Andy
Burnham: I understand the reasonable points that the hon.
Gentleman is making. I fully respect the argument that he just put
forward. Of course it would not be right if the scheme were just a
fast-track compensation scheme or an explanation scheme whereby
complaints were quietly put on the shelf, everybody forgot about them
and people were slightly let off the hook. We are trying to create a
scheme that allows accountability and properly opens up whether there
has been poor practice or whether there are defective procedures. The
scheme has to be balanced. It should not be unduly administrative or
bureaucratic, but should be able to deal with issues speedily and
properly and then report on them. In response to amendments, the
commitment was given that an annual report should be published, the
purpose of which is to differentiate those cases that she is talking
about from others that do not carry the same
significance.
Sandra
Gidley: Although the idea of the annual report is welcome
in many ways, somebody who is trying to come to terms with something
that has happened to them could be waiting a long time before they gain
access to that report. In order for an individual patient to move on
and put an incident behind them, it could be important to have the
facility to request an explanation of what happened and an action plan
to prevent it happening again. So I revert to my previous question.
Will the Minister consider a clause or a scheme by which an individual
could ask for an action plan if they felt that it was important to
them? It would not create a bureaucratic burden in every case, but it
would help those patients for whom that was the prime motivation in
bringing a
case.
Andy
Burnham: That is largely what happens in the health
service at present. I understand what the hon. Member for Birmingham,
Erdington said about the strong sense of grievance, and I always pursue
cases. Most of us do that—we do not give up on the case because
we were not on the receiving end of it. People who feel motivated to
keep coming through the doors of our surgery obviously have unresolved
issues that need to be dealt with. I fully believe that good practice
in the NHS means a direct confrontation between the service and
patients, often face to face, through a meeting with a senior clinical
director or the chief executive so that the issues can be
unlocked. In my
experience, if people are clear about what they want and what was wrong
in their case, the national health service is good at responding. I am
not disagreeing with the hon. Lady. I am resisting placing in the Bill
a requirement to produce a report on each complaint handled by the NHS
redress scheme that would lead to lessons being learned and action
being taken. I do not think that that is appropriate for a scheme of
this kind. As the hon. Member for Southport rightly said, many cases
will arise from human error, a basic mistake or a very complicated set
of circumstances that is extremely unlikely to happen again. There would
not be any merit in such a
report. Mark
Fisher (Stoke-on-Trent, Central) (Lab): I have been
listening very carefully to what the Minister has been saying. I am
waiting to hear an explanation of why he is resisting what seems to be
an eminently reasonable and modest amendment. If we are here discussing
redress for patients, the publication of the individual account of what
has gone wrong seems to be the most modest and basic way of redress. It
is not victimising people or causing an enormous fuss; it is just
getting to the facts and allowing people to have the chance in the
light of evidence to come to terms with what has been traumatic for
them. All that I have heard from the Minister in resisting the proposal
is that it will be an administrative burden and an unreasonable burden.
I am not sure that that addresses the problem.
Has he any evidence
from hospital authorities about the cost, either in time or finance, of
the burden upon which he is putting so much emphasis? Has he any
empirical evidence that it would be a great burden to produce a report
on an individual case? Surely that is the least that a patient, or a
family if the patient is deceased, has a right to expect. I cannot see
that it would be a huge financial or administrative cost to a hospital
authority to carry out such a simple
act.
Andy
Burnham: Perhaps I have not explained myself well, and I
shall try to do so in response to my hon. Friend, who raises fair
points. In response to the hon. Member for Romsey, I said that the Bill
states that “ordinarily”—we take that to mean in
almost every case—an explanation will be given to a person. As
she rightly said, that is what people want. They want to know what
happened and why. The explanation will essentially be a report on what
happened, and the person concerned will be able to examine it and
consider whether they believe it to be accurate. As the Bill says, an
apology may also be
made. Amendment No. 15
would require a
report “on action being
taken to reduce the risk of similar errors being
repeated.” As I tried to
say to the hon. Members for Romsey and for Southport, that may not be
appropriate on every occasion. A report on action being taken to
prevent a repetition may not be needed in every
case.
Mark
Fisher: What are the
figures?
Andy
Burnham: I will be interested to find out the figures,
which I do not have to hand, on how many of the cases in question
relate to simple human error or a basic mistake such as a product being
used that should not have been used. The individual who has made the
error may readily say, “I made a mistake. I shouldn’t
have done that.” However, there might be a complicated, unique
set of circumstances. There is a difference between cases of human
error and those that raise broader issues about the way in which
services are provided.
Clause 10(2)(i) deals with such
cases, stating that a scheme may require a trust to prepare a report
for local consumption on the cases of that nature that have been
referred to it and the action that has been taken to
address the problems. It is right to make a distinction between the two
types of case, with which we are all familiar. There should not be a
blanket requirement to produce a report on action taken, which will not
always be
appropriate. Mark
Fisher: I am sure that my hon. Friend the Minister is
defeating his own case. Everybody would concede that there is a
distinction between cases of human error and cases that are not human
error and need to be put right for the future. He says that dealing
with cases of human error through reports would be unduly bureaucratic,
but surely the return on such cases will be effectively nil—just
a one-line statement at the end of a report stating, “This was
human error. We need to learn no lessons from it except that we are all
human.” There will therefore be no administrative burden or cost
at all. The Minister has defeated his own argument by identifying the
fact that there will be no cost attached to making such a
statement.
Andy
Burnham: I do not think so. I shall leave others to be the
judge of that. I hope that in the making of an explanation and the
giving of an apology, it will be good and normal practice for a trust
to say, “Following your case, these were the issues
raised.” That should be part of the normal conclusion of a case
under the scheme. I accept my hon. Friend’s legitimate point,
and a trust should at least consider whether broader issues have arisen
when finalising the terms of an explanation and an apology, should one
be
required.
