David Fuller Case
Lord Faulks Excerpts(2 years, 6 months ago)
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Lord Kamall (Con)
I thank the noble Lord for that suggestion. As far as I understand, the inquiry will be as wide ranging as it can be and wants to include input from as many people and stakeholders as possible who are affected by, or will be affected by, the implications of the investigation. There are already a lot of calls. A number of people have spoken to me today informally, for example, with a number of suggestions, making me recognise how much wider this goes. It is not just about the storage of bodies in hospitals but in other places, including funeral directors’ premises. I am sure that the suggestion will be considered, but I will confirm that.
Lord Faulks (Non-Afl)
My Lords, I welcome the Statement and welcome the inquiry that is to be set up. I hope that lessons will be learned from it. The Minister mentioned the question of compensation and how legal advice was being sought in relation to that. I think that advice will indicate that the law is extremely complex in this area, unsurprisingly perhaps. Of course, it is also complex in the criminal area, as the noble Baroness, Lady Brinton, pointed out.
On the question of civil compensation, there have already been certain stories to the effect that millions of pounds of compensation are going to be obtained. There is the likelihood, I suspect, of there being some great case—as there was, for example, in the Alder Hey body parts litigation, and I declare an interest as being one of the lawyers involved in that. I respectfully suggest that that is not something that will benefit very much all those affected by these dreadful events. I respectfully suggest to the Minister, for consideration by his department, that, rather than embark on long, complex and uncertain litigation, it would be wise to set up a scheme to provide some form of statutory compensation for a set amount which would be an appropriate recompense for these dreadful events.
Lord Kamall (Con)
I thank the noble Lord for that suggestion. As we are all aware, there is a wide range of experience across this House, and it is important that we draw on that when it comes to considering the terms and parameters of the inquiry. The trust and NHS Resolution are considering the right approach to compensation and, as the noble Lord acknowledged, that does involve getting further legal advice. The trust has been quite clear that it will provide support to the families concerned. One of the things that this Statement has brought out is the wide range of experience and the suggestions that have been made by noble Lords for helping the inquiry along. I welcome those suggestions and will feed them back into the department.
Health Service Safety Investigations Bill [HL]
Lord Faulks ExcerptsTuesday 29th October 2019
(4 years, 7 months ago)
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Lord Faulks (Non-Afl)
My Lords, on the face of it, who could fail to welcome a Bill that, in the words of Clause 2(2), is designed,
“to identify risks to the safety of patients and to address those risks by facilitating the improvement of systems and practices … of NHS services”?
It can hardly be in dispute that things go wrong in the NHS. This is not surprising, given the number of interactions that take place between doctors, healthcare professionals and individuals. I join other noble Lords in my admiration for those who work in the NHS.
I should declare my interests as a barrister who, for the last 30 years, has acted for the NHS, the Medical Defence Union and claimants in medical negligence claims. The amount that the Government spend on these claims is said to be second only to the cost of decommissioning in the nuclear industry. To be more exact, in the 2018-19 annual report and accounts for the NHS, the cost was put at £2.4 billion. However, the NHS actuaries assessed that the true estimate of harm at current prices is £9 billion, 60% of which relates to maternity claims. As of 1 March 2019, it is estimated that £83 billion will be required for claims, to include those incidents which have taken place but have not yet been reported and those that have. Surely this has to change.
The Joint Committee that carried out pre-legislative scrutiny of the Bill did not suggest that there should be any changes to the claims system. Understandably, it might well have thought that this was beyond its remit. However, while this Bill will not reduce the NHS bill to allow more money to be spent on treating patients, that is not my main concern about it. I ask myself two central questions: first, what will it do; and secondly, are the powers that will be given to the HSSIB really justifiable? The body will investigate “qualifying incidents” and the body itself will decide what they are. I ask the Minister: what will the HSSIB be able to investigate which cannot be investigated at the moment?
