I greatly welcome much of what is in the Bill. I am slightly disappointed by the tone of some—not all—Labour Members, who seem to suggest that the challenges our society faces with social care are in some way new. I looked after an old lady from 2003, during the economic boom times, and became very well acquainted with her
care package, care needs and care challenges, and the challenges faced by her social workers. Back then, social workers were expected to get across London in 20 minutes, which was obviously impossible, so the care time that they had with my friend was severely cut down; in fact, sometimes it was 15 minutes, a figure that we have already heard. There was also a massive challenge in terms of raising the status of the profession of social work. Those challenges existed back then, during the boom times, and they still exist now. It is very brave and ambitious for the Government to be making such significant steps in unifying health and social care at a time when the economic situation is very difficult.
Other Members have dealt with the care and support aspect of the Bill more eloquently than I can, and I am sure that others will too. I want to focus my brief remarks on part 2, which is about the response to Francis and care standards.
I think that one lesson we have learned following the Mid Staffs scandal is that making rules does not necessarily mean making change. I remind the House of the 2002 “Code of Conduct for NHS Managers”, which states:
“As an NHS manager, I will observe the following principles: make the care and safety of patients my first concern and act to protect them from risk;…be honest and act with integrity; accept responsibility for my own work and the proper performance of the people I manage”.
Following the unravelling of scandals in Mid Staffs and elsewhere, it is very hard to understand how NHS managers were adhering to that code of conduct, which was written for them, and why none of them has faced the consequences of not doing so. That is a salutary lesson: we need to be wary that putting things in writing does not always mean that they will happen culturally. People have remained unaccountable for a serious breach of that managerial code of conduct, many of whom, I am afraid to say, continue to work in the NHS today.
As the Bill progresses, I want to see more detail on how the contractual obligation for a duty of candour, which is welcome, will be enforced. I understand the desire for a statutory duty on individuals, but I share fears that it may oversimplify the blame culture that this House has discussed at length. Having seen what happened with our hospitals’ complaints system and the cover-up of blame, I am very worried that a statutory duty on an individual clinician could be abused, such that blame could be parked at a clinician’s door by a management system that does not want its own failings to be highlighted. That could lead to unfortunate false allocations of blame by the system in which clinicians work.
If a contract’s duty of candour is not met, what will be the consequences? It is an issue that there have been no consequences for those who have breached things written down in guidelines and codes of conduct. It is important to understand in more detail what the consequences will be of a breach of contract.
I would particularly like to know whether managers, organisations such as NHS England, and Department of Health officials will have the same duty of candour. The reason why scandals such as Mid Staffs have been allowed to go on and on is that it was not just the hospital that was complicit in it; the entire system around the hospital should have been acting in patients’ interests, but it did not.
Some have faced consequences for their actions—their actions were good, but the consequences have been diabolical—namely whistleblowers. I know and understand that real reform of how we treat whistleblowers and enable whistleblowing will require changes to the Public Interest Disclosure Act 1998. If a whistleblower has been found to be correct in raising concerns in the NHS and those concerns are recognised, I would like to know why any future employer would choose not to employ them. If an employer is a good employer, they would welcome a whistleblower into their ranks as someone who would not go native and accept appalling care when others might do so and who would also have the moral fortitude to stand up and talk about failings when others might not. The test of a good employer is how well they employ people who have been proven to be whistleblowers.
People such as Eileen Chubb and David Drew have sacrificed their careers to highlight bad care, but they have not seen the systemic changes for which they made those sacrifices and they are still suffering the consequences. Surely that is a part of NHS and health culture that the Bill should seek to change.
I welcome the fact that the Care Quality Commission will be looking at the issue of whistleblowers and I welcome James Titcombe’s involvement in the CQC. As someone who thought that the CQC brand was so damaged that it should probably just be scrapped and we should start again, I have to say that I think David Prior has made remarkable progress, given what he started out with, in beginning to turn this monolith around.
Statutory independence of the CQC is very long overdue. I think that everyone in the House has been concerned about the fact that the CQC’s mission seemed to be reputation management for itself and the NHS, and not a brave and courageous stand on behalf of the patients it was supposed to be protecting. In order to ensure that the CQC remains independent from Government—independence in words is fine, but independence in culture is what really matters—it might be illustrative to look back to the era before the CQC and other regulatory bodies were in place, when royal colleges used to send their members into hospitals. They would do so not to inspect hospitals as such, but for reasons of medical training. However, by getting a granular view of the training on offer they could see whether or not it was sufficient. If not, the royal colleges could, under bodies such as the hospital recognition committee, withdraw training from a hospital, which gave the inspection teeth. It was the royal colleges that went in—often without any pay at all; just enough to cover expenses—and interviewed junior doctors and consultants individually, and problems naturally came to light because the interviews were often confidential.
A Wigan hospital fell foul of an inspection in 2001 and its chief executive did not take kindly to it. Funnily enough, just after the inspection took place, the chief executive, who was quite close to Alan Milburn and the then Prime Minister, went into the Department of Health and abolished the system whereby professional clinicians could get a granular view of what was going on in hospitals, replacing it with the postgraduate medical education training board and then the medical training application service, which was disastrous. The more we can put those who do not have an interest in bolstering
the Government of the day—namely the professionals, clinicians and members of the royal colleges—on the ground and doing granular investigations, the more confident we can be that the CQC will be independent.