Mr.
Simon: Will the Minister give
way?
Andy
Burnham: In a moment. I will give way to everybody who
wants to contribute. I agree with what my hon. Friend says, but I am
resisting the notion that a report on the action being taken to prevent
a problem happening again should be prepared in every case. I do not
believe that such a report would properly deal with the explanation.
There is no need for a report in every case. My argument is that if a
person agrees to the redress that they are being offered, the trust
should come back and make a broader statement about how the case is
being dealt with. I
draw hon. Members’ attention to clause 10(2)(h), which places a
duty on scheme members
“to charge a specified person with
responsibility for overseeing the carrying out of specified
functions... under this Act and advising the member about lessons
to be learnt from cases involving the member that are dealt with under
the scheme.” That creates
a mechanism within the trust whereby a named individual is responsible
for the functions to which my hon. Friend rightly drew my attention. I
argue that we have probably got the balance right here, between
something that is not a paper-shuffling scheme or a box-ticking scheme.
That is not the intention; the intention is to create a scheme that
does what we want it to do, which is to investigate people’s
complaints properly and then take the action appropriate to provide
redress to the individual, and to ensure that the organisation has
learned from its errors. If there is a difference between us on the
issue, that is it, although I do not know whether I have convinced my
hon. Friend.
Mr.
Charles Walker (Broxbourne) (Con): There seem to be some
grey areas in the arguments being advanced. Almost all errors committed
in the NHS are due to human error. After all, we control the
environment in which we work. There will be catastrophic disasters,
such as a plane crashing into a hospital, or a tree falling
down— Martin
Salter (Reading, West) (Lab):
When?
Mr.
Walker: I am talking “Casualty”, with all
those exciting incidents—it is oil tankers in
“Casualty”. However, most error is down to human error.
We seem to be confusing the issues, thinking that human error will
always be well-meaning error. We should not assume that if someone
makes a mistake, they will apologise for it, because it was a totally
understandable mistake to make. However, a lot of error will be down to
idleness and incompetence. It is very important to the patient that
when idleness or incompetence are identified, they receive at least the
assurance that the individual or individuals responsible will be dealt
with effectively.
Andy
Burnham: I am not sure that it will always be down to
idleness or incompetence, but I understand the point that the hon.
Gentleman is making. I do not think that I am at odds with the majority
of the Committee on the matter. I want to be sure that we are getting
the scheme right. All of us must be careful about the kind of scheme
that we pass over to the national health service. It is not a trivial
matter, and we must all think carefully before we put in place an extra
burden on anybody who works within the national health service. We have
to think whether it is clearly justified, right and proper that an
extra requirement is given, judging the benefits versus the
cost. I am arguing
that the benefits that the hon. Member for Romsey seeks in her
amendment are already addressed in the Bill. The mechanisms are there
to deal with those cases: in the annual report that we have said that
we would accept; in the further scrutiny of such reports by the
Healthcare Commission, which we welcome; and in stipulating that a
named individual within the trust will ensure that lessons are learned
from
cases.
11.45
am
Mr.
Simon: We are at risk of continually hearing that if we
look at best practice in the health service, this is already being done
and that is already being done. But that is not really the point. There
is no doubt that there is good practice in the health service and lots
of good things, but we are supposed to be writing a law saying exactly
how things are supposed to be done in future. We are not supposed to be
leaving it to people’s good will and intentions. Many people in
the health service are already doing things very well.
On the specifics of amendment
No. 18, we should be clear that it does not talk about learning
lessons. It is not a lessons-learning amendment. Nor does it talk,
crucially, about the commissioning of a report. This is not about
imposing a bureaucratic requirement on the health service, or on
anybody, to commission a report. The amendment talks about providing to
the claimant
the details of the report, which as part of the process will, de facto,
already have been written. This is not about commissioning a new
report, but about publishing details of the inquiry already undertaken.
On that basis, what good reason have the Government for withholding
from the claimant details of a report that has already been written?
And if one has not been written, what kind of investigation has there
been? Andy
Burnham: I disagree; I think the amendment is a
lessons-learning exercise.
Mr.
Simon: Amendment No.
18?
Andy
Burnham: Amendment No. 15 is the amendment we are
discussing. Our debate with the hon. Member for Romsey concerned
amendment No. 15, which is very much about a lessons-learning exercise.
It refers to “action
being taken to reduce the risk of similar errors being
repeated.”
Mr.
Simon: I was talking about amendment No.
18.
Andy
Burnham: I accept that and shall address that amendment.
My hon. Friend is right, and there are important issues in that
amendment, too, but I should first like to finish dealing with the
issues relating to amendment No. 15, which is very much a
lessons-learning exercise. I heard the comments that hon. Members made,
particularly the my hon. Friend the Member for Stoke-on-Trent, Central
(Mark Fisher). He made a fair point, as did the hon. Member for
Romsey. I said that
people should ordinarily know what action is being taken. Perhaps we
could go further and set it out in good practice guidance that all
explanations provided under the NHS redress scheme should conclude with
an account of the action being taken in response, where that is
relevant. It will not always be relevant because often there will be a
self-contained issue. I accept the point that it may be relevant in
some cases, but the giving of the explanation to me is the preparation
of the report. If we take on board what the hon. Lady has said, and
extend the process in that way, we may get to where she wants to
be. Mr.
Nick Hurd (Ruislip-Northwood) (Con): The Minister’s
fig leaf in this debate is clause 10(2)(i) and the annual report. To my
reading that paragraph does not impose a duty; it simply says that if
the Secretary of State sees fit, a scheme may require members to
prepare a report. Am I to deduce from his remarks that the Government
intend to firm that up and make it a
duty?
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