It should be remembered that hospitals and trusts carry out their own investigations, which are sometimes called root cause analysis. Incidentally, these are routinely disclosed in litigation, which may give a clue as to how the courts are likely to exercise the balancing powers that exist in relation to the safe space provisions. The CQC has powers of investigation. NHS Resolution has a safeguard and learning department, designed to identify themes emerging from claims and lessons to be learned. There are complaints procedures, including the Parliamentary and Health Service Ombudsman. There are claims at inquests and disciplinary proceedings, and there are major inquiries such as those into Mid Staffordshire hospital, Bristol heart surgery, or HIV and haemophilia. Let us not forget the contribution of the royal colleges, or the considerable amount of published literature which contributes to the corpus of learning. I have not even mentioned all the less formal teaching and learning that goes on in the NHS. There is a duty of candour. As the noble Lord, Lord Hunt of Wirral, mentioned, we have Section 2 of the Compensation Act 2006. Then there is the sort of frankness with which we are familiar, as described by the noble Lord, Lord Turnberg.
Do we really need this additional body? It will take over from its non-statutory predecessor, set up in April 2017. Was that body really considered insufficiently independent? Was its work really hampered by lack of statutory powers? At the moment, I have serious concerns that there may be a serious duplication of investigation. Is it surprising that Keith Conradi, the chief investigator of the HSIB, told the National Health Executive that one of the issues in deciding whether to investigate was:
“Do we really want to waste our resources if there are others already involved in this?”
The problem with this new body is that it will understandably feel it is necessary to investigate in order to justify its existence. Will it find 30 matters per year which satisfy the qualifying criteria? Many problems are one-offs, involving rogue practitioners such as the much-mentioned Ian Paterson. I must declare an interest in that I was originally instructed for the NHS in connection with his claims, but I then became a Minister and had to give up that involvement. Problems may involve particular hospitals which have developed bad practices. There may simply not be that many general themes which need investigation. Of course I entirely agree with others who have suggested that if this body is to exist it must include the private sector as well as the NHS if lessons are to be learned.
Clause 33 requires the Secretary of State to publish a review of the effectiveness of the board. How will this be measured? How good a response will it be for it to say, “Well, we did not find much that met our criteria and we were concerned to avoid duplication”? Such restraint is not characteristic of quangos. Surely the measure of effectiveness might be much better to avoid the dust-gathering that we have heard about. In other words, if there has been a report and there have been recommendations, what is being done about them?
The second issue, which I can deal with much more briefly, refers to the HSSIB’s powers, which will undoubtedly be probed carefully in Committee; a number of cogent points have been made in the debate about them. The justification for the really quite draconian powers is the need for this safe space. They are not popular with lawyers for claimants, the ombudsman, the Professional Standards Authority, the Campaign for Freedom of Information and the News Media Association. I was going to declare an interest as the chair-designate of IPSO, but the noble Lord, Lord Hunt, has already done that for me. It explains my change of location in your Lordships’ House. At the moment, I am not persuaded that the Campaign for Freedom of Information is not right in saying that the Freedom of Information Act, whatever its shortcomings, provides a more balanced mechanism for encouraging candour yet protecting individuals. The NMA is right to point out the absence of any consideration of Article 10 of the ECHR in the HRA memorandum to the Bill.
I am sure that, if the Bill becomes law, the members of the body will perform conscientiously and with the best possible motives. I remain somewhat unconvinced about the analogy with the aircraft industry, although I take the point made by the noble Lord, Lord Ribeiro, about the need to learn from near misses, which was established in that industry. I also think that it is a good idea to learn from other disciplines. I have seen an extraordinary demonstration by a special care baby unit specialist, describing how they had learned how to make themselves more efficient by watching pit stops at Formula 1 races. The co-ordination there was a useful lesson.
Whichever party is in government, the department of health needs to spend some time deciding how it can reduce the huge amount of money spent on claims. Money can be saved to improve patient outcomes, which, after all, is what we should all want. The Bill will result in the creation of an expensive quango. I am afraid it smacks a little of blue-sky ministerial thinking. Despite my reservations, I very much hope that the Minister’s optimism is justified and that this body is not in due course placed on some sort of legislative bonfire.
