, the national body, HealthWatch England, will have enormous expectations upon it. That is why it is so important to get these arrangements right. The

proposals for HealthWatch England and local healthwatch are an advance on what we have at present in terms of LINks. There is no question about that-they are a step forward. The record of successive Ministers and Governments in terms of patient representation in the NHS is not very good. This is a step forward from where we are at the moment. So, let us try to get it right. Why not deal with what are comparatively small issues in terms of how the system works?

The trouble is that, at the moment, the arrangements that the Government are proposing are flawed in two key respects: first, on the issue of independence, as the noble Lord, Lord Patel, has already indicated; and secondly, in terms of the resources available. Let us consider for a moment the position of HealthWatch England as a sub-committee of the Care Quality Commission. That might be a very neat way of not increasing the number of quangos by one; it may be that was the sole motivating feature. However, the reality is that it dangerously compromises the independence that I talked about as being so important. Often, HealthWatch England will have to say, on behalf of local healthwatch organisations, that the regulator should be doing something, has failed to do something or has been inadequate in the way that it has done that. In the last few weeks, we have seen the Minister’s colleagues in the Department of Health making quite critical comments about the way in which the CQC has fulfilled its remit. If Ministers are saying that-and Ministers are, after all, the paymasters of the CQC-what is it going to be like for those people whose remit is to raise these issues but are themselves subordinate to that regulatory body? It is going to be a real conflict and a very difficult position for them. The nature of that relationship-the fact that they are a mere sub-committee and are subjected to all of the panoply of arrangements that go with that-is going to be seriously limiting.

I am aware that the CQC is making enormous efforts to try and demonstrate their good faith in all of this. I am sure that the individuals involved have good faith as far as this is concerned. However, we are here considering legislation that will set those arrangements. Once those arrangements are set, the good will of the individuals who may be trying to make it work at the moment may not persist-not because those individuals will change their minds, but because, over time, those individuals will move on and others will take their place. Budgetary and other pressures on the CQC will rise. The feeling that they do not like being criticised by a body that is technically subordinate to them will increase. That is why that arrangement does not work.

There is an even stronger argument as to why local healthwatch organisations should not be subordinate to principal local authorities in their area. The Government’s flaws here are flaws twice over. Not only are they imperilling the independence of local healthwatch organisations by saying that-even though they are supposed to be independent-they are creatures of the local authority, the funds will be provided by the local authority and many of the facilities may well be provided by local authority but, because the funds will not be ring-fenced, it will be far too easy for local authorities to start to apply the screws if they do not like the criticisms that come from it.

A major conflict of interest is being created. HealthWatch cannot be accountable to, and at the same time funded by, local authorities because the bodies which commission and provide the services are the local authorities in many instances. However, the Government are saying that HealthWatch can advise members of the public about those services. How can HealthWatch organisations be funded by the same bodies that are commissioning and providing those services? This is precisely the area where the confidence of members of the public and of individual patients is so important. They have to go for advice to a body which is funded by the people about whom they wish to take advice. That hardly looks independent or satisfactory. If HealthWatch is made accountable to local authorities as the Bill proposes, the public will, frankly, have no confidence in that and all the efforts that the Department of Health and the Government have made to try to create a better structure will be wasted. That resource will be wasted because the public will not have confidence in these arrangements.

There is also a failure to protect the funding. I do not know how many hot coals Ministers in the Department of Health had to crawl over to get £60 million out of the Treasury for HealthWatch. I am not suggesting that the Department for Communities and Local Government is any more evil than any other government department, but if you hand the funding to that department, which then hands it on to individual local authorities without a label saying, “Not only is this money to be used for HealthWatch but it cannot be used for anything else”, my experience as a former council leader tells me that you cannot guarantee that the money will be used for the purpose that you wish.

I spoke earlier about localism and said how wonderful it was that the Government should devolve responsibility for this issue. However, it is not a wonderful example of localism if you expect something to happen, you pass the money on and then you are shocked if the money is not used for that purpose. If you want the money to be used for a particular purpose, you have to label it and ring-fence it. However, the Government will not do that. They say that they cannot do that as it would be inappropriate in the spirit of localism.

I have received numerous e-mails and messages from LINks on this very subject. Their experience of not having ring-fenced budgets this year is salutary. One message states:

“As a LINk our funding was reduced by the local authority by 65 per cent this year”.

Another states:

“I have spent 30 years as a senior business professional and business consultant and it is ludicrous to set an organisation targets to be funded by set criteria and then reduce those funds by 65 per cent. This makes a mockery of the organisation’s ability to carry out its public remit”.

