Consideration of Bill, as amended in the Public Bill Committee
New Clause 1
Oversight role of the National Data Guardian
‘(1) The Secretary of State shall within 30 days of this Act coming into force commence a consultation process on making the role of the National Data Guardian statutory. The consultation process must—
(a) include reference to the overarching aims, objectives and role of the National Data Guardian, including oversight of data sharing as set out in this Act; and
(b) last a minimum of 61 days.
(2) The Secretary of State shall publish a report following the consultation process and shall lay the Report before each House of Parliament.”—(Mr Jamie Reed.)
Brought up, and read the First time.
I beg to move, That the clause be read a Second time.
Before I begin, I am sure that the eyes of every Member are on events in France and we wish the French authorities the very best of luck in their endeavours in the aftermath of Wednesday’s events.
I congratulate the hon. Member for Stafford (Jeremy Lefroy) on navigating his Bill to this stage. Not many private Members’ Bills make it to this point. This is a good Bill and I am sure we would all like to see it on the statute book. I hope that it can complete its final Commons stages today.
On 13 November 2014, the Secretary of State for Health announced that Dame Fiona Caldicott would be the new national data guardian for health and care, and that her role would become
“the patients’ champion on security of personal medical information.”
“be able to intervene if she is concerned by how an organisation is sharing data. She can refer concerns directly to the Information Commissioner’s Office (ICO) and the Care Quality Commission (CQC)”.
Those principles are supported by all Opposition Members. Sharing data and information can and, indeed, should improve health care, but we must ensure that patient privacy is protected at all times.
If Dame Fiona’s role is to look at how organisations share data, that role will become directly relevant to the provisions in clause 3. In his announcement, the Secretary of State for Health said:
“I intend to put the National Data Guardian on a legal footing at the earliest opportunity”.
The business of the House is not so demanding that he can blame a lack of parliamentary time for not introducing such plans, especially as there have been concerns about data for a very long time. Those concerns have become even more acute since the bungled implementation of the care.data scheme, which is so important to our research base.
In Committee, I told the Minister that if the Government did not make progress on their announcement, the Opposition would help them out. That help has arrived today. The Government have done nothing, so I have tabled new clause 1 to place a duty on the Secretary of State to hold a consultation process on the role of a statutory national data guardian. We do not wish to prejudice the role by prescribing its functions. It is right that the role should be determined by consulting those on whom it will have an impact, not least Dame Fiona herself. Many stakeholders will be keen to contribute to a consultation process; they are crying out for progress.
The Bill places a duty on health care providers to share information wherever relevant. As new systems are put to the test, there will inevitably be more pressure on the national data guardian. The new clause would place a duty on the Secretary of State to start a consultation within 30 days of the passage of the Bill. We are all keen to see progress, and the new clause would ensure that the process got under way almost immediately.
We want the consultation to be meaningful and thorough to ensure that the new role is as effective as possible in maintaining standards by highlighting and, more importantly, fixing poor practice as and when it occurs. The Minister said in Committee that the delay to date was because the Government wanted to consult widely with stakeholders. That is the precisely the purpose of new clause 1, so I can only imagine that the Government will support it. If they oppose it, will he explain why? Will he commit himself to writing to me about the proposed timeline for the consultation and the planned legislative timetable for putting the role on a statutory footing, as we discussed in Committee?
Sharing data can lead to much better outcomes for patients throughout the health and social care sector, but we must ensure that personal data are used safely, and that any promotion of data sharing is done responsibly to improve health outcomes. That principle has already been explored in depth, and the Labour party is clear that it supports that principle, as I am sure do all Members. There is wide support for the role of the national data guardian. Putting it on a statutory footing has cross-party support. I hope that the Government will get on with it today.
I thank the hon. Member for Copeland (Mr Reed) for tabling new clause 1, which allows us to debate the issue. I am most grateful to him for his full and constructive engagement with the Bill. A consultation on making the role of the national data guardian statutory is extremely important, and I fully appreciate the reasons why he has tabled the new clause.
I welcome the appointment last November of Dame Fiona Caldicott as the first national data guardian. Her extensive knowledge and experience in this area will ensure strong and visible leadership. She, together with her panel, will act as a source of clear authoritative advice and guidance across the health and care system. The Secretary of State said at the time of her appointment:
“We need to be as determined to guarantee personal data is protected as we are enthusiastic to reap the benefits of sharing it. Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence.”
Let me make it quite clear that the clauses on the duty to share information are not about care.data, which is another issue for another time. My Bill is about data being shared only with those who are directly responsible for an individual’s care for the purposes of that care. Its remit is very restrictive.
A consultation should, as the new clause provides, include reference to
“oversight of data sharing as set out in”
the Bill. Understandably, concerns have been raised that a duty to share information might somehow dilute the vital principle of patient confidentiality, which is protected by statute and common law. As I have explained before, I do not believe it will do so.
The seventh of the revised Caldicott principles, as set out in “The Information Governance Review”, is that
“The duty to share information can be as important as the duty to protect patient confidentiality. Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles.”
As was set out on Second Reading and in Committee, clause 3 introduces a duty to share information. That must be done when it is in the person’s best interests and it is
“likely to facilitate the provision to the individual of health services or adult social care”.
Having a statutory duty to share information for the benefit of a person’s care, within the clear limits set out in the Bill, would, alongside the existing strong statutory protection for confidentiality, provide health and social care professionals with the confidence to which Dame Fiona’s report refers.
The consultation on the national data guardian will provide the opportunity to set out how oversight would work for the duty introduced by the Bill, should it become law, under the legislation that will make the role of the NDG statutory. If the consultation cannot be established through a clause in the Bill, which I understand may be the case due to the timing of the general election—the Minister will go into that, I believe—it needs to happen at the earliest possible opportunity.
The new clause relates to clauses 2, 3 and 4. Clause 2 will place a duty on providers and commissioners of publicly funded health and adult social care to use a consistent identifier in a person’s health and care records and correspondence. The consistent identifier must be specified in regulations, and the Government’s intention is that the NHS number will be specified. It is important to note, as my hon. Friend the Member for Stafford (Jeremy Lefroy) outlined, that the duty to use the NHS number would apply only in the direct provision of care and when it was in the individual’s best interests. As he articulately said, this matter is very different from the issues with care.data that we have discussed. There is a duty on professionals to share information in the best interests of patients in respect of the provision of direct care.
Clause 3 will introduce a duty to share information that is held by providers and commissioners when it is in an individual’s best interests and will support their direct care and treatment. As we discussed in Committee, that is an essential part of the delivery of safe, effective and high-quality care.