NHS: Clinical Negligence
Lord Faulks Excerpts(6 years, 4 months ago)
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Lord O'Shaughnessy
I recognise the issue the noble Lord has raised; it has been raised by a number of people who are concerned about and interested in this issue, as we all are. The problems are significant. The annual costs of dealing with these injuries and other issues has quadrupled over the last 10 years. That is the scale of what we are dealing with. We have to act—indeed, the National Audit Office has implored us to act. It is one of the issues we are considering as part of a cross-government strategy that will report in September. I am not in a position to give more detail at this stage, but it is an area we are looking at.
Lord Faulks (Con)
My Lords, I have acted for the NHS and the MDU on a number of occasions. However, perhaps the Minister will help me. One of the reasons why these claims have increased in value is because of the rather mysterious decision by the Government to alter the discount rate, which has often resulted in the doubling of the size of claims. Can he tell the House whether the Government are seriously considering placing a cap or tariff on damages, as is often done in other jurisdictions? That would not only clarify the amount of damages obtained, but significantly reduce the legal costs involved in such disputes.
Lord O'Shaughnessy
The noble Lord knows more about this issue than anyone in the House, I think. The issue of reform to tort law is difficult. We have to be very careful when stepping across the idea of full compensation. It is one of the issues we are looking at. Other countries, such as Australia, have looked at this and we are considering it as part of the cross-government strategy. As I said, we will report by September this year on our plans in this area.
Care Bill [HL]
Lord Faulks Excerpts(10 years, 7 months ago)
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Lord Warner (Lab)
I rise as a member of the Joint Select Committee to strongly support the amendment. I shall not go over the previous legal history, or repeat what I said in Committee, other than to emphasise a particular aspect of the case to which I drew attention then. That case related to an elderly woman in her 90s who was resident in a private care home and was totally self-funded. She had been a resident for some time and had the temerity to air her views on assisted dying, which did not please some of the home’s staff. She did not seek anybody’s help to commit suicide; she just expressed her views. The home’s management gave her four weeks’ notice to leave the home as a result. When her son raised the issue of her rights under the Human Rights Act with legal counsel, the opinion he was given was that she lacked protection under that Act because she was not in receipt of a service from a body providing a function of a public nature as her placement was neither publicly provided nor in a publicly funded home.
As a member of the Joint Select Committee I raised this matter when we were looking at the Bill and, after deliberation, the committee was unanimous in recommending that the Bill should be amended to clarify matters. This is what the amendment moved by the noble Lord, Lord Low, does. It covers all users of a regulated social care service. It is clear that there are differences of legal opinion on this matter when particular cases are raised. I consider that as parliamentarians, it is our duty to put the matter beyond doubt and provide self-funders with the legal certainty that other elderly people may have when they are in receipt of either domiciliary or residential care.
One of the most important new points that has been made on this issue since we debated it before was made by the noble and learned Lord, Lord Hope of Craighead, when he said that courts will notice if we do not take this opportunity to amend and clarify this legislation. That means that we cannot—as one of my children would say—faff around any longer on this issue. We have to make a decision; the amendment makes that decision, and we should all support it. Frankly, the Government should stop the legal equivalent of counting how many angels can be put on the head of a pin and accept the legal certainty that the amendment moved by the noble Lord, Lord Low, provides. They should be supporting people who are paying their own way by funding their care, not the reverse. There will be a lot more of them in the future so let us provide that protection now.
Lord Faulks (Con)
My Lords, I share, of course, the concern of all noble Lords that we should take all reasonable steps to protect vulnerable people who receive social care in whatever circumstances. I enter this debate for the first time with considerable trepidation, having regard to the great distinction of those, both present and absent, who support this amendment. I have to express some real doubts about it.
As far as I am aware this is the first time an attempt has been made to include, within the scope of the Human Rights Act, what may be a purely private function. Those who receive care may not be overly concerned with whether it is being provided by a public authority, a private provider, or in some hybrid arrangement. Nevertheless, this amendment is in effect extending the scope of the convention beyond the terms of the Human Rights Act.
It is important to consider what protection would be available anyway, in the absence of this amendment. If a poor standard of care is provided to an individual, it is likely that the provider will be in breach of an express term of any contract or in breach of a term implied by the Supply of Goods and Services Act 1982. There will almost certainly be a claim in tort, probably relying on the tort of negligence. There is, of course, a further safeguard in relation to all providers of publicly arranged care, in that all such providers have a duty imposed by Section 6 of the Human Rights Act, at least following what I would submit was the closing of the YL loophole by Section 145 of the Health and Social Care Act. The CQC, as a regulator and a public authority, is subject to the convention.