That is what is happening at the moment. What guarantees can the Government give that it will not happen in the future?

There is a technical point here. The Department of Health has presumably secured these funds through the comprehensive spending review. Who will own those funds the next time that the comprehensive spending review is negotiated? Will it be the Department

of Health or the Department for Communities and Local Government? If it is the Department for Communities and Local Government, how will it rank given its other priorities which have nothing to do with HealthWatch? If it is the Department of Health, how will it answer the question from the Treasury, “How do you know that this money is being spent in the way that you intend?”. It will not be able to answer that question, as I suspect that the correct answer is that the money will disappear. LINks already have huge concerns about the resources question.

The other element of this concerns what sort of patient representative mechanism we want. Do we want something which is top-down or something which comes from local organisations? The amendment that stands in my name seeks to establish an arrangement whereby local healthwatch organisations have ownership of the national body which speaks in their name. I believe that that is essential. Even if you created HealthWatch England as an independent structure without the problems of it being a tool of the regulator, you will still not get the necessary buy-in at local level unless local organisations feel that they are part of it and have a say in its organisation. I speak as someone who was director of the Association of Community Health Councils for England and Wales for 12 years, and I know how important it was for the member organisations to feel that what we were saying as the national body reflected-not to the letter, but reflected-what they felt was important as local organisations. If you do not have that mechanism, if you do not have that process built into the legislation, I am afraid that you will create a gulf between the national body and the local bodies. That is surely unsatisfactory.

The Government’s proposals could make an enormous difference to patient representation in the new NHS, and patient representation is going to be enormously important in the new structure, because I think that many patients will feel disempowered and worried by what is happening. However, those arrangements are flawed unless the Government accept the spirit of the amendments in this group-and unless they accept that HealthWatch, both nationally and locally, should be independent, and that resources should be clearly ring-fenced and clearly identified and cannot be used by bodies that have no interest, necessarily, in patient representation used for other purposes.”

*This relates to a procedural manoeuvre instigated by the Government late the day before that I thwarted.

Yesterday was the seventh day of the Committee Stage of the health and Social Care Bill.  In theory this should be the half-way point of the discussions, but the Committee has only got up to Clause 20 and there are another 323 Clauses to go.

One of the debates yesterday centred on the “mandate” (crazy word, crazy Bill) that the Secretary of State will give to the National Commissioning Board (this is the biggest quango in the known universe and it will effectively run the NHS).  The “mandate” is essentially the Government’s instructions to the Board, but as they are claiming that they are giving away all responsibilities to the Board (and thereby absolving Ministers from taking responsibility for what happens to the NHS as the budget is cut) the content of this “mandate” is really rather important.  How detailed will it be and will it be subject to proper Parliamentary scrutiny?

I am afraid the Government’s attitude brought out the normally-hidden (!) cynic in me:

“My Lords, I confess that I am something of a cynic about some of the proposals in the Bill. I am a great believer in the principle of localism, the local determination of services and local decision-making. Therefore, in principle I would applaud any Government-even this Government-who desire to devolve responsibility for various things to local authorities and, in this case, local commissioning groups.

However, my cynicism kicks in because what I suspect is happening here-I suspect that it will happen in other service areas-is that Ministers are cynically saying, “We are leaving these responsibilities to you, the local bodies concerned. We are very happy for you to make all these decisions. The snag is that we will not provide you with the resources to meet all the expectations that the public, who rely on those services, might legitimately have hoped to be provided. However, we are not taking these decisions. We will not be involved. It is a matter for local determination”. To be honest, I think that is what underpins much of the localism, devolution or autonomy agenda that we are seeing.

However, the experience of all previous experiments of localism is that while Ministers say, “Yes, this is a wonderful idea. We want to do it”, pressure starts to be applied to particular things. They want to have a mechanism whereby they can say, “It is, of course, your decision. However, we want you to make sure that these things happen”. Gradually, the list of the things that must happen gets longer and longer and the list of areas of discretion gets shorter and shorter.

When I saw the proposal for a mandate to be in the Bill, I thought that that was the mechanism whereby on the one hand Ministers will proclaim that they have no involvement in these decisions and say that they are all local decisions, but on the other hand this will enable them to ensure that certain things still happen because they are being subjected, as elected politicians, to pressure to make sure that they happen. That is why the amendment of my noble friend Lord Warner, which would restrict the extent to which this could be done, is very important. If we do not have an amendment of that sort in the Bill, I can tell you now what will happen; every single pressure group, voluntary organisation and lobby will say, “We want included in the mandate”, which is being issued to the national Commissioning Board, “the following service. We will want to see it there.”