Clause 4 defines health or adult social care commissioners or providers. Its effect will be that the duties imposed by clauses 2 and 3 will apply only to relevant health or adult social care commissioners or providers. They are defined as public bodies exercising health or adult social care in England and any person, other than an employee, who provides such services or care under arrangements within a public body.
I welcome the constructive support of the shadow Minister, the hon. Member for Copeland (Mr Reed), throughout the passage of the Bill. There has been a great deal of consensus, and rightly so. I am grateful for his support for the role of the national data guardian. As was discussed in Committee, the Government are committed to consulting on the role of the national data guardian and the Secretary of State has given his unequivocal support to the consultation. We believe that having a data guardian is an important additional safeguard in the system.
As the House will be aware, Dame Fiona Caldicott has been appointed as the first national data guardian and has already built up significant credibility in her role of challenging and scrutinising the way in which information is shared across the health and social care system. Strengthening and broadening the role of the national data guardian will further enhance the confidence of patients and the public that there is a strong voice for their rights and protections in this area.
Even without a legislative basis, Dame Fiona’s panel, which was previously known as the independent information governance oversight panel, has built its reputation as an effective and authoritative voice. It has helped to ensure that data and information are shared in a way that allows the health and care system to access what it needs to improve outcomes for patients, while protecting against their inappropriate use. Having made significant progress, there is now clear agreement across the House that it is important to embed the national data guardian in the health and care system as a powerful independent voice, and to put that role on a statutory footing.
I understand that the new clause is motivated by a desire to support the further development of the national data guardian, but I hope that the hon. Gentleman will agree on reflection that primary legislation is not appropriate or necessary to ensure a consultation. I am pleased to see the desire across the House to consult, and there is a clear commitment from both main political parties to consult on the role of the guardian. Given that Government commitment, I hope the House will be reassured, particularly with the clear cross-party support, that the new clause is not necessary.
A public consultation is something to which the whole House is committed. The Government believe that the role of the national data guardian is crucial for protecting the interests of patients and service users, and rebuilding public confidence in how personal information is used. We must get the role of the data guardian right and consult properly. I do not believe that taking the unprecedented step of setting short and arbitrary deadlines to consult on legislation will in any way assist in getting the consultation right. Establishing the role of the data guardian is a complex process, and as the House will agree, it is critical that the role and powers of the data guardian are properly consulted on. I am therefore pleased to inform the House that we are already consulting informally with key stakeholders, and the outcome of those informal conversations will be used to inform the full public consultation that will follow. It is likely that the deadline for any consultation as required in the new clause would fall within the period of purdah, and it is a long-standing convention, followed by successive Governments, that consultations may not take place within that period.
I reaffirm the commitment to put the national data guardian on a statutory footing at the first suitable legislative opportunity, with legal duties requiring organisations to abide by the advice, and legal powers and sanctions, including the ability to withdraw inappropriate access to data. We must protect against the misuse of personal data. We are committed to consulting a wide range of stakeholders on what functions and powers the national data guardian should have, and as I have outlined, that informal consultation has already begun. In future, the public consultation will include consideration of any sanctions that the national data guardian may place on those who misuse personal health and care information.
We are determined that the public consultation will ensure that the functions and powers associated with the national data guardian play an important part in increasing public confidence that information is being appropriately used and shared. The House will be pleased to note that we have established interim arrangements under which the national data guardian already has a strengthened role. Those interim measures include the Information Commissioner’s Office and the Care Quality Commission agreeing to pay regard to any concerns raised.
As there is so much common ground on the role of the national data guardian, and a clear commitment to consult fully, I hope the hon. Gentleman will agree with the approach I have outlined and be satisfied with my reassurances, and that he will withdraw the new clause.
I am grateful to the Minister for his response and for the constructive way that we have dealt with the Bill, which in many ways demonstrates some of the best traditions of the House. I am a little disappointed, given the fallow—dare I say useless—fifth year of this five-year Parliament, that time has not been found to address these issues. The protection and use of individual data, not just in health services but across the public sector, is one of the biggest and most important emerging issues facing our politics and society, and the Minister is right to say that such matters need to be treated carefully, judiciously, and with diligence and attention to detail.
Given the cross-party support and the Minister’s assurances, I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 2
Care and Quality Commission reviews and performance assesments
‘(1) Section 46 of the Health and Social Care Act 2008 (health and adult social care services: reviews and performance assessments) is amended as follows.
(2) For subsection (3) substitute—
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”’—(Sir William Cash.)
Brought up, and read the First time.
With this it will be convenient to consider:
New clause 3—Care and Quality Commission annual State of Care Report—
‘(1) Section 83 of the Health and Social Care Act 2008 (health and adult social services: reports for each financial year etc.) is amended as follows.
(2) After subsection (2) insert—
“(2AA) The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”’
Before I make my remarks on the proposals, I pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), my neighbour, with whom I have worked for the past five years with great enthusiasm, because he has dedicated himself to all matters in his constituency, but specifically to dealing with the problems that came out of the Mid Staffordshire public inquiry—I campaigned vigorously to get that public inquiry. I also pay tribute to Ken Lownds, whom I regard as a hero of that inquiry in many respects. I pay tribute to his work on zero harm and the Bill. I do not in any way want to leave the Minister out of the tributes because he has done a great job, as has the Secretary of State for Health. I wanted to put that on the record. We are reaching the climax of the Bill and this is the moment to pay tribute to those who so richly deserve it.
The object of new clause 2 is to amend section 46 of the Health and Social Care Act 2008. The section deals with health and adult social care services reviews and performance assessments. It comes under the rubric of reviews and investigations under chapter 3 of the Act on health care standards.
Section 46, “Periodic reviews”, provides that:
“In respect of each Primary Care Trust the Commission”—
the Care Quality Commission—
“must…conduct reviews of the provision of health care provided or commissioned by the Trust…assess the Trust’s performance following each such review, and…publish a report of its assessment.”
It also makes special provision with respect to each English national health service provider. Subsection (3) states:
“In respect of each English local authority the Commission must…conduct reviews of the provision of adult social services provided or commissioned by the authority…assess the authority’s performance following each such review, and…publish a report of its assessment.”
In the light of experience, and to improve the 2008 Act, particularly section 46, the new clause would substitute for subsection (3) the following:
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”
The purpose of that is to require the CQC to ensure that the indicators used to assess ratings cover the safety of care, which goes back to the question of harm-free provision. Basically, the argument goes like this: the object is to stress that the CQC can be an effective regulator only if it is free of undue influence from Ministers. The measure is a good indicator of whether the Government are prepared to say that they want the CQC to be able to exert influence and carry out its functions irrespective of undue influence from Ministers. In other words, are they prepared to step back and allow the CQC to do its job properly?
The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. On many occasions, I have discussed with Ken Lownds over dinner and otherwise the origins of much of his thinking on the subject, some of which I had difficulty understanding—apparently some of it comes from aviation safety, but I will leave that to the experts.
Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams able to scrutinise the quality and safety of care more rigorously. Inspections no longer simply consider whether providers are meeting the registration requirements, but provide a judgment about the quality of care on a scale running from outstanding to inadequate, offering providers, commissioners and local people fuller information about the quality of care.
The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and the CQC has already rated many good services. That new approach has also exposed poor care and variations in care, making the level of quality transparent in a way it has never been before.
I have to say that my experience of what happened after Mid Staffordshire—this was before my hon. Friend the Member for Stafford came into the House, and I pay tribute to what he has done to help me since—was itself a matter of the gravest concern. Having witnessed what went on there, I then had to engage in a campaign, and I tried, unsuccessfully, to push the Government of the time into having a public inquiry, but Ministers, including two Secretaries of State, refused point-blank to hold one.
Furthermore, I had to nudge—if I can use that word—those on my own party’s Front Bench quite vigorously. I think that would be the appropriate description. That included our then shadow Secretary of State and the now Prime Minister, who responded magnificently, making an inquiry a manifesto commitment. One of the very first things the Government did when they came into power under the present Prime Minister was to say, “We will have this Mid Staffordshire public inquiry under the Inquiries Act 2005.” As a result of that and of the work of Ken Lownds, my hon. Friend and others of us who have been involved in this issue, including the sponsors of the Bill—I should also refer to them—we now have this new Bill in my hon. Friend’s name, which will make quality transparent in a way it never has been.
We are already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. I hope that the Minister will accept that new clause 2 is exploratory, but I tabled it in the fervent belief that he will respond satisfactorily to my request, because this is a matter of grave concern.
If it is convenient, Madam Deputy Speaker, I will move on to the next new clause, unless my hon. Friend the Member for Stafford would like to respond to my points now. Would that be appropriate?
That is very good. I just wondered whether my hon. Friend wanted to respond on new clause 2 before I move on to new clause 3.
New clause 3 proposes to amend section 83 of the 2008 Act, which deals with health and adult social services and with reports for each financial year. The new clause would insert proposed new subsection (2AA), which says:
“The reports under subsection 1(b), (c), and (d) must, in particular, cover the safety of health and adult social care services in England.”
To put that into ordinary language, the purpose is to require the Care Quality Commission to cover safety of care in the annual state of care report. That is hugely important, because it is the narrative to which people will be able to refer in identifying progress on these incredibly important provisions.
The object of the exercise, as I understand it, is that the CQC’s annual report should cover safety issues. The most recent state of care report, published in October, already does, but it is not currently a statutory requirement. That would be the case if the Government were good enough to agree to the new proposals. It is difficult to conceive of circumstances in which the CQC’s annual report would not cover the safety of care provided by the organisations it regulates. Indeed, a report that did not address this area could amount to a failure by the CQC to discharge its functions. Where that is the case, section 82 of the 2008 Act gives the Secretary of State the power to direct the CQC on how to discharge its functions.
There we have it: both new clauses are a really important move to improve greatly the movement, proposed under the Bill, towards harm-free care in the health service; the direct result of the enormous progress made by the Government in relation to the outcome of the Francis report. I pay tribute to Sir Robert Francis, the chairman of the inquiry, for his very powerful help in all these matters over the years. It has been a tremendous but very difficult experience to be in the front line of the disaster and tragedy that occurred at Stafford hospital. The most important thing is that we should learn the lessons. We have done so and the Bill is an exceptionally good demonstration of that. Above all else, it will help the people—not just those in our constituencies—who have been affected. The Mid Staffordshire public inquiry and report can now be translated into national legislation through this Bill, introduced by my hon. Friend the Member for Stafford, which could not be more appropriate, relevant or significant.
I offer sincere thanks to my hon. Friend, to Ken Lownds, the Minister and all the officials who have played such an active part in ensuring the Bill’s success. I wish it well on its way. It will make an enormous difference to health care throughout the entire national health service.
I would like to speak to new clauses 2 and 3 together. The new clauses tabled by my hon. Friend the Member for Stone (Sir William Cash) seek to embed safety as the central component of the CQC’s inspection regime. My hon. Friend is not only a supporter of the Bill but a major inspiration behind it. His determination in this place to establish what went wrong in the care of his constituents and mine, and to ensure that our NHS was improved as a result, is a major reason for us being here today.
I agree entirely with the principles contained in the new clauses. New clause 2 would place a duty on the CQC to include safety in its annual performance assessment and ratings, while new clause 3 would require the CQC to consider safety in its annual state of care report. I believe that clause 1 of my Bill would already ensure that the CQC has a duty to do all that is contained in new clauses 2 and 3. I will try to explain why.
Clause 1 states that the requirements for registration with the CQC will always cover safety by securing that registered providers of health and social care “cause no avoidable harm”. The CQC will therefore be under a duty both to consider safety in its inspections and ratings and to cover this area in its state of care report. Indeed, it already does so, and here I pay tribute to the previous Government for introducing this annual state of health and social care report through the 2008 Act.
The foreword to this year’s report, to which my hon. Friend the Member for Stone has already referred, is hard hitting about safety and indeed quality. It states:
“The variation in the quality and safety of care in England is too wide and unacceptable. The public is being failed by numerous hospitals, care homes and GP practices that are unable to meet the standards that their peers achieve and exceed.”
I welcome this candour. This is what we expect from the CQC—to hold the NHS and indeed the Government to account, and to ensure that action is taken.
Let me mention an article that appeared in The Times yesterday, showing the huge variability of standards within the NHS and praised some outstanding trusts, specifically mentioning one in Birmingham and a couple of others. What we want to see is those standards being uniform across the NHS. I know that all those working within the NHS and social care want to see that. Nobody goes into work wanting to fail; they want to succeed for their patients to whom they have a duty of care. For our part, it is our responsibility to ensure that they have the environment in which that can happen. That is a small part of what this Bill is designed to bring about.
I recall the extraordinary experience of discovering that in order for the original trust in Mid Staffordshire to achieve trust status, an interview was necessary. In that interview, I believe 48 questions were put, 35 or so of which were about finance—not about care and safety. That demonstrated why everything went wrong. Now, however, under these arrangements, the whole situation is completely reversed, which is a thoroughly good idea.
I entirely agree. There were moves towards that when the Healthcare Commission, which was responsible at that stage and manifestly failed in the case of Mid Staffordshire, was replaced by the Care Quality Commission—an understanding by the previous Government that progress needed to be made in ensuring the quality and safety of care. That progress has been maintained and accelerated under the present Government.
I was referring to the 2013-14 report. One of my hon. Friend’s new clauses specifically provides that safety should be a part of such reports. Indeed, the report goes into detail over the way in which the CQC has inspected for safety. On page 12, for instance, it gives an example of a wide variation in the ratings on safety and four other measures—effective, caring, responsive and well led—for each department in a particular hospital. The ratings for safety range from inadequate to good, which shows that even within a trust or a hospital, there is a wide range of safety performance. The CQC is therefore already fulfilling what my hon. Friend is seeking in these two new clauses.
Of course, the same might be argued for clause 1 itself: why is it necessary when the CQC is now implementing the Secretary of State’s requirement to ensure that providers “cause no avoidable harm”? The reason is that, without clause 1, a Secretary of State would not have that obligation. While I cannot imagine a Secretary of State who would not consider safety and “no avoidable harm” as top priorities, experience and indeed the CQC’s own report from which I have quoted show that some of the organisations for which the CQC has the responsibility for regulation have not, and might still not, take safety seriously enough.
I distinctly remember insisting over and over again during the debates on the whole question of Mid Staffordshire that were taking place until the last general election that it was the Secretary of State who had to take the final responsibility for these matters, and that the duties imposed on him and the functions that he had to perform had ultimately to be his and must not be transferred to some other agency, however worthy it might be and however hard it might work to achieve objectives which, as we now know, were not being complied with satisfactorily, but which are being complied with satisfactorily now, under the Care Quality Commission. The argument that my hon. Friend is advancing comes straight from the history of the experience of Mid Staffordshire, and there is no one better to put the case than him.
I thank my hon. Friend for what he has said. I entirely agree that this is an extremely important matter. Clause 1 will ensure that there is no slippage in the future, because the Secretary of State cannot get out of her or his responsibility, and the Care Quality Commission’s annual state of care report will be part of the process of holding the Secretary of State to account. I encourage, indeed challenge, this or any future Government to hold a proper annual debate on the report, because it is a vital report. Indeed, I should welcome a debate on the 2013-14 report, uncomfortable thought it might be for certain people.
I believe that new clauses 2 and 3 are unnecessary, because what they prescribe flows from clause 1. However, I am most grateful to my hon. Friend the Member for Stone for tabling them.
I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.
A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”
That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.
Section 3 of the 2008 Act states:
“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”
Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.
New clause 2 requires the CQC to
“include indicators of the safety of health and social care services.”
We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.
As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.
I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.
My hon. Friend the Member for Stone was also right to say that we need to learn the lessons of the Francis inquiry and translate some of those terrible learned experiences into improvements in care through this Bill. I believe that is exactly what this Bill will help to achieve when, hopefully, it becomes law.
My hon. Friend has tabled two perceptive amendments that seek to extend the principle behind clause 1 of the Bill to other areas of the CQC’s work. While I applaud the sentiment behind these new clauses, I would like to briefly explain why I do not believe they are necessary.
New clause 2 would require the CQC to include safety of care as an indicator against which providers of health and adult social care services are to be rated. It would require the CQC to consider safety in the ratings of quality that it now produces following every inspection of a hospital, social care provider and GP practice. The question in considering this new clause is not whether safety of care should be considered in the CQC’s performance assessments of providers and reported on. Of course, safety is, and should be, a major consideration in how the CQC carries out its work. Rather, the question is: should this House prescribe the way that the independent regulator conducts its business?
There is a key distinction that needs to be made here. Clause 1 relates to the requirements that are placed on providers of health and adult social care services. Importantly, it does not place an additional requirement on the CQC itself. This new clause is different in that it would have the effect of instructing the CQC in how to carry out its regulatory role. The previous Government established the CQC under the Health and Social Care Act 2008 with the primary objective, under section 3, to protect and promote the health, safety and welfare of people who use health and social care services. This is its core purpose, and we strongly believe that the CQC can be an effective regulator only if it is free from undue influence from Ministers.
The Care Act 2014 underlined this by putting in place a number of measures to enhance the CQC’s independence: the appointment of chief inspectors of hospitals, general practice and adult social care as members of a new unitary board and the removal of nine separate powers for the Secretary of State to intervene in the day-to-day operation of the CQC. As part of this, the Secretary of State delegated the function of devising the ratings methodology when putting in place the new arrangements for ratings and performance assessments of providers in the Care Act 2014. Devising the indicators against which providers are to be assessed and rated is, therefore, a matter for the CQC to decide, having consulted with the Secretary of State and other appropriate stakeholders.
The CQC has decided to make safety one of the key indicators for the assessment of provider ratings. As a result, safety is a critical component of the CQC’s new inspection regime. Under the leadership of the three chief inspectors, the CQC has put in place specialist inspection teams that are able to scrutinise the quality and safety of care much more rigorously.
These inspections ask five key questions of the services that are inspected: first, are they safe; secondly, are they effective; thirdly, are they caring; fourthly, are they responsive to people’s needs; and, fifthly, are they well led? That is the core of the inspection regime. These inspections no longer simply consider whether providers are meeting the registration requirements, and have moved us away from a tick-box methodology that was in place, sometimes to the detriment of patients, in the past. The inspections now provide a judgment about the quality of care on a scale running from “outstanding” to “inadequate”, offering providers, commissioners and local people fuller information about the quality of care. To date, the CQC has carried out more than 80 inspections and published 48 ratings of acute trusts alone. The CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care, and it has already rated many services as “good”. This new approach has also exposed some examples of poor care and variations in care, which I am sure we would all agree are unacceptable, and has made quality transparent in a way that it has never been before.
So I am sympathetic to new clause 2, but my sympathy is in part constrained because I am already confident of the great strides the CQC is making to be an effective regulator of health and social care providers. Safety, of course, is one of the key questions the chief inspectors ask when rating the quality of health and adult social care services, and therefore the CQC is already meeting the aim of the new clause. I hope my hon. Friend the Member for Stone will agree that the CQC has made significant improvements, and that safety is already a major feature of its inspection process and ratings of care providers, and will feel able to withdraw his new clause.
My hon. Friend has also tabled new clause 3, which would require the CQC to include its assessment of the safety of health and adult social care services within its annual state of care report. That report is issued under section 83 of the Health and Social Care Act 2008, which requires the CQC to make a report on the provision of NHS care and adult social services and the carrying out of all the CQC regulated activities during the year. Hon. Members will be aware that under the 2008 Act, which established the CQC, the CQC’s main objective in regulating providers of health and adult social is to protect and promote the health, safety and welfare of people who use health care services. As such, safety and the avoidance of harm are already key elements of any CQC assessment of the provision of care by regulated providers.
I entirely agree that the CQC’s annual report should cover safety issues, and indeed the most recent state of care report, published in October, does exactly that. It is difficult to conceive of circumstances in which the CQC’s annual report would not cover the safety of care provided by the organisations it regulates. A report that did not address this important area of safety could amount to a failure by the CQC to discharge it primary functions as set out in the 2008 Act. In extremis, where that is the case, section 82 of the 2008 Act gives the Secretary of State the power to direct the CQC on how to discharge its functions. However, we must be clear that there is a distinction between the power of the Secretary of State to intervene if the CQC fails to perform the primary functions for which it was created and the need for the day-to-day operational independence of the CQC. As my hon. Friend outlined, this Government have rightly ensured that the day-to-day operation of the CQC is free from political interference, and we now have a genuinely independent inspector of health and care. So although I entirely agree with the spirit of the new clause, which seeks to ensure that the state of care report should cover the safety of care, I believe that the current legislative framework strikes the right balance between providing operational independence for the CQC and having a power for Ministers to intervene, in extremis, if the CQC fails to discharge its primary functions—those for which it was set up. Once again, I pay tribute to my hon. Friend’s work in taking forward the interests of his constituents, following the terrible events at Mid Staffordshire, and I hope I have given him sufficient reassurance to allow him not to press his new clauses to a vote.
I have listened carefully to the arguments that have been put, including those from the Labour Front Bencher. In the circumstances, I am content not to press my new clauses to a vote. There will be an opportunity for reconsideration as the Bill makes further progress and it is just possible that some people will take another look at them—we will have to see. For now, I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 4
Doctors’ language skills
The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors holding a licence to practise medicine in the UK have appropriate language skills to communicate effectively with their colleagues and patients.”—(Sir William Cash.)
Brought up, and read the First time.
I beg to move, That the new clause be read a Second time.
It is terribly important to use opportunities of this kind to discuss matters of such importance properly on the Floor of the House. It does not mean that we always have the right answers—sometimes, we do not even have the right questions—but there are some really important issues that need to be given an airing so that people outside can hear the nature of the discussion, rather than having that discussion held by an agency on its own account or, alternatively, by the civil service and then put forward in a Government brief.
Basically, this is a new proposal that deals with doctors’ language skills. There are many people in this country who believe that this is an important issue. It is pretty obvious that ensuring that doctors have appropriate language skills is rather important, especially given what happened in a particular case. I do not remember the names of the individuals concerned, but I seem to recall that the case involved a father who died after being treated by somebody from Germany. It seemed to be pretty likely, if not certain, that the reasons that happened were to do with a lack of proper language skills and proper experience of the medical practices in this country. The doctor was effectively coming here as a locum without appropriate qualifications or sufficient skills to be able to give the kind of treatment that was needed, and the result was a tragedy. Other Members of Parliament may have other such examples.
This is a very important issue. Indeed in April last year, the Medical Act 1983 was amended to strengthen the arrangements to ensure that all doctors have sufficient knowledge of English before being able to work in the UK. My new clause would help to ensure that all doctors were able to communicate effectively with colleagues and patients, which would sufficiently reduce the risk to patient safety caused by a lack of understanding of the English language that could result in the misdiagnosis and mistreatment of conditions. Many people regard that as common sense.
My hon. Friend quite properly puts that question to me as I am Chairman of the European Scrutiny Committee of which he is a member. We always come across these questions of interpretation. The short answer is that in relation to the issue of having appropriate language skills, the parameters for the communication of information between the patient and the person giving the treatment would be described as being within the framework of public health and the importance of ensuring that the people concerned—the patient—had not only adequate treatment but the opportunity to ensure that they were not put in danger. I think that in those circumstances it would pass muster and that we could legislate on our own account. If there were ever a challenge, I would propose that we introduce a further provision reading “notwithstanding the European Communities Act 1972” and then legislate. If we did that, under sections 2 and 3 of the 1972 Act the notwithstanding formula would enable us to bypass the European Court of Justice and ensure that we could legislate on our own account in this House to ensure that language skills were needed in English to ensure that patients in this country were properly safeguarded. I hope that I have dealt with my hon. Friend’s point.
I see him nodding and I am glad that I managed to pass that test. I am always grateful to my hon. Friend, who ensures that we all keep up to the mark.
On this occasion, I think we would have the capacity to make the change in the first place, but, if not, perhaps we can take a belt-and-braces approach in the House of Lords and use the notwithstanding formula. We shall see.
Again, I am most grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling this new clause, which covers an important subject—the language skills of doctors—although of course the language skills of all involved in clinical care are vital.
Clear and understandable communication is essential to safety and the quality of care of patients. Language skills are a necessary condition for good communication, but not a sufficient condition. They must be accompanied by good communication skills, with which not all of us are automatically blessed, however good our language skills. Communication skills teaching is now an essential part of training in medical and nursing schools and it is to the credit of the previous Government that they ensured that it was embedded in the curriculum of new medical schools and was taken forward in existing schools. I welcome the Government’s support for that important approach.
I understand that regulations have been in place for a short while to ensure that all doctors, whether from within or from outside the European Union, have appropriate language skills before being granted a licence to practise. I want to hear from the Minister what the effect of those important regulations has been and whether he believes that new clause 4 is necessary. I would also like him to consider whether the assessment of language skills should include communication skills within that language.
I want to speak in support of my hon. Friend the Member for Stone (Sir William Cash). This is an important new clause on a matter that it would be wise to have clearly set forth in primary legislation.
The heart of the matter is, unfortunately, the European Union and the mutual recognition of qualifications within the EU, and there are good reasons for that. The only way to open up service industries generally is if mutual recognition of qualifications takes place, so if we are to have a single market in services that is an important basis for it. However, above and beyond that there must be a fundamental principle of patient safety, which is embodied in this excellent Bill, and a lack of good language skills and of understanding of a language is a danger in both directions. It is a danger for the doctor who is listening to the patient explain his or her symptoms and it is also a danger when the doctor explains to the patient what steps the patient needs to take for better health. If there is confusion, it can have a seriously deleterious effect on the patient’s health.
