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Earl Howe: My Lords, perhaps I may start by welcoming Amendment No. 13 in response to a concern raised by me and others in Grand Committee, which the noble Lord was good enough to acknowledge both at the time and in his subsequent very helpful letter. For many people who feel that they have been badly treated in hospital, what they are looking for above anything else is an explanation of what happened and an apology for the mistake. It is therefore very gratifying that the Government have felt able to agree to our suggestion that the giving of an apology should feature as an integral part of the redress process in the Bill.

We all appreciate that an apology will not be warranted in all cases. Sometimes a grievance will be investigated and the finding will be that everything possible was done for the patient, both correctly and in a timely fashion, but that the outcome, through no one's error, was not what had been hoped for. In a case like that, an apology would be inappropriate, but the patient would still be entitled to an explanation of what had happened and why. That is why, while welcoming Amendments Nos. 10 and 13, I must voice a mild degree of concern about Amendment No. 14, although that concern has been softened somewhat by the comments that the Minister has just made.

As I have said, there may be circumstances where an apology is not required, and where compensation is not required. But I suggest that in just about every case where proceedings have commenced and an investigation is being carried out, the patient or his representative will expect and be entitled to an
 
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explanation. The wording of Amendment No. 14 throws up the possibility of widespread exceptions to that principle. I hope that that is incorrect and that the Minister can reassure me that it is not the Government's intention to discourage the giving of an explanation in any other than very exceptional circumstances of the kind he outlined.

Lord Warner: My Lords, I am happy to give that assurance. It is certainly not our intention to do that; it would defeat the objectives of the scheme. One of those objectives is that people should learn from their mistakes, and part of that learning process is explaining to people what has gone wrong and why it happened.

On Question, amendment agreed to.

Lord Warner moved Amendment No. 11:

On Question, amendment agreed to.

Earl Howe moved Amendment No. 12:

The noble Earl said: My Lords, in moving this amendment, I return to an issue that I raised in Grand Committee—that of lessons learnt. We have already spoken about the need for an aggrieved patient to receive an explanation and, where appropriate, an apology, but there is a third thing most patients want when they seek redress: a clear sense, when the investigation is complete, that appropriate lessons have been learnt, to prevent similar mistakes from happening to other people. The Government's Amendment No. 36 is welcome. It speaks of the requirement for members of the scheme to publish an annual report about cases brought under the redress scheme and the lessons to be learnt from them.

I am not sure that goes quite far enough, however. Receiving an annual report with cases anonymised is not quite the same thing as being presented with an action plan flowing from your own particular case, in which, let us say, the chief executive of a trust or the head of a clinical department writes you a personal letter setting out exactly what has been or is being done to improve procedures, training or whatever is necessary, in response to the facts uncovered by the investigation of your case. When genuine lessons have been taken on board by the hospital, that is what the patient will want and should have, whenever it is appropriate and relevant. I hope therefore that the Minister will not dismiss my amendment, which attempts to address a central issue for patients in such circumstances. I beg to move.

Lord Warner: My Lords, in Committee, as the noble Earl, Lord Howe, has said, a number of noble Lords raised concerns that lessons learnt under the scheme were not to be made public. The redress scheme has a number of aims, among them the desire to create a cultural shift within the NHS towards a greater willingness to learn from mistakes and to improve the
 
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quality of service offered to patients in the future. Throughout consideration of this Bill, there has been no difference between any of us regarding that purpose.

4.15 pm

Clause 10(2)(h) enables the scheme to impose a new duty on scheme members, to charge,

the scheme by the scheme member and,

However, we have listened to the concerns of the noble Lords about demonstrating a more public commitment to ensuring that lessons have been learnt and acted upon. Amendment No. 36 enables the scheme to require scheme members,

involving the member that are dealt with under the scheme,

The annual report is intended to demonstrate to patients within a scheme member's locality that lessons are being learnt from the redress scheme and that the scheme is being used effectively to improve local delivery of services. Guidance on best practice will set out how best to ensure patient and clinician anonymity when preparing and publishing these reports. To support the close links between the NHS complaints procedure and the redress scheme, it will be open to scheme members to combine the annual report on the redress scheme with their annual report on complaints.