However, the amendment would, as I understand it, purport to provide some additional remedy; presumably some award of damages. The noble Lord should be aware of the relatively limited scope of damages awards under the Human Rights Act. As Lord Bingham said in the Greenfield case in 2005,
“the 1998 Act is not a tort statute. Its objects are different and broader. Even in a case where a finding of violation is not judged to afford the applicant just satisfaction, such a finding will be an important part of his remedy and an important vindication of the right he has asserted. Damages need not ordinarily be awarded to encourage high standards of compliance by member states, since they are already bound in international law to perform their duties under the Convention in good faith, although it may be different if there is felt to be a need to encourage compliance by individual officials or classes of official”.
The House of Lords also emphasised that the Human Rights Act was not to be regarded as a panacea. Indeed, Lord Bingham went on in Greenfield to say that the purpose of the Act,
“was not to give victims better remedies at home than they could recover in Strasbourg”.
However, that would be the position here if this amendment was passed. My conclusion is that the amendment amounts to an illegitimate extension of the Human Rights Act and would not, in reality, provide any significant extra protection for those who, quite understandably, we wish to protect.
The future of the Human Rights Act will have to await the outcome of the next election. However, amending the Act, which is what in effect this will do, would be inappropriate and, I have to say, unnecessary.
Lord Mackay of Clashfern
Before the noble Lord sits down, can he explain what, in his view, the remedy is for the case to which the noble Lord, Lord Warner, referred?
Lord Faulks
I understand that in the case to which the noble Lord referred, there was a private provider. There would therefore be the remedies I referred to earlier in my remarks—the normal remedies that those who receive services through a private arrangement would have. The Human Rights Act of course is concerned entirely with remedies against public authorities. I respectfully suggest that one must not lose sight of the remedies that exist, and have always existed, in relation to breaches or violations of anybody’s rights in the circumstances described.
Baroness Finlay of Llandaff (CB)
Before the noble Lord sits down, can he just clarify something? Noble Lords will have to forgive me, because we have had some very learned legal arguments here and I speak as a simple clinician. Half of the patients in a place of care run by a private provider may be funded by, and have gone through assessments provided by, the NHS. They would therefore be covered by the Human Rights Act but the other half, who have to fund their own care because some official somewhere said that they did not fall within the bar for continuing care funding, would not be covered. The decision as to whether the cover, at the end of the day, applies or does not apply will be left to whichever person determines the funding bar for that individual, as opposed to our knowing that we have protection for those who are vulnerable across the piece.
Lord Faulks
The noble Baroness refers to protection. With respect, the assumption behind her question is that, whatever the arrangements, those people would lack any protection. The burden of my speech is that they would have protection anyway. There is, of course, a distinction between whether their care is a result of a publicly procured arrangement or a purely private arrangement. In the latter case, as the law is currently, there would not be any involvement of the Human Rights Act. But, with respect, the House should not be under any illusion that there is no remedy or no protection for people in the circumstances where there is a private arrangement.
Lord Mackay of Clashfern
The noble Lord sat down without answering the question that I asked him, which I am very keen for him to answer. My understanding is that this elderly lady was in a home and she was given full notice to leave; there was no question of any breach of contract or anything of that kind. Therefore, the sorts of remedies to which the noble Lord has referred would not be available, whereas under the Human Rights Act there is at least a very considerable probability that she would have some protection.
Lord Faulks
I am sorry that I did not answer the question adequately for the noble and learned Lord. My response is that actually the Human Rights Act remedies, which I endeavoured to deal with in my remarks, would not of themselves provide the sort of remedy that the noble Lord, Lord Warner, had in mind. As was outlined by Lord Bingham in the Greenfield case, the remedies are in fact very limited, very often amounting to a decision that there has been a violation, rather than the sort of practical remedy that I understand the noble Lord to have in mind. That is my response.