For any sensible Minister the simple answer to all this is to write an extremely long mandate that covers all those points rather than sticks to them. If they were

obliged to be limited to just five or six or another small number of issues, that would be extremely salutary. It would stop the creep that would happen. However, I suspect that the Government are not going to say suddenly, “My goodness, the noble Lord, Lord Warner, has come up with an excellent idea. Why didn’t we think of that? We must accept it, of course”, because unfortunately that is not always the way in which government Ministers react. They will stick to the letter of the Bill without those specifications. They will say, “Well, why five? Why not 10? Why not 12? What about three?”. All these different things will be argued as an excuse for not doing it. You will then get the drift and the pressure to say that more and more things must be added.

Amendment 100A is so important because there must be parliamentary scrutiny of what is happening, because this will be the mechanism that drives decision-making in the NHS. It is not going to be a pure version of devolution, localism and autonomy; this is going to be done through the mandate. The mandate is then going to be the most important document that drives the NHS at any one moment. That is why parliamentary scrutiny is essential. Parliament must have the opportunity not just to see it and to know what is being done in the name of the public but to comment, amend, or put forward amendments and have the Government respond to them.

I therefore hope that when the Minister responds he will accept not only the principle of my noble friend Lord Warner’s amendment but the principle of detailed parliamentary involvement in this process in the amendment of my noble friend Lord Hunt of Kings Heath.”

The full debate is here.

 

I see that Ken Livingstone is planning to reverse Mayor Boris Johnson’s abolition of the Zone 2-6 Travelcard.  This is welcome news for the very many people who travel around London but have no need to go into the centre.

When this was announced last October, the BBC reported how this was a slap in the face for the Mayor’s core constituency of outer-Londoners:

“Day travelcard users on London’s Underground and buses face price hikes of up to 74% from 2011.

The Zone 2-6 Travelcard will be withdrawn meaning passengers wishing to continue using travelcards will have to buy a Zone 1-6 version instead.

This would mean a peak hours ticket rise from £8.60 to £15.

Tube bosses said they were simplifying fares, but watchdog London TravelWatch said outer London residents and tourists would be worst affected.

“We are very concerned that these inflation-busting fares will price people off public transport,” said Jo deBank from London TravelWatch.

“Everyone will be hit, but it appears that infrequent users, those in outer London and visitors and tourists will be hit particularly hard.”"

Even Andrew Gilligan in the Telegraph was moved to comment that this was one of:

“a series of unnoticed, but hugely above-inflation, fare rises in One Day Travelcards and Oyster price caps that will hit thousands of users with rises of up to 74 per cent.”

I wonder if he will be amongst those welcoming Ken Livingstone’s announcement.

Tonight the House of Lords debated the Protection of Freedoms Bill.  This was my contribution:

“My Lords, I declare an interest as a member of the Metropolitan Police Authority. I fear I may be spoiling the consensus that seems to have emerged as to what a wonderful Bill this is. This is a very grandiosely entitled Bill: “Protection of Freedoms”, no less. I am sure that when the title was chosen the Deputy Prime Minister had visions that, like the authors of the Magna Carta, seven centuries on, his creature would still be seen as a cornerstone of British liberties.

Frankly, he can dream on. This Bill is a mish-mash of ill-sorted provisions, a mish-mash without any overarching or underpinning philosophy and, worst of all, a mish-mash that will bring about unintended and damaging consequences. Balancing the civil liberties of the individual against the security of the state and the protection of the lives and well-being of other individuals is never an easy task and I wish that I could be confident that that balance has been appropriately struck in this Bill. Let us take, for example, Part 5, which makes major changes to the Safeguarding Vulnerable Groups Act. The noble Baroness, Lady Walmsley, who is not in her place, will remember the time spent in this House trying to ensure that children and vulnerable adults were properly protected against those who might harm them.

When we hear from organisations, such as Fair Play for Children, that this Bill introduces,

“elements of serious risk to children”,

we need to consider the points with very great care. The Government say that the arrangements under the 2006 Act were too complicated and onerous for those who had to implement them. Yet the people who will have to implement this Bill say that its provisions do not reduce or simplify the current system and that it runs the risk of sowing considerable confusion and unnecessary complexity.