We must be clear that this is not about restrictive practice or protecting the market for British doctors but about ensuring that there can never be such confusion. As my hon. Friend the Member for Stone says, if this provision runs into trouble with the European Union, we need to state clearly that it is of such fundamental importance that it must override international treaty obligations. It was Disraeli who said in his speech in the Manchester free trade hall in 1872, “Sanitas sanitatum, omnia sanitas”—that the first duty of Minister is the health of his people. That statement has underlined and guided Conservative policy for nearly a century and a half.
Indeed, although I am less clear on the relevance of that, and I was not intending to swap Disraeli quotations all morning. I just wanted to make that point about a fundamental principle that has guided our party since the 1870s and its relevance in defending health through ensuring that there is a proper standard of English-speaking—or in Wales, Welsh-speaking—physicians.
My hon. Friend used the word “ensuring”. That reminds me that insurance is a very important ingredient in the question of health and language skills—and, as my hon. Friend the Member for Stafford (Jeremy Lefroy) said, communication skills as well. If there were to be a failure of language, the consequence of which was to breach the terms on which an insurance contract was devised as between the patient and the national health service, as well as others involved in the contractual relationship, there would be massive financial consequences that could, in certain cases, run into millions of pounds.
My hon. Friend makes an interesting point. It is possible that that is taken care of by other parts of the Bill. Clause 1 contains the fundamental commitment that unreasonable risks should not be taken, and language could be seen to be part of that. The reason I like the new clause is that it makes it absolutely clear that language is fundamental.
It is very hard to think of a circumstance where a lack of communication could possibly be safe. There may be cases where a patient cannot speak, or absolutely dire emergencies where there is no alternative form of treatment, but in the ordinary course of events language skills must be essential for somebody who looks to work in this country for any length of time.
I hope that the Government will think about this new clause very seriously, and perhaps consider whether a “notwithstanding” aspect is necessary, and that if they do not accept it today, they will look at the matter again in another place.
I apologise for not being here when my hon. Friend the Member for Stone (Sir William Cash) opened the batting on this new clause.
I very strongly support the sentiment behind the new clause. It should go without saying that people who are practising medicine should be able to communicate properly in English. It is a sad state of affairs when we have got to a point where we feel the need to introduce legislation in this regard. Whatever the rights and wrongs of the matter, sufficient examples have been reported around the country to indicate that we do have a problem. It may not be widespread—it may only occur in pockets—but it is perfectly clear that in some areas there is a problem that needs to be addressed. If the Government do not intend to accept the new clause, I would like to know what they intend to do about this genuine problem that people have identified.
My hon. Friend the Member for Stafford (Jeremy Lefroy) made a reasonable point about the measures that were put in place, partly by the previous Government, relating to new doctors and people who are currently going through training. The problem with that, however, is that it does not deal with the people who are already practising.
My hon. Friend makes an extremely important point. Does he accept—perhaps the Minister will comment on this as well—that the revalidation process that doctors now have to go through should include, if it does not already, as I am sure that it must, language and, indeed, communication skills?
I take my hon. Friend’s point. I am not entirely sure, though, how robust that process is or whether the same test is applied for people who are currently practising as for those who are starting out on their training. I suspect that there may well be a slight difference in the standard that is expected. I hope that I am wrong and he is right; it will be interesting to hear what the Minister says. I would be interested to know how many people have been struck off because they are unable to communicate effectively—if it is hardly any, or none, that would indicate that the current regime is not working effectively—and how often the measures that my hon. Friend mentions have been invoked.
As ever, my hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) made an interesting point about the European Union. I do not intend to get bogged down in that today, but it would be interesting to know what the Minister’s understanding of this is. If he will not accept the new clause, is my hon. Friend’s point a factor in that, or is it his position, and that of the Government, that nothing in EU law would prevent such a provision from being introduced?
Although I agree with the sentiment behind the new clause, I wonder whether its wording is deficient and could lead to some unintended consequences. My hon. Friend the Member for Stone made great play of the need for people to be able to communicate effectively in English, and he is absolutely right, but unfortunately there is no mention of English in his new clause. That seems to be a rather glaring omission that could lead to unintended consequences at a later date. The new clause merely says that people who practise medicine should
“have appropriate language skills to communicate effectively with their colleagues and patients.”
I think what he is really trying to say is that they should have appropriate English language skills to communicate effectively with their colleagues and patients. As drafted, the new clause would place an onus on people practising medicine to have appropriate language skills in general to communicate effectively with their patients. In the case of a patient who speaks no English whatsoever and speaks Urdu, for example, would the new clause insist, in effect, that their doctor must be able to communicate effectively with them in the only language that they are capable of speaking? That would seem to be a possibility, because the crucial word that has been omitted is “English”.
My hon. Friend makes a good point. That enhances the complication that could arise as an unintended consequence. I agree wholeheartedly with the sentiment of the new clause and the intention behind it, but I wonder whether its wording may lead to unintended consequences in relation to languages other than English that were not foreseen when it was tabled.
As my hon. Friend will appreciate, the new clause says:
“The Secretary of State shall by order make regulations enabling the General Medical Council to ensure that all doctors…have appropriate language skills to communicate effectively”.
I am not prejudging this—I will be interested to hear what the Minister says, if he can take advice on the matter, and of course there is the House of Lords to come—but it may well be that the regulations can identify how my hon. Friend’s points, which I completely understand, can be addressed.
I am grateful to my hon. Friend. He may be right that the points I make can be overcome in one way or another, whether through his existing wording, which may well work, or perhaps a slightly amended version in another place. I just wanted to flag up this issue because I would not want any unintended consequences to come about as a result of the new clause. The whole point is that the onus should be on everybody to be able to speak English, and I would not want anything to allow for a loophole that prevented that from happening.
I wholeheartedly support the sentiment underlying the new clause. Integration is essential in this country and speaking the language is one of the key forms of integration. I do not see how it is possible to integrate into society if one is not competent in speaking English. I support the idea that people who come to this country should be able to speak English, whether they are patients or doctors—the requirement should apply to both equally. I shall be interested to hear the Minister’s view.
Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.
I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.
In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes
“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”
Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.
Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.
These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that
“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.
So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.
I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.
We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.
I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.
I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.
To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.
Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.
The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.
One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.
In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.
However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.
The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.
Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?
I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.
Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.
I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.
As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given additional statutory responsibility for ensuring that doctors
“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.
In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up to date with medical practice.