Amendment No. 37 would provide that the annual report must also include details of the nature and incorporation of the lessons learnt. I believe that the drafting of Amendment No. 36 makes it clear that the nature of the lessons learnt is to be covered. This aspect of Amendment No. 37 is unnecessary. Similarly, it is not necessary to stipulate that the report must detail how lessons learnt have been incorporated. This is implied by the duty.

This amendment would introduce too much detail into the Bill, as it seeks to cover areas best dealt with as good practice guidance. Provision is already in place to ensure that learning from mistakes is taken forward and incorporated. The Bill already provides, at Clause 10(2)(h), for the appointment of a person with responsibility for ensuring learning from mistakes within the organisation. This person's responsibility will be to ensure that lessons learnt are incorporated and that a culture of learning is established within the
 
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organisation concerned. I support Amendment No. 36 and suggest that Amendment No. 37 be not moved.

Earl Howe: My Lords, I am not sure whether the noble Baroness, Lady Barker, wishes to speak. I expect that, with the leave of the House, that would be in order.

Baroness Barker: My Lords, I apologise. I wondered whether the Minister might deal with Amendment No. 38, which is about the need to ensure that individuals who have had cause to seek redress should be informed. From what he has said, I understand that there is an intention to make sure that general information is made available about lessons learnt. However, there is nothing to make it absolutely clear that that would get back to the individual concerned, who is perhaps the person who needs and wishes to have such information the most.

Lord Warner: My Lords, I am sorry. I got tangled up in my amendment numbers. I am grateful to the noble Earl, Lord Howe, for coming to my rescue. I apologise. I did have some more things to say. I am happy to delight the House with further and better particulars.

The noble Baroness mentioned Amendment No. 38, which I had not thought to pre-empt until she had spoken to it. The amendment provides for the annual report to be submitted to the Healthcare Commission. It also provides that copies of the report will be made available to all who have sought redress during the period covered by the report. We suggest that this level of detail is not appropriate to be set out on the face of the Bill. Government Amendment No. 36 provides for the report to be published. It is clear that this information will be available to the public, including the Healthcare Commission and patients whose cases have been considered under the scheme. It is not for the Bill to seek to determine how best to assist the Healthcare Commission in its operations. It is appropriate for the Healthcare Commission itself to determine the types of information that it requires and subsequently to make it clear that it requires that information. That is the way it behaves in all sorts of other areas—it requests information to enable it to discharge its duties and responsibilities.

With regard to the proposal that copies of the report be made available to each individual who has sought redress under the scheme, that is already provided for in the requirement that the report will be published and therefore will be available to the public. The method by which each scheme member publishes its report is a matter for local discretion subject to good practice guidance rather than primary legislation. We envisage, however, that guidance may advise that reports be available to all patients within a scheme member's locality to demonstrate that lessons are being learnt from the redress scheme and that the scheme is being used effectively to improve local delivery of services.
 
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We also do not support Amendment No. 12, which I should have spoken to earlier. This amendment is inappropriate as it would commit scheme members to providing such a report on all cases falling under the scheme. However, there will be cases where an error truly is a mistake arising from circumstances that are unlikely to occur again. In other cases, it may not be possible to identify an immediate cause or an obvious solution to prevent a similar error from occurring. In those cases, an explanation and an apology will already be offered and a report on action to be taken to reduce the risk of the error being repeated would be inappropriate and meaningless. At worst, it could exacerbate an already emotive situation. However, I accept that patients harmed during their healthcare often wish to be reassured that similar incidents are unlikely to occur again. That is why we propose Amendment No. 36, which amends Clause 10 to require scheme members to publish an annual report. Those are my reasons for not accepting the non-government amendments.


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