---

Health and Social Care Bill

Before discussing the specific amendments I should point out that this measure is in the Bill because the common conclusion of recent inquiries into doctors who have harmed their patients, including the Shipman, Ayling and Kerr/Haslam inquiries, was that healthcare organisations failed, both singly and collectively, to ““join up”” the information that was available to them and that this led to the abuse and death of patients. The noble Earl is correct to say that this is a very sensitive issue and that it is important that we get it right. There is always a balance to be struck between making sure proper measures are in place to protect patient safety and ensuring that doctors and other healthcare workers do not have their careers blighted by unfair or malicious accusations. We think we have got the balance right here. I hope that I will be able to persuade noble Lords of this and set out why I cannot support the amendments. Amendment No. 150 would have the effect of only allowing information to be shared if the case was proven. That by itself would be a threat to patient safety. It would apply a more stringent test to the kind of information that might be shared than is currently in the Bill. Similarly, Amendment No. 150A would require the information to show a definite risk to patient safety in order for it to be shared. While I understand the reasoning behind these amendments—they were adequately explained by the noble Earl and the noble Baroness—we believe they would still be too restrictive and could, in certain circumstances, prevent valuable information being shared that may reveal a threat to patient safety. For example, a set of clinical indicators for a health professional who works across a number of locations could potentially suggest there is a problem, but the interpretation of this data is not clear cut or definite. In this case, the information that the healthcare organisation has shows only that there ““may”” potentially be a threat to patient safety. If I accepted these amendments, the information that ““may”” show a threat to patient safety could not be shared. But other healthcare organisations in which this professional is working may hold similar isolated incidents of concern. Put together, they form a pattern that definitively shows that he is a threat to patient safety. That pattern could be identified and action to protect patients taken only if healthcare organisations can share information that ““may””—not ““does””—show a threat. I do not deny that it is a sensitive and difficult issue. I know that we need to ensure that healthcare organisations share information appropriately, but the best way to do that is by secondary legislation and guidance detailing the tests that need to be applied and the steps that should be taken before information is shared. An expert group charged with helping to implement the White Paper is looking at this issue and will help us to develop the necessary secondary legislation and guidance. The effect of Amendment No. 151 would be to ensure that no information could be shared unless the healthcare worker involved had been informed. As a general rule it must be right that healthcare workers are made aware of concerns whether these are shared or not, and certainly before such concerns are shared with other organisations. However, there may be exceptional cases when this is inappropriate or even impossible, for example, when there are concerns that informing the worker might hamper an investigation, possibly by enabling that worker to influence witnesses. For example, the Kerr/Haslam inquiry took the view that a letter of retraction written by a patient who had allegedly been abused by William Kerr was probably written as a result of pressure from him, or one of his supporters, after he had been informed of the accusation. There may also be cases where the worker has already left the employment of the healthcare organisation and has not left contact details. While it may then not be possible to inform the worker, the healthcare organisation may judge that it is necessary to share the information with other organisations where that individual might work. In such circumstances, the amendment would stand in the way of action needed to protect patients. We intend instead to provide healthcare organisations with detailed guidance setting out the limited circumstances in which it would be justified to share information without informing the healthcare worker, while making clear that the general rule should be that he or she should be told before any information about them is shared. I hope that the Committee will feel that I have explained why the Bill is drafted as it is and that the noble Earl will withdraw his amendment.