Patient Safety Review

Debate between Preet Kaur Gill and Rachael Maskell

Monday 6th July 2026 Commons Chamber

[Preet Kaur Gill]

Absolutely. I am very privileged to have patient safety in my brief. I know everybody across this House really cares about it, and I will make sure that officials do as the hon. Gentleman requests.

[Rachael Maskell (York Central) (Lab/Co-op)]

I want to concur with all of the remarks by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), who has made a crucial point. But there is a wider issue, which the Health Bill completely misses and which I urge Ministers to look at, around the accountability systems within the NHS. The reforms are not going to deliver accountability. They are going to weaken it, and as a result we will see more requests for investigations into patient safety. I want the Minister to take that point away, because I am really worried that we are going to see a system that is more unsafe as a result of these reforms.

[Preet Kaur Gill]

I thank my hon. Friend for her contribution—she is absolutely right. I take accountability very seriously and am going to talk about it in my remarks in this debate. Far too often, we see so many inquiries and so many recommendations but nobody taking responsibility for implementing the change. In the end, patients have to feel that things have changed, not that we are just having further reports and recommendations.

The Penny Dash review examined six organisations that are overseen by the Department: the Care Quality Commission; the National Guardian’s Office; Healthwatch England and the local Healthwatch network; the Patient Safety Commissioner; the Health Services Safety Investigations Body; and the patient safety learning functions of NHS Resolution. The review’s conclusion was clear. The problem is not that people working in patient safety lack commitment—we all know that there are dedicated people across the system doing important work every day—but that the system around them has become too cluttered, complex and difficult for patients, staff and leaders to navigate.

We inherited a landscape with more than 70 routes for patients and service users to raise concerns or provide feedback, and around 40 public bodies with a formal role in quality and safety. That complexity does not automatically make patients safer. It can make responsibility unclear, create duplication and make it harder to ensure that learning leads to improvement. A cluttered landscape, as we would all agree, is not an effective landscape.

The hon. Member for Harwich and North Essex asked me about the expertise in HSSIB, the full-time job that it does and whether it could undertake investigations more cheaply and quickly than public inquiries. The investigation function within the CQC will be expert and full time, and it will be able to conduct investigations in the same cheