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NHS Redress Bill [HL]

My Lords, I hope that I have some fresh points to make. When I was still working in the National Health Service in 1991, I remember Rosie Barnes, the SDP Member of Parliament in the other place, introducing a Bill for no-fault compensation for health service patients. I have watched with interest as successive governments have tried to deal with this problem. Like the noble Baroness, Lady Murphy, when I was a Member of Parliament I certainly saw those awful letters in response to complaints from my constituents. I noted that the majority of patients give up in despair under the current complaints system and simply cannot face the legal fees or the stress of litigation. Therefore, of course I welcome the Government’s attempts to address the problem, but I have many areas of concern. First, I was discomforted to read the press release put out by the Minister, Jane Kennedy, in which she talked about medical negligence. In fact, she referred only to ““negligence””. I felt that that was rather an affront to the majority of hard-working health professionals in the National Health Service. Mistakes are not necessarily negligence; they can be made by doctors as well as accountants and other professionals, and she should have acknowledged that. Those mistakes, or errors of judgment, can be due to fatigue, often brought on by the need to achieve the targets of which the Government are so fond. The Minister smiles, but as one who has tried to achieve those targets and lives with someone who is still trying to achieve them, I know what I am talking about. A safe health professional is a relaxed and unhurried one who can spend all the time that is needed to explain to patients their diagnosis and treatment, not someone who is conscious of a bulging waiting room outside and a manager looming with a clipboard around the corner. A culture of defensiveness has developed in the health service, so that health professionals are unable to be totally frank with patients when an error occurs, as other noble Lords have said, because of the fear of litigation. As the noble Earl, Lord Howe, said, what patients really want is an explanation and an apology. It is as simple as that. I therefore hope that the Bill will help to dispel that culture. But it is difficult to know because in nearly every clause there is a reference to the Secretary of State making regulations. As many noble Lords have said, the secondary legislation is all-important but we do not know what it is. Perhaps the Minister will tell us when the regulations are due to be published, so that we can adequately address them in Committee. Otherwise, how can we effectively amend the Bill? I have several questions as a consequence. We are told that trusts will be registered under the scheme, which will be overseen by the National Health Service Litigation Authority and operated by current complaints departments in hospitals. There is no independence there for the patient. How will the complaints department have the expertise to perform what is a medico-legal process? Will it mean more non-clinical staff—managers, in common parlance—to investigate clinical mistakes and a larger NHSLA to oversee them? Reports made by complaints managers at present are often lacking in clinical veracity and have to be rewritten by overburdened clinical staff, which wastes more of their time and puts more pressure on them. We need to know how this will operate in practice. Will the low level of claims suggested—under £20,000—encourage people to try to get a few thousand pounds out of the NHS? It will cost them nothing to try. What estimate has been made of the cost of that and will it really reduce the current litigation bill, which is generally made up of much larger claims? I understand that there is a duty on scheme members to appoint a person to learn from mistakes. I find it quite extraordinary that that had to be in the Bill. Do people in the NHS not already learn from mistakes? Are we suggesting that more staff should be employed to consider mistakes and how they have been made? When I was in the NHS, I spent many hours considering mistakes and drawing up and revising protocols that drove doctors and nurses nearly mad. Surely we are doing this already and, if not, why not?