Doctors must now provide evidence at their appraisals that they are communicating effectively in line with the standards set out in the GMC guidelines, “Good medical practice”. Effective communication skills include treating patients with compassion and sensitivity. That is just as important as having technical knowledge of the English language and goes to the heart of the Bill promoted by my hon. Friend the Member for Stafford, which addresses some of the problems flagged up by the Francis inquiry, including the need for all patients always to be treated with dignity and compassion. Those values are at the very core of our revalidation process, which is overseen by the GMC.
The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.
The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.
Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.
As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.
The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.
For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.
The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.
The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.
The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.
I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.
I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.
I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
I beg to move, That the Bill be now read the Third time.
I thank all those who have worked with and supported me in bringing the Bill to this stage. I especially thank my hon. Friend the Member for Stone (Sir William Cash), who, as I mentioned on Report, has been an inspiration, as have Julie Bailey, Ken Lownds and many others who campaigned for the Francis inquiry. My hon. Friend the Member for Mid Norfolk (George Freeman), who is now a Minister, was also a driving force—clauses 2 and 3 are substantially based on a Bill that he had previously introduced—and I thank him for his work and support. I also thank all hon. and right hon. Members who served in Committee and who sponsored the Bill.
I thank the Clerks in the Public Bill Office for all their help, advice and skill, as well as the Bill team and others in the Department of Health, who worked extremely hard, for all their skill and advice. Finally, I thank the hon. Member for Copeland (Mr Reed) and his Front-Bench colleagues, and my hon. Friend the Minister and his Front-Bench colleagues for supporting measures that I believe will assist us to get what we all want—higher-quality, safer and more integrated health and social care.
That is the purpose of the Bill: if it does not help in some important ways to achieve that, it will serve no purpose. I believe that it will do so for several reasons. First, it will ensure that every Secretary of State makes patient safety a priority at all times. Would that have prevented the tragic events at Mid Staffordshire or in other hospitals, surgeries or care homes? It would certainly not have done so in every case, but I am convinced that the attention given to safety would have done precisely that—prevented much avoidable harm to patients. In the important words of the Prime Minister in response to the Francis report on 6 February 2013:
“Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means.—[Official Report, 6 February 2013; Vol. 558, c. 281.]
Secondly, the Bill will put in place another of the necessary building blocks for the integration of health and social care that we all desire. A consistent identifier is not sufficient to bring about integration, but it is most certainly necessary and will help in some way.
Thirdly, the Bill will help the sharing of information, which is vital for a person’s care. Almost everyone with whom I have discussed this matter has told me of times when they or their loved ones have had to repeat information about their care on several occasions, or found that vital information—perhaps regarding medication or allergies—was simply not available to the person caring for them.
Finally, the Bill will bring consistency to the objectives of the regulation of the health and social care professions under the overarching objective of the protection of the public.
During the passage of the Bill, a number of important questions have been raised, both within and without the House. I am grateful to those who have raised them, because it is vital that a Bill such as this receives strict scrutiny.
A fear was expressed that the consistent identifier would become an ID card by the backdoor. The identifier could never become an ID card because it will be used only to facilitate the provision of health services or adult social care, and it must only be used in the individual’s best interests.
It has been asserted that there is no need for the duty to share information because the sharing of information is already required as part of the professional duties of health and care professionals. However, Dame Fiona Caldicott’s review in 2013 concluded that such sharing was not always happening as it should as a result of a “culture of anxiety”. The legislative landscape was found to be a contributory factor and a risk-averse attitude to information sharing was cited as a barrier to sharing by staff who deliver care directly to individuals. The Bill seeks to provide a remedy, while setting clear limits on the information that can be shared and the circumstances under which it can be shared.
Others have concerns about the Bill’s introduction of
“public confidence in the professions”
to the objectives of the regulatory bodies. The Law Commission’s report of April 2014 noted:
“It was argued that maintaining confidence in the profession was being used to punish professionals who pose no threat to the public for something which incurred the profession’s, or the public’s, disapproval. Specific examples included a nurse who was disciplined for publishing a work of fiction about euthanasia and an investigation into a doctor’s behaviour at a Parent-Teacher Association meeting. Some argued that the concept of maintaining confidence in the profession was too subjective and difficult to quantify to form the basis of a statutory duty.”
The report concludes that in constructing the draft Bill on which the provisions of the Bill are based, the Law Commission was
“not seeking to change the current legal position or disrupt the relevant case law. The clause restates the existing legislative position that public protection is the regulators’ ‘main’ objective, and recognises that the public interest also consists of promoting and maintaining public confidence and proper standards of conduct and behaviour.”
I have no doubt that, should the Bill receive its Third Reading today, all the matters that I and others have raised will receive further scrutiny in the other place by experts.
No legislation can guarantee that there will be safe, high-quality care. Such care is founded on the capability, commitment and compassion of those who work day and night in our health and care services; no law can bring it about. What legislation can do, and what this Bill seeks in some small way to achieve, is to ensure that the framework within which those people work is sound—that the systems, resources, training and regulation that they need to provide safe, high-quality care are in place. In doing so, this is a Bill for both patients and professionals; for avoidable harm and poor care hurt both, while safe, high-quality care is a blessing for all.
I simply want to say how glad I am that the Bill has reached its Third Reading and to congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on piloting it through, with the conspicuous help of the Minister and the Government. As I have said before, Ken Lownds and others have also been involved. Over the many years that I have been involved in the Mid Staffordshire situation, Ken Lownds has been a tower of strength, and we are all very grateful to him.
This is a Bill of national importance on a scale way beyond that of many private Members’ Bills. My hon. Friend deserves congratulations from all parts of the House on bringing it forward. I am glad that the Opposition are giving it a fair wind because it has a truly national purpose. It is in the interests of everybody that we achieve the kind of zero-harm care to which we should aspire.
I am extremely glad that the Bill will now go to another place, where, as my hon. Friend said, there are many experts who will no doubt say quite a lot about it. There may well be further amendments that will come back to this place. I urge their lordships to have regard to the importance of the Bill and the principles that lie behind it, and to seek amendments in the light of the fact that it is about our constituents. We, as an elected House, know—certainly my hon. Friend and I know—of the hard experience and tragedy that have been experienced by our constituents. Our constituents—the people of this country—deserve to have the improved health care that the Bill will help to achieve.
After those few words, I simply reiterate my thanks to my hon. Friend.
I follow my hon. Friend the Member for Stone (Sir William Cash) in congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy) on piloting the Bill so safely through the House. It is not necessarily easy to get private Members’ Bills through—and nor should it be—given the Scylla of the Back-Bench Tories who are not keen on new Bills coming through and the Charybdis of the Opposition, who sometimes suck Bills down to the bottom of the sea. I therefore congratulate him warmly on having achieved it.
