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Health and Social Care Bill

I am most grateful to the Minister and I am particularly grateful to the noble Earl, Lord Howe, and the noble Baroness, Lady Cumberlege, who spoke so eloquently to these amendments—far more eloquently than I was able to do. They filled in a lot of the areas that I had not done adequately when I moved the amendment. The Minister spoke about regulations. I am reassured that the responsible officers will always be medical practitioners and that there will be guidance to accompany their role. I hope that that will include clear guidance on remedial action, including training, retraining, support and so on. However, I am still concerned about system failures and how they will be rectified. I hope that in the guidance power will be given to the responsible officer to ask questions about system failures. These failures will almost inevitably involve people from other professional groups, clerical staff and possibly volunteers and so on, and they may involve other trusts as well where, ultimately, the problem has landed on the clinician. However, an accumulation of system failures may have occurred—for example, out in the community before a patient went into hospital or in the hospital before a patient went back out to the community, or it may be a system failure in a relationship between health and social care. When a crisis occurs, it seems to land in the doctor’s lap. I have a real concern that this does not seem to be clearly thought through in relation to system failures, remedial action across the board and the powers that the responsible officer will have, because unless that officer has powers, when they try to investigate something they will hit a brick wall and be told that it is outside their area of jurisdiction or whatever, yet the matter may be really important in terms of what needs to be done. With that in mind, I have been minded to suggest pilot schemes. I hope that the Government will think carefully about pilots before simply rolling out their proposals across the board, so that lessons can be learnt and problems ironed out. The final group about which I am concerned is locums, whom the Minister did not address in her reply. When people work in a hospital trust in either a training post or a permanent post, it is easier for them to be attached to a responsible officer, but locums are very mobile and they may leave their problems in one area and move into a different area. They might move from England to Wales or vice versa, or up to Scotland. Allocating responsible officers to them will be particularly difficult. I know that the noble Earl, Lord Howe, raised the issue of the Armed Forces, which also needs to be addressed. I would be interested to hear the Minister’s response to my questions.