Health Bill [HL]

With the clarity with which the noble Earl speaks, I would always be glad if he were to speak on my behalf. As he has forgone that privilege on this occasion, I will do my best. I am very much attracted to many of the noble Earl’s comments and hope the Minister will come back to them. My amendments would ensure that improving patient safety is given equal importance to the pursuit of quality in the NHS and seek to ensure that the potential of quality accounts to drive safety improvements is fully realised. I should declare an interest as chairman of the National Patient Safety Agency, which has a central role in increasing the safety of healthcare. Improving patient safety is often cited by patients and policy-makers as the number one priority in the NHS. It has been estimated that one in 10 healthcare episodes results in patient safety incidents of some sort, and the NPSA’s national reporting and learning system—the NRLS—receives 3,000 patient safety incident reports every day. So the challenge is significant. Over the past few years, much effort has gone into raising the profile of patient safety: establishing the national reporting and learning system, providing guidance and support to healthcare providers, putting patient safety systems into place and developing interventions to reduce the risks of known sources of harm. In the report by the noble Lord, Lord Darzi, High Quality Care for All, quality is defined as a combination of clinical effectiveness, safety, and patient experience. It seems to be taken as a matter of faith that that definition will become universally adopted. The difficulty with that assumption is that definitions of quality are notoriously variable and imprecise. Within the report itself quality is sometimes paired with safety, and at other times it is mentioned alone or with clinical effectiveness and so on. I was interested to see that the Care Quality Commission used a different definition of high quality care in its recent manifesto. While I am pleased that safety is included in the definition, it highlights the risk that a lack of clarity in definitions will result in patient safety being sidelined as different bodies pursue their own ideas about quality. ““Quality”” is currently left undefined in the Bill and the Explanatory Notes, and that, together with the fact that safety is not mentioned in the legislation, sends a message that patient safety is not important. Specific reference to safety in the legislation would send a powerful message to the contrary and help to mitigate the risks that I have highlighted. Failing to define quality adequately could lead to differences in interpretation of what should be included in quality accounts and to the exclusion of information related to patient safety. That would be a shame, because quality accounts have the potential to become powerful levers for the improvement of healthcare in the NHS. I want to give some examples of how quality accounts could be harnessed to improve patient safety. ““Never events”” are serious, largely preventable patient safety incidents that should not occur if the available preventive measures have been implemented. Next year, PCTs will require healthcare providers to put in place preventive guidance in relation to a core list of never events; report the occurrence of events on the core list of never events to them; and, if events occur, put in place action plans to prevent recurrence. Requiring providers to report publicly the occurrence of never events would act as further encouragement to prevent them occurring in the first place. Another example is safer surgery checklists. Earlier this year the National Patient Safety Agency issued an alert requiring healthcare organisations in England and Wales to implement World Health Organisation surgical safety checklists for every patient undergoing a surgical procedure. That was based on the results of a pilot which included the department of the noble Lord, Lord Darzi. The checklist is intended to strengthen the commitment of clinical staff to address safety issues in a surgical setting. It includes measures which will improve anaesthetic safety practices, ensure that surgery takes place on the correct site and reduce the risk of infections. The NPSA has a target next year to ensure that the checklist is used in all relevant healthcare organisations. Making organisations report publicly on whether they are complying with the checklist would be a powerful encouragement for organisations to do so. The next example is Matching Michigan, a two-year initiative which will reduce the number of central venous catheter-associated bloodstream infections in intensive care units in England. It draws on lessons learnt from the successful Michigan initiative, called the Michigan study, on the same topic. If providers with intensive care units were required to report their rates of central venous catheter-associated bloodstream infections, I am sure that that would add to the success of the initiative. Patient safety is a fundamental aspect of high quality care for patients. It is essential that healthcare organisations put in place all that is required to improve the safety of patients—such as local systems to record, investigate and respond to patient safety incidents; systems to report patient safety incidents nationally; and systems to implement national patient safety initiatives and interventions. They should also implement all national guidance and initiatives related to safety improvement. Making providers report on whether they are doing these things as part of quality accounts is a powerful lever in ensuring that they do. I hope the Minister agrees that patient safety is of paramount importance in modern healthcare and that we must not risk it being cast aside as we seek to improve the quality of healthcare in general.