My hon. Friend has done something that rather surprisingly was not done in the first place. The explanatory notes state that clause 1
“has the effect of removing the Secretary of State’s discretion around whether the requirements for registration with CQC should cover safety of care.”
It is amazing that the Secretary of State had that discretion. Why on earth would anyone want the Secretary of State to be able to think, “It doesn’t really matter if the safety of care is implemented or not. I think on this occasion I won’t bother with it.”? How reassuring it is that somebody has had the sense and wisdom to bring forward a Bill to close that extraordinary loophole, drawing on the experiences that are well known, particularly to the Members of Parliament from Staffordshire.
I take great comfort from what my hon. Friend said about the identifiers not being—to carry on with my Greek mythology—a Trojan horse to bring in an identity card system. It really would have set trouble alight if he had been trying to do that, but it seems perfectly reasonable to have a system that sees efficiently who people are within it and has a consistent form of identifying them. Having a notional go at an identity card system does not seem reasonable, so I am glad that he has stated so clearly that the Bill is not intended to do that. I am sure that their lordships will take careful note of that.
It is a tremendously important Bill that is being passed today, and one that I am sure that the other place will want to expedite because there is little time left between now and the end of the Session. The Bill will ensure that the primary duty of not doing harm to patients is established in law. As I said, it is extraordinary that it was not there before. I commend my hon. Friend for his discovery of that lacuna and his closing thereof.
I, too, pay tribute to the work of the hon. Member for Stafford (Jeremy Lefroy). The diligence and tenacity with which he has pursued the Bill, and the collegiate nature in which he has done so, are to his eternal credit.
Members across the House, many professional bodies outside this place and others support the principles and aims of the Bill. Harm-free care is something to which everybody in our NHS aspires. Although it is something that, frankly, we should take for granted, it is something that any health care system in any part of the world must work tirelessly to achieve. Credit must go to the NHS staff, both clinical and non-clinical, who work tirelessly, often in very trying circumstances, to deliver high-quality care. I am sure that Members from all parties will echo that sentiment.
I do not wish to repeat what I said on Second Reading, in Committee or on Report, so I will keep my remarks relatively brief. The key principles of harm-free care, data sharing, and consistent objectives for regulatory authorities have been welcomed by the Opposition, and I will touch briefly on the why those things are important.
I have already mentioned harm-free care, and the Bill will give power to the Secretary of State to bring forward regulations to ensure that high-quality, safe care can be delivered. A wide-ranging power is being granted to the Secretary of State, and I welcome the Government’s assurances that any measures introduced will be subject to full parliamentary scrutiny, as is proper with such issues.
We have already debated the benefits and risks of data-sharing, and Third Reading is not the place to do so again. I have been clear about the benefits that can be realised through effective data-sharing, although there are still concerns, many of which I raised on Second Reading. It is important that the national data guardian is put on a legal footing to ensure that any issues that arise can be dealt with effectively and swiftly.
On the regulation of health and social care professions, it is logical to have a consistent overarching objective for regulatory bodies, and right that that objective is patient safety. A number of bodies continue to express concerns about a possible conflict between the practical implications of a number of those objectives, and I ask the Government to keep that under review to ensure that the Bill is effective.
The issue of public confidence runs through the entire Bill, and the hon. Member for Stafford touched on that in some detail. We all want to have confidence that the care we receive is of the highest quality, and to have confidence in the integrity and security of the data and private information that the NHS holds about us. We need to know that our data are used only with our permission and for the betterment of health and social care provision. Finally, we want confidence that doctors, nurses and others are properly supported and regulated to ensure that best practice is always followed. The Bill should help to ensure public confidence in those areas, which is why Labour will support it today.
We have had a productive debate, and I thank hon. Members on both sides of the House for their contributions. I put on record my appreciation for the consensual way that the Bill has been approached by all parties, and I thank the hon. Member for Copeland (Mr Reed) for his constructive attitude. Few private Members’ Bills make it beyond Second Reading, and there is determination across the House to improve patient safety. I hope we can get the Bill on to the statute book as soon as possible.
I commend my hon. Friend the Member for Stafford (Jeremy Lefroy) who, with tireless effort, is doing his best to ensure that the terrible experiences at his local hospital never happen again. The Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients and protect the public. I also commend my hon. Friend the Member for Stone (Sir William Cash) on his dedication to raising some of the issues that led to the Francis inquiry and to this Bill, and for his tireless advocacy on behalf of his constituents in Stone and its surrounding areas.
We would not be where we are with this Bill without my hon. Friend the Member for Stafford. All MPs can learn from his example of outstanding public service and putting the interests of his constituents and local patients first. I congratulate him on his dedication and hard work on the Bill. I also thank my officials in the Department of Health, the Clerks of the House, and everybody who has contributed and put a lot of work into the Bill. It is rare for a Bill to get past Second Reading, and a lot of work has been done. I thank everyone who has supported my hon. Friend’s efforts to make these important changes.
I will not dwell on the importance of the Bill because we had that debate on Second Reading, in Committee and on Report. I am sure we all agree that ensuring that the CQC is operationally independent from the Secretary of State and free from political interference is vital. Not Whitehall nor the Secretary of State, but independent, professional inspectors on the ground who understand what good care looks like must carry out hospital inspections, and the Bill will further support the independence of the CQC.
The Bill will also ensure that we improve the use of information for the purposes of direct care. In Committee we discussed the importance of joined-up care, so that a doctor who receives a vulnerable patient with dementia from a care home is better able to care for them because they have access to care records for the immediate purpose of delivering care to that patient. That saves doctors and nurses time and means they can understand their patient better, and the patient will therefore be cared for in a better way. These important measures will help health care professionals to look after their patients more effectively. As Fiona Caldicott said, there is a duty on professionals to share information for the provision of direct care. That is what the Bill is about and it will hugely benefit patients. I reiterate the Government’s commitment to consulting on the role of the national data guardian in the future.
In conclusion, the Bill is about patient care and safety, which should be at the heart of everything our NHS does. This is what everyone engaged in the delivery of health care is primarily concerned about, and that is why many people—including myself—became health care professionals. We care about patients and want to do our best for them. The Bill will do much to improve the safety of patients and protect the public. It is a welcome Bill, and patients in Stafford and across the country will be grateful to the hon. Member for Stafford for introducing it. I thank him for that and urge hon. Members across the House to give the Bill their full support.
Question put and agreed to.
Bill accordingly read the Third time and passed.