There is no evidential basis for these changes. There is to be no pilot and what is being done throws away the broad cross-party consensus on which the previous legislation was based. A major concern lies in the proposed definition of what constitutes supervision in respect of affected activities. This remains worryingly vague. One suggestion is that the definition of supervision should be “line of sight”. This is so vague as to be frankly laughable and out of touch with daily realities. If the activity stays in one or perhaps two rooms and there are two staff or supervisors to monitor all volunteers, perhaps that would be possible. But in a multi-feature environment where there is outdoor activity, and in many other situations, it will be next to impossible for many organisations to provide that level of supervision. It will result in increased costs and/or a restricted number of activities, and, no doubt, fewer volunteers involved and fewer children benefiting.

In any event, supervision misses the point. The supervised activities of a volunteer are one thing but it is precisely during those activities that the trust of the child with that individual is created. It is that trust that makes possible unsupervised contact and the risks that that brings with that trust being exploited and betrayed. Of course, the risk of such exploitation and betrayal taking place during supervised activities can be reduced by good supervision. But what of the contact outside the supervised activity? The child now trusts that adult because they have encountered them in the supervised activity. But that trust is where the potential for abuse is created outside that secure environment.

That is an example of where the balance is being struck wrongly. It is based on the false belief that the bureaucracy involved is stifling volunteering. Fair Play for Children surveyed its member groups and found that more than half believe that the existing vetting arrangements have improved their overall practice. In only one instance in 200 did a group report that the arrangements had made it more difficult to recruit volunteers. Most parents will say that when they hand over their children they want the reassurance that the adults who their children will encounter have been properly vetted. Do the Government really want to put the rights of the potential paedophile above those of the child? That is just one part of an ill-thought-out Bill.

Part 4 reduces the maximum period of pre-charge detention for terrorist suspects from 28 to 14 days. The periods of detention longer than 14 days have been used extremely sparingly and are subject to judicial approval, which has not always been given. The Government, moreover, acknowledge that sometimes a longer period—up to 28 days—may be necessary, presumably because of the nature and complexity of some counterterrorism investigations.

If circumstances require it, it is proposed that the Home Secretary comes to Parliament to introduce emergency legislation to reinstate the longer detention power. That has to be nonsense. It means that during—I repeat, during—a terrorism investigation, the police and security services may have to ask Parliament to be recalled to debate an issue that it cannot discuss without prejudicing a future trial. The remarks made by the noble Lord, Lord Armstrong, are extremely pertinent on this point. Ministers recognise that 28 days may be necessary to investigate or avert a serious terrorist threat, but none the less intend to remove the power, even though there is no evidence that the power has ever been misused.

Part 2 adds to police bureaucracy, which is another example of extra expenditure being incurred as a result of pressure from the Daily Mail. It will make it more difficult for the police and local authorities to use CCTV to prevent and detect crime. This no doubt reflects concerns about a surveillance society, although when I was a local government leader my experience was that communities always—I repeat, always—welcomed the introduction of new CCTV schemes. If that concern about a surveillance society was so important, why are there no restrictions on the use of private CCTV cameras? I do not want to labour the point, but this oh-so-cleverly-worked-out Bill makes it more difficult and more expensive for our already overstretched police service to prevent crime but does nothing to restrict the proliferation of privatised surveillance.

Finally, Part 1 restricts the retention of DNA samples and profiles taken during a criminal investigation. This will make it harder, not easier, for the police to catch and convict dangerous criminals. The Home Office’s own research produced last year contradicts what this Bill will do. It showed that, each year, 23,000 people who will be taken off the database under these proposals will go on to commit further offences. Of these, 6,000 will commit serious crimes, including rape and murder.

Whose civil liberties are we protecting here? It will certainly not be those of anyone like Sally Anne Bowman who was 18 when she was murdered close to her home in south London in 2005. The police investigation initially drew a blank. But a year later, Mark Dixie, a pub chef, was arrested following a brawl in the pub where he worked. No further action was taken for that pub brawl but his DNA was taken and subsequently loaded on the database. It produced a match to the DNA evidence retrieved from the murder victim and within five hours he was under arrest. He was subsequently charged, convicted and sentenced to life imprisonment. So what are we doing removing the ability to protect people like Sally Anne Bowman? There are plenty of other such examples.

This Bill repeatedly gets the balance wrong. Of course, we should protect freedom. But why is it that the only freedoms that this Bill seems to care about are the freedoms of the would-be terrorist, the manipulative paedophile and the serial rapist?”

The House of Lords likes to talk about itself and this afternoon is no exception.