Lord Warner
My Lords, just to clarify matters, if this lady had been covered by the Human Rights Act, the son would have been able to take legal action to try to prevent the home removing her. The mischief that was being committed was the forcible removal of a woman in her 90s from the place that she had lived in for a very long time. What the Human Rights Act—as I understand it; I am not a lawyer—would have provided protection for was the ability of a relative to seek protection from the courts that this home, in taking that action, was actually in breach of the Human Rights Act. I do not think that the noble Lord’s suggested remedies would have helped in this case or any other like it.
While I am on my feet, I say to the noble Lord that this Act changes the position anyway, because that lady, or a similar person in the future, might well have come up against the cap on her privately funded care and her care would then be paid for by the state, which would be performing a public function—or a function of a public nature—in paying for her care in that private provision. This Act changes the dimension from the past as well.
Lord Hope of Craighead
My Lords, I do not know whether I am permitted to speak again since we are on Report but perhaps I might just say for clarification that in my opinion the analysis by the noble Lord, Lord Warner, of the reach of the Human Rights Act is entirely accurate. We have had a number of cases, in both the House of Lords Appellate Committee and the Supreme Court, dealing with the kind of problem where people say that they are losing their home because of steps being taken to remove them from premises that they occupy. It is that reach and the uncertainty that has been drawn attention to, where some people have the protection and some do not, that causes real problems.
Lord Faulks
In response to that, of course the Act provides that a court can give just satisfaction, and the remedy may include something of the sort to which the noble and learned Lord refers. However, if there is, as I think I understand the facts of the case, a violation of ordinary private law principles, the remedy should in those circumstances be available. But I think I have trespassed on the House’s patience for long enough.
Lord Skelmersdale (Con)
My Lords, this debate seems to have degenerated into a recommittal stage, which the noble Lord on the Front Bench opposite called for at the very beginning of today’s proceedings. However, I do not think that he, or I, or probably anybody else, wants to recommit this particular clause which is, after all, a new clause.
Health and Social Care Bill
Lord Faulks Excerpts(12 years, 3 months ago)
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Baroness Finlay of Llandaff
My Lords, I support this amendment and urge the Government to accept it as it is written. I hope that the Government can see that this is very helpful; it fits with the points made by the Minister in his summing up in response to the previous amendment tabled by my noble friend Lady Masham about there being agreement on the importance of openness and candour in healthcare. The Minister went on to say that,
“the NHS could only call itself a world-class health service if it embraced openness wholeheartedly”.—[Official Report, 13/2/12; col. 590.]
He added that there was agreement that something needed to change.
The beauty of the way in which the amendment is worded is that it distinguishes between major and minor occurrences. It emphasises the true duty of candour to disclose events that have affected a patient either medically or physically and that may have long-term effects. It does not focus in any way on anything trivial and requires the contractual duty of candour to be put into the contracts, which was exactly the content of the Minister’s summing-up speech last time.
Lord Faulks
My Lords, I remember well the degree of consensus in your Lordships' House when we debated the statutory duty of candour—namely, that everything should be done to embed in the NHS the culture of openness and to be against any form of cover-ups. However, as I said on that occasion, the world has moved on a little since the days of Lord Cohen—with great respect to the noble Lord, Lord Walton. A number of initiatives have resulted in greater openness by clinicians and a sense of responsibility, which one can find right across the health service. All is not perfect, of course. The duty of candour has been much discussed in academic circles, and the noble Baroness referred to the experience in America where some states—not many—have a duty of candour. But there are very serious arguments that run to the effect that imposing a duty of candour can have adverse effects in that many are thereby encouraged to sue in circumstances where they might not otherwise have sued.
The form of this amendment is certainly good in the sense that it focuses on the serious rather than the trivial. None the less, it does contain the word “incidents”, which is extremely difficult to define. In what circumstances does a clinician, or those employing a clinician, have to go through the processes that the amendment involves? From what the noble Earl said on the last occasion, the Government clearly take the matter of candour extremely seriously. There is a consultation about it and, in due course, there will be reflections of that duty in the contract. Although I am entirely sympathetic to what lies behind this amendment, I am a little concerned that imposing terms, with the inevitable imprecision that this form of amendment carries with it, is not at the moment the answer.
