---

Health and Social Care Bill

I would certainly like to speak to the amendment in my name but do so considering the generous invitation from the noble Earl, Lord Howe, to join it with his amendment. That might provide the solution to the problem in hand. There are real dangers about information being passed on, based on tittle-tattle, gossip or suppositions, some of which may relate to cultural or perceptual differences between clinicians, but have no substance in how they actually affect their care of patients. For example, the fact that someone may eat their lunch on their own, join others or not join others, does not affect their clinical competence even though their colleagues might feel affronted, shunned or offended. But we are talking about clinical competence, not personal judgment, and for that reason it is very important that there is hard evidence. Indeed, when there is hard evidence to alert one to the fact that there may be a problem, it is very appropriate for it to be handed on. Perhaps I may illustrate that with a specific example. A doctor’s handwriting may be more easily read by some than by others, but if it is not legible it has serious implications for the care of the patient because it is not only a clinical record but it hands on information to others. If the handwriting is so poor that the drug chart is difficult to read, that is another order of serious implication. A doctor challenged about his or her handwriting would be expected to take—and should be supported in taking—remedial action to relearn patterns of handwriting and the use of capital letters on drug charts and so on. Even when he or she has done that, it would be appropriate to hand on to their next employer the fact that there has been a problem. The hard evidence of copies of the entries in the case notes and on the drug chart would apply pressure for the doctor to keep up the remedial action. However, that is quite different to saying that one does not like the way someone wrote or entered something in the notes where there is no hard evidence to back it up. This has implications for the registration. Hard evidence should be available to hand on. Unsubstantiated allegations may turn out to be defamatory and we could end up with some nasty cases being brought by doctors who fear that their reputation has been unfairly smeared by allegations without any substance. A second trust could inadvertently get caught up in such an action if it takes at face value hearsay evidence which has no substance to it.