The House has been debating a series of (modest) amendments to its own procedures. First off is the idea that during Question Time the Lord Speaker should be allowed to arbitrate between the political groupings in the Chamber as to whose turn it is to ask a supplementary question.  This is regarded as revolutionary stuff.  At present the House itself decides by growling whose turn it is and, if there is still a conflict with two (or more) Peers trying to speak at the same time, the Leader of the House intervenes and arbitrates.  The Leader of the House is, of course, a Government Minister and to most people it might seem odd that he should decide who should ask a question of one of his Ministerial colleagues.  But that is the way it is at the moment and after more than an hour of debate, the House voted by 169 to 233 to retain the status quo.

The House did agree that Peers could refer to the House of Commons as the “House of Commons” rather than the “Other Place”, but the idea of simplifying the forms of address proved much more controversial.  At present, former senior judicial figures have to be referred to as “The Noble and Learned Lord”, Field Marshals or holders of the Victoria Cross as “The Noble and Gallant Lord”, and Bishops as “!The Right Reverend Prelate”.  It was suggested that “The Noble Lord” or “The Bishop of _____” might suffice.  After lengthy debate, the House divided with 173 in favour of the proposition and 173 against and the proposed simplification was declared “not carried”.

For the time being, procedural reform will  have to wait.

 

Earlier this evening I seconded an amendment to the Health and Social Care Bill which would have placed “a duty of candour” on those providing health services requiring them to disclose “full information to patients, their carers or representative about any incident or omission in or affecting their care which may have caused harm, or may in the future cause harm.”

My speech was as follows:

“Lord Harris of Haringey: My Lords, when I was director of the Association of Community Health Councils, the message from community health councils around the country was that people who complained were seeking not compensation from, or retribution against, those who had perhaps caused the reason for their complaint—for example, the death of a loved one—but information. They wanted to know what had happened, and they wanted some reassurance that what happened to them or their relatives would not happen again.

Always, the most tragic cases were those in which people had not known what had happened and discovered the actual circumstances only much later, perhaps when their relative’s case came to an inquest or, in some cases, even long after that. I would like to hope that, in the 10 years or so since I was director of the Association of Community Health Councils, this problem would have become less, but it remains a serious blemish on the health service that, too often, such mishaps are covered up.

In a case reported only three weeks ago—the most recent case that I have come across, but I am sure there are many others—a mother discovered long afterwards that the death of her seven year-old daughter, which she had blamed on herself for not being able to perform the necessary first aid, was actually the consequence of a failure by a paramedic called to the scene. She discovered that only ages afterwards when she became aware of the transcript of the inquiry which led to the paramedic being dismissed. That case, reported in the Doncaster Free Press only three weeks ago, is an indication of the sorts of incidents that one is talking about.

I met the family of someone who had died while detained in a secure mental health facility. They discovered the circumstances in which their loved one had died only when the matter was reported at an inquest. In such incidents, the health service officials knew what had happened and had conducted their own inquiries but did not think it necessary or appropriate to tell the families concerned. That is why it is so important to have this amendment, which would place a statutory duty of candour on the health service, to make it something that runs right the way through the system.

Of course, accidents can never be eradicated. Healthcare is of its very nature a risky business and health professionals are only human, so these things will happen. However, what is unforgiveable is that the fact that something has gone wrong is not told to those concerned. The noble Baroness, Lady Masham, quoted Sir Liam Donaldson, but I thought that she was also going to quote the maxim that he gave:

“To err is human, to cover up is unforgiveable”.

That is precisely the concern that motivates this amendment.

In the White Paper Equity and excellence: Liberating the NHS, the Government said that they will require hospitals to be “open and honest” when things go wrong. That stems directly, I think, from the Liberal Democrats’ manifesto commitment, but, unfortunately, their manifesto referred only to hospitals rather than to the wider health service. I think that the Liberal Democrats intended that such a duty should be statutory, but my understanding is that the Department of Health is looking at this as something that could be written into contracts. As the noble Baroness, Lady Masham, has pointed out, having a lesser status than a requirement to inform a central agency that something has gone wrong would mean a lesser status in terms of informing the family. It is really important that we look at this issue and take it seriously, so I hope that the noble Earl will accept the amendment.

In 2005, a National Audit Office report revealed that only 24 per cent of NHS trusts routinely informed patients of a patient safety incident—that implies that more than three-quarters of NHS trusts do not do so routinely—and 6 per cent admitted that they never informed patients of a patient safety incident. Quite clearly, there is a “culture of denial”. Noble Lords may think that that is rather an alarmist statement, but I am simply quoting from a Department of Health document from 2006.