Baroness Tyler of Enfield
My Lords, I, too, spoke briefly in the debate last time about the statutory duty of candour. At the end of that debate the Minister gave a number of important reassurances. One was to review the contractual duty in a specified period to see how effectively it was working. The second was to do with further work to explore how this whole issue could be taken forward in the area of primary care—an area which I, and certainly colleagues on these Benches, still feel is extremely important. I would be grateful if the noble Lord, in summing up, could say anything further about how a contractual duty of candour would apply to those in primary care. Also, could he give any further reassurances at this stage about the reasons why he feels that a contractual duty of candour in the way which is set out in this particular amendment would be effective?
Lord Campbell of Alloway
I very briefly take the point made about an apology for the mistake. I do this because when I was an advocate I appeared before the BMA for quite a lot of medical professionals. If your client says, “I am terribly sorry for my mistake”, it puts one in a very difficult position; the advocate must show that the mistake had nothing to do with the result. I will not take up time, but say merely, as an erstwhile advocate, watch it.
Lord Faulks
Before the noble Lord sits down, could he confirm that, since the Compensation Act 2006, an apology is no longer deemed to be an admission of liability?
Baroness Hollins
My Lords, I support the amendment, particularly because it draws attention to the point that often patients experience prolonged psychological harm after an incident, something that is not well understood across the whole of the medical field. Such psychological harm is often overlooked. However, there is plenty of evidence that an honest and prompt apology can do so much to help the person and their family going forward. It is fair to say that delaying a response is very much like denying a response. The timeliness of a response is critical.
Health and Social Care Bill
Lord Faulks Excerpts(12 years, 3 months ago)
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Lord Faulks
My Lords, I join the debate for the first time, conscious that I was not here in Committee. However, I read closely the debate that took place then and have also read the debates on the subject in the other place. My perspective on the issue comes from spending the past 25 years or so involved in clinical negligence cases, acting as a barrister for patients, doctors and other healthcare professionals, employed privately or by the NHS. Although the amendment is not specifically about litigation, the effect it may have on claims is important.
Much has changed in the way that healthcare professionals approach complaints and claims made against them. Where once it was difficult to obtain clear information about what had happened in some adverse event, often this is no longer the case. Similarly, where once medical professionals were inclined to close ranks, this is very far from the case now, where many current and former healthcare professionals provide opinions about the competence of their fellow professionals. In my experience, some of them are remarkably uninhibited in doing so.
Why have the changes come about? The establishment of the National Health Service Litigation Authority, which commenced its activities in November 1995, has been very much a force for good. Consistent with its aims, objectives and functions, the NHSLA has administered the schemes in a way that has done a great deal to increase public confidence that the truth can be obtained without too much difficulty. Where fault is found, the NHSLA is committed to providing proper apologies and explanations.
I pay tribute also to organisations such as AVMA, which was mentioned by the noble Baroness and which has championed the cause of the victims of medical errors and contributed to a much more effective system of litigation. It is appropriate to acknowledge also the major contribution of the civil procedure rules, which were the result of the investigation into civil procedure by the noble and learned Lord, Lord Woolf. The result is a much more open approach, with disclosure of rival opinions before trial and much greater control by the courts of this potentially vexed field of litigation.
I have a reservation concerning legal aid. The LSC, shortly to be replaced as a result of the LASPO Bill, has ensured that firms that conduct this type of litigation are franchised. I worry that with the potential disappearance of legal aid in this field we could return to a situation where those who conduct this complex litigation would not necessarily have the relevant experience. Be that as it may, matters have advanced very considerably and many experiences that were encountered by those in your Lordships’ House who in the past had to deal with constituents would not now happen on anything like the scale that they did in the past.
That is not to say that all is perfect. The duty of candour was, I think, first encapsulated in the Making Amends report in 2003 and has been championed by the former Chief Medical Officer, Sir Liam Donaldson; and, as other noble Lords have pointed out, the case of Robbie Powell has had a great deal to do with promoting the need for candour. I cannot imagine that anyone in your Lordships’ House is against candour or in favour of medical cover-ups. However, the question that the House has to consider is whether this amendment is really the right way of improving the culture when there are iatrogenic events.
