Health and Social Care (Safety and Quality) Bill — House of Lords, 2015-02-06
Topic: Social Welfare
Norman Warner (Labour, Centre-left): My Lords, it is a pleasure to follow the noble Lord, Lord McColl. I reassure him that before my NHS hernia operation two or three years ago I was very appropriately marked up in indelible ink as to where it should take place. To my pleasure, I found that it had taken place at that same spot—there may be others who thought that perhaps the surgeon should have moved somewhere further north and east I had originally told the noble Lord, Lord Ribeiro, that although I wanted to raise issues relating to children in the Bill, I was unlikely to want to table amendments. However, that was before I had read the Bill as carefully as I should have done and certainly before I had considered the amount of briefing that we have had, particularly about Clause 1, which I did not read until yesterday evening. These concerns have been enhanced by the points made by my noble friends Lord Turnberg and Lady Pitkeathley First, I will say a few words about children. In doing so, I declare an interest as the Secretary of State for Education’s children’s commissioner in Birmingham City Council. I should make it clear that my remarks are not based on that experience, although it has brought home to me the growing volume of children in need and at risk that many local authorities, health bodies, police and schools are having to deal with. It has brought home the importance of the flow of information between those agencies if children are to be protected I very much welcome the provisions in the Bill on consistent identifiers across health and adult social care. However, if this is being done for adults, why are children left out of the Bill? It is yet another example of how often, under all Governments, children get lost sight of in terms of the needs that must be addressed. They are less able to answer back and pressurise for change in some of these areas. It is of great concern, given what we know about children in need and at risk, that we have again in this piece of legislation forgotten about or failed to address the needs of a common identifier in the area of children’s services. I recognise that some progress has been made with the child protection information-sharing project which, if properly done and developed, would enable healthcare staff to see whether a child attending unscheduled care services had a child protection plan or looked-after children status. That is progress: it is better than where we were. Yet it is a long way from what is promised in the Bill—a single identifier for adults. It is a long way from that for children It is worth reminding the House of a sterling report by the noble Lord, Lord Laming, in 2003, after the Victoria Climbié disaster. In recommendation 18, he said there should be a proper, common identifier database of all children under 16 in the country, which agencies could know about and have access to when they came across children. This Government decided to abort the work taking place on that. That was a mistake. We are now, yet again, failing to deal with the issue of a common identifier for children that enables all agencies—not just health and care ones—who have a duty to protect children at risk and in need to do so. We need to think a lot more about why, if we are to do this for adults, we will not do it for children A number of bodies working in this area have already said to parts of the government machine, "In this age of digital technology, why do we not even consider producing a web-based database for children that could use a unique identifier to help the agencies do a better job?". It is no good wringing our hands over child protection and exhorting agencies to work better together in this area if we then neglect to provide them with the tools and ability to access those data that would protect children. I regard that as a missed opportunity in this particular legislation I turn briefly to Clause 1, with particular reference to the letter and briefing mentioned by other noble Lords that came from the Health Foundation, drawing very much on the work of the Berwick advisory group. I recognise that the intentions of the architects of the Bill are entirely well meant. However, the duty in Clause 1 would, I suggest, go against all the evidence of what is required in the delivery of safe health and care services. I do not want to quote at length from that letter, which other noble Lords have mentioned. But I will put two quotes from it on the record because they summarise the problems with Clause 1 The first quote is from the report of the Berwick advisory group, which concluded: "While ‘Zero Harm’ is a bold and worthy aspiration, the scientifically correct goal is ‘continual reduction’. All in the NHS should understand that safety is a continually emerging property, and that the battle for safety is never ‘won’; rather, it is always in progress" The second quote is from a recommendation: "To introduce this new law would not be supportive of the Berwick Advisory Group’s key recommendation for ‘the NHS … to become more than ever, before a system devoted to continual learning and improvement of patient care, top to bottom and end to end’" If we are not going to listen to people who put a lot of effort into study in this area and take account of what they say in framing legislation, that is a poor show. If we do not think that it is worth giving the time to scrutinise the legislation and pay attention to views being offered in a very professional and politically independent way, that is an even poorer show. We cannot rush through legislation when we choose not to give enough time to draw on that expertise and use that information It is a shame that we are trying to rush on with the Bill in this way. We need to stand still and think about how we can give proper time to a well intentioned piece of legislation. If not, if people want to rush on with this, they should consider taking out of the Bill the provisions that are controversial and not generally agreed There is a lot of support for a common identifier, if the Government want to put that on the statute book. I say "the Government" because although the Bill is a Private Member’s Bill, it is being given every encouragement by the Government. Like my noble friends, this is the first time that I have ever been approached by a civil servant to encourage the progress of a Private Member’s Bill, almost implying that I am somehow failing in my duty if I do anything to impede it. That is not the way to proceed. The Minister needs to give us some assurances about what is the Government’s position on and attitude to the Bill and whether the Government want to provide some of their time to give us proper scrutiny of the legislation in Committee I hope that the noble Lord, Lord Ribeiro, will not take that as a personal attack on him; it is not. He is honourably trying to progress the Bill for good reasons, but we must ask some questions about the Government’s position and whether they will provide the time to enable us to have proper scrutiny of all parts of the Bill.