Lord Mawhinney: My Lords, I am extremely grateful to the noble Lord for giving way. I do not want him to interpret my question as opposition to the general point that he is making, but before he finishes will he say a word about the role of lawyers of health service bodies in these circumstances? I am not a lawyer, as I have told the House before, but in both cases that he has cited I could see legal advisers saying, “Say nothing”. If we are to take this amendment seriously, we need to have some idea of what part the law might play if the Bill were to be so amended. As the noble Lord has experience, I would be grateful if he would reflect on that.

Lord Harris of Haringey: My Lords, the noble Lord, with all his experience—albeit, like me, as a non-lawyer—is speaking exactly the truth. In many of those cases, the legal advice would be, “Say nothing”. There therefore needs to be a statutory duty, because then the responsibility of the lawyers concerned would be to advise, “There is no option but to tell the patients or their families”.

An interesting point is that insurers in the United States often require open disclosure policies and practice by health providers to qualify for insurance. The international evidence is that, as well as being the right thing to do morally and ethically, being open and honest when things go wrong can actually reduce litigation and complaints.

My concern is that the Government will say that they are doing enough by saying that the duty of candour can be achieved through a contractual process. However, as the noble Baroness, Lady Masham, has pointed out, this would apply only to hospitals with an NHS contract; it would not apply to GPs, dentists, pharmacists or private healthcare providers. I do not see why the duty of candour to patients and their families should be regarded as of lesser importance and impact than those things where there is direct regulation. I hope that the Minister will say that the Department of Health will take this away and that he will come back to the House with proposals to give a statutory duty of candour to protect the interests of patients.”

After a debate of over 90 minutes, the Minister was not prepared to concede a statutory duty of candour although the Government is consulting on how they might make a “contractual” duty of candour work.

I am sure there will be more debate on this at the Report Stage of the Bill.

The Home Secretary’s statement on the UK Border Agency was repeated in the House of Lords by Lord Henley this afternoon.

My exchange with him was as follows:

“Lord Harris of Haringey: My Lords, is it not the case that Home Office Ministers frequently visit our border posts? In the circumstances, is it not surprising that they did not visit sites where these pilots were taking place—or if they did, that they did not notice or hear from the staff concerned how the pilots had been extended? Can the Minister also tell us what arrangements Ministers made to monitor the pilots and the way in which they were working?

Lord Henley: My Lords, speaking for myself, I have to say that I have not visited any of the pilots, but then I have not been in the Home Office for that long. No doubt I will make inquiries of my honourable and right honourable friends and let the noble Lord know what visits have been made. However, I believe that Ministers have visited ports and airports on quite a regular basis to see how these things operate. I certainly was intending to do that at some point in the near future, but when I will be able to manage that is another matter. Of course Ministers always want to evaluate any pilot schemes they put into place, whether by visits or by other means.”

So, it IS likely that Ministers will have visited the pilot sites and YES they will have been monitoring the pilots.

Eight days ago, the House of Lords adjourned in mid-debate on an amendment to the Health and Social Care Bill which would have restored the role of the Secretary of State for Health to “provide or secure the provision” of health services (which the Government’s Bill would have taken away).

Adjourning in mid-debate is a pretty rare (if not unique) procedure, but it has allowed for all sorts of last minute discussions to take place behind the scenes before the debate resumed this afternoon.

The original amendment was moved by Baroness Williams of Crosby (Shirley Williams as was) and was signed by Lord Patel (former President of the Royal College of Obstetricians), Baroness Glenys Thornton (Labour spokesperson on health in the Lords) and Baroness Margaret Jay (former Leader of the House).  Also debated at the same time was an amendment from Lord Mackay of Clashfern which talked more vaguely about the Secretary of State having “ultimate responsibility to Parliament for the provision of the health service”. 

In last week’s debate, I commented:

“I rise to speak to the amendment in the name of the noble Baroness, Lady Williams of Crosby, because this is an issue that requires greater clarity, and the debate and discussion that has already taken place in Committee this evening demonstrates why that is so. As my noble friend Lord Warner has reminded us, Professor Malcolm Grant, the newly appointed chair of the national NHS Commissioning Board, has made clear what appears to be the Government’s intention with regard to the role of the Secretary of State. I assume that he did so under advice, because you do not take on a role like the chair of the NHS Commissioning Board without extensive discussions with Ministers and civil servants. He must have been briefed on the matter and quite clearly the intention is to separate out the day-to-day responsibility and answerability of the Secretary of State. There has to be some clarity on this point. …