There has been a considerable amount of research, mostly in the United States, about the effect of greater candour on patients’ willingness to sue, including an article in the New England Journal of Medicine in 2006 by two obscure politicians, Hillary Clinton and Barack Obama. I think it would be fair to say that the research on the issue is somewhat inconclusive. While some have clearly welcomed an earlier explanation of medical errors and have been dissuaded from litigation by a culture of openness, equally others have been encouraged to pursue cases that they might otherwise not have pursued because of the disclosure of errors by medical professionals.
The House is, of course, aware that when mistakes happen the NHS constitution requires staff to acknowledge them, apologise, explain what went wrong and put things right as quickly and effectively as possible. Professional codes of practice for doctors, nurses and NHS managers contain similar duties, and there are rights in the Data Protection Act that serve to empower patients, but the Government, as we know, intend to go further. It is a matter for consultation, but it is anticipated that there will be a contractual requirement on the part of all those engaged by commissioning bodies to have this duty of candour, which will involve openness about incidents involving at least moderate or severe harm or death, if not even minor incidents.
We must be careful not to underestimate the difficulty involved in trying to encapsulate the obligations that could be placed upon healthcare professionals. Thanks to the Compensation Act 2006, an apology is no longer to be construed as an admission of fault, but the House ought to consider, I suggest, just how difficult it may be for an individual, albeit via an organisation, to decide whether there has been an error such as to come within the scope of this amendment so as to bring about the various consequences envisaged by it. Where there has been an egregious error, such as the wrong patient being administered an injection or even the wrong limb being removed, that is one thing, but there are many cases in which there may be a suboptimal outcome and it is arguable that there was a departure from the appropriate standard of care.
I have spent a large part of my professional life listening to doctors of one sort or another giving their opinions, often contradicted by other opinions, about whether there has been fault. Even a so-called reasonable opinion, the expression used in the amendment, may not be accepted by another reasonable expert. What of the quite frequent cases where some acknowledged risk involved in a procedure has eventuated? Very often, this will just be the result of happenstance and involve no fault on anyone’s part. I am concerned about how this amendment would work in such circumstances.
I noted the observations made by the noble Lord, Lord Winston, and the noble Lord, Lord Walton, who is in his place, about this. I have often found that some doctors are almost too ready to admit mistakes when they have not made one, so anxious are they about the welfare of their patients. We should be careful that in encouraging candour we do not impose what I have to say is a not particularly coherent obligation in the form of this amendment. Surely the most important objective is to encourage candour so that it becomes embedded in the culture of the NHS. The intense difficulty in defining what that obligation should mean is far better teased out as a result of the consultation that is being undertaken rather than being imposed in the statutory form proposed.
I do not know whether those who propose this amendment intend to press it to a vote. Of course all noble Lords are in favour of candour and against cover-ups. Those who have supported this amendment have done a great deal to contribute to the continuing debate about the whole question of candour and should be congratulated on that, but I respectfully suggest that this amendment will not help patients or provide clarity for professionals and therefore will not provide any real benefit. I will oppose it.
Baroness Oppenheim-Barnes
My Lords, I am obliged to my noble friend Lord Faulks for provoking me into thanking him for having read the proceedings of our earlier debate on a similar amendment, in which I spoke at length about the total impossibility of someone with money and influence bringing a case against a doctor or a hospital in a situation that was completely black and white. I went into this detail only to convince those who—quite rightly—want this candour that it will not result in an “open sesame” for bringing cases in which a mistake has been made or completely bad treatment has been given.
I would also say that I wish anyone trying to deal with the General Medical Council the best of British luck, because it is not easy. It is a long process, and it involves a great deal of information being given. Even when the consultant involved has said, “I am very sorry, I have made a mistake, I have failed”, the GMC still does not find it necessary to criticise that surgeon in any way at all.
On the amendment, my noble friend the Minister was kind enough following the last debate to circulate to those who had participated a note from the NHS giving details of the steps that it takes after a mistake has been discovered: dealing with patients in counselling, apologising, all the important things that we would expect it to do. However, one thing was missing, and I hope that my noble friend will feel kind enough to grant it; it did not say that in such cases the NHS was required to circulate throughout the health service what accident had happened or what mistreatment had taken place, so that it could warn in advance that special care must be taken in the future.