 I have some reservations about the wording used by the noble and learned Lord, Lord Mackay, in that he talks about ultimate responsibility. We may have an inkling about what ultimate responsibility means, but I wonder where else in legislation a phrase such as this is used. I defer of course to the noble and learned Lord’s far superior knowledge of the law. However, in my limited experience in this House, I have never before come across the words “holds ultimate responsibility to Parliament”. It seems a very strange usage and I think that there needs to be greater clarity and understanding about what it means. That is why it might be better to revert to the wording chosen by the noble Baroness, Lady Williams. It is tried and tested and at least we understand it.  …

The final test that your Lordships need to consider is: what do the public expect? The public’s expectation is that government is responsible for what happens in our health service; and unless there are locally elected officials who are responsible for what happens at a local level, they will expect their elected Government to be responsible, and that means the Secretary of State.”

The Government had indicated that they were prepared to accept the Mackay amendment – indeed eight days ago they announced that the amendment had been agreed, even though the debate had not been finished.  And Baroness Williams had also hinted in her speech that she might accept the “compromise” offered by Lord Mackay.

Labour Peers, however, were standing firm and had indicated that they would divide the House on the Williams amendment even if she tried to withdraw it in favour of the Mackay version.

The Government was clearly running scared and at the last minute – just as the debate resumed this afternoon – indicated that if both amendments were withdrawn they would consult all sections of the House to try and find a form of words that would be acceptable to everybody.

There followed forty-five minutes of debate when all sides of the House indulged in an orgy of mutual admiration on reaching a sensible way forward.

This orgy, however, began to go rather flat (if that is not an inappropriate metaphor) when the Minister, Earl Howe,  having promised further discussions then began to explain in some detail why the Government disapproved of the Williams amendment, saying:

“In future, all NHS services will be provided by NHS trusts or foundation trusts, both of which have their own self-standing powers to provide services and do not rely on the Secretary of State’s duty to provide under Section 1(2), or by independent providers. The Secretary of State will have no powers to provide NHS services. That is the reality.  …

There is another reason why it would be wrong to reinstate the duty on the Secretary of State to provide. Under the legal framework of the Bill, the Secretary of State no longer possesses powers to direct others to provide services. Therefore, unless we were to re-impose a system of regulations or directions by which the Secretary of State could delegate his duty to provide and control its exercise, which would risk replicating the micromanagement of the status quo, it is hard to see how this legal obligation to provide services could be fulfilled. For obvious reasons, it would be undesirable to create a situation in which the Secretary of State provided services himself. Also, in practice he would lack the capacity to do so, for example in terms of staff and facilities.”

At which point, the House began to become rather restive – the Minister seemed to be saying that there could only be more discussions provided the eventual wording still restricted the role of the Secretary fo State and the right of Parliament to scrutinise what was happening in the NHS.

So, Baroness Patricia Scotland interrupted:

“My Lords, I hesitate to intervene on the noble Earl, who knows I hold him in the highest possible esteem, but I think he is now treading on some contentious legal issues. Bearing in mind the wonderful consensus that we have now reached, I would just ask him to consider whether, at this stage, some of those issues are really helpful because the noble Earl will know that the Secretary of State does, by his servants, agents or otherwise, provide services and, indeed, there have been times when there has been a pandemic when the Secretary of State has had to make such provision. These are contentious issues which I am sure could intrigue us for many hours, but since we have happily come to the conclusion that we have had a surfeit of such happiness and wish to go forward, I gently say to the noble Earl that this might be a moment when we could swiftly do that.”

Then Baroness Glenys Thornton had a go:

“I respectfully say to the Minister that we could start the whole debate all over again if he continues telling us what the Government do or do not believe on this because that is presupposing, and possibly pre-empting, the discussions that we are about to have. The noble Lord may find it useful, but we have had a lot of this discussion. We have now, I thought, agreed to move into discussions outside the Chamber.”

The Minister kept reiterating that he thought it would be helpful to put on the record the Government’s position.

As he seemed to be preempting future discussions, I tried to get some clarity which elicited the following exchange:

“Lord Harris of Haringey: I appreciate that the noble Earl is moving to a position of not addressing those questions, but it is important that he tells the Committee whether the Government have a fixed mind on these matters or whether they are going to approach with an open mind the discussions that we, in an outbreak of consensus, have agreed should happen and try to build on that consensus. If the views are closed, it raises some very difficult issues for the Committee.

Earl Howe: No, my Lords, there are no closed views. That is the reason why I suggested earlier that it was time to reflect and engage in discussions in the spirit of co-operation. I would not have said that if I had had a closed mind to them. There would not have been any point in the discussions. I simply wished to do noble Lords the courtesy of answering their questions and addressing the points that they had made. If noble Lords would rather that I did not do that, then we can make life easier for ourselves. I will certainly write to noble Lords if they would like to inform me afterwards that they wish to receive a letter. If they do not, I will not write. It is entirely up to them. I do not wish to make work for myself unnecessarily.

I have said that I believe the balance of advantage for this Committee lies in our agreeing collectively not to amend the Bill at this stage and I am pleased that there seems to be consensus around that view. I believe instead that it would be profitable for me to engage with noble Lords in all parts of the House, both personally and with the help of my officials, between now and Report to try to reach consensus on these important matters. I would just say to my noble friend Lord Marks that that includes the issues that he has helpfully raised this afternoon. I believe that he is right to associate Clause 4 in particular with the matters that we have been considering. Those discussions can be carried out in an informal way with interested Peers or in individual meetings in the House or my department. There is a place for either type of discussion. My concern is only that it is an inclusive process involving Peers from all sides of the House, and that will include listening to the views of the Constitution Committee should it choose to continue its valuable role.

With that, I hope that no noble Lord will feel cheated by the brevity of my contribution and I shall sit down.”

So we’ve been promised discussions and a Government with an open mind.

We’ll just have to wait and see what transpires.

 

 

The Metropolitan Police Authority is in session and Deputy Mayor Kit Malthouse AM, Deputy MOPSY*-in-Waiting, is in the Chair.  He hastened to start the meeting by announcing that the Home Office is working towards the abolition of the MPA and its replacement by the new MOPSY structures on 16th January 2012 – just 123 days before the Olympics Torch arrives in the country, fifteen weeks before the London Mayoral elections, and ten months before the rest of the country elects its Police and Crime Commissioners.

The Deputy MOPSY-in-Waiting admitted that his detailed plans for how the new arrangements were going to work were still being developed, but he did promise that he would publish these soon for discussion. He asserted that he wanted the public to feel more engaged with policing issues under the new arrangements.  John (“not for me to be critical”) Biggs AM (a Labour member) was keen for there to be clear structures for this, which goaded Tony Arbour AM and Steve O’Connell AM (both Tory members) to assure the meeting that as elected Assembly Members they were fully engaged with all of their several hundred thousand constituents all of the time.

The Commissioner was keen to live up to his blunt-but-fair tough-guy “Hulk” image and announced that he was a HIT MAN (“My values are Humility, Integrity and Transparency” who wants to be open and accountable.

So that’s all right then.

 

* more properly MOPC – the Mayor’s Office of Policing and Crime

The first day of Committee stage consideration of the Government’s Health and Social Care Bill is taking place in the House of Lords today. 

To no-one’s surprise the LibDems again demonstrated that they are happy to place their loyalty to the Coalition with the Tories above the future of the National Health Service. 

They voted en masse to reject a Labour amendment which would have reaffirmed the basic principles of the NHS as the first clause of the Bill.

The amendment was to begin the Bill by stating:

“Principles of the Health Service in England

(1) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England must have regard to the principles and values outlined in the NHS Constitution.

(2) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England, or providing services as part of the Health Service in England, must provide quality, equity, integration and accountability, not the market.

(3) The primacy of patient care shall not be compromised by any structural or financial re-organisation of the Health Service in England.

(4) There must be transparency and openness wherever taxpayers’ money is being spent, and all accountable individuals and bodies should abide by the Nolan principles.

(5) “The Nolan principles” means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850).

(6) Schedule (Principles of the Health Service in England) has effect.”

The amendment was rejected by 212 votes to 244.

59 Liberal Democrats voted against the amendment with only one (Baroness Tonge) in favour.*

So can someone just remind me – after all the fuss about how the LibDems were going to fight for the NHS – when did they decide that it wasn’t necessary to require providers of health and social care to provide ”quality, equity,  integration and accountability”, when did they decide that it doesn’t matter if the primacy of patient care is compromised by structural or financial re-organisation, and when did they decide that the Nolan principles of public life weren’t necessary for those responsible for the provision of the NHS?

 

*  The full figures were as follows: in favour of the amendment - 172 Labour Peers, 37 Crossbenchers and others, two Bishops and one LibDem; against the amendment – 147 Tory Peers, 38 Crossbenchers and others, and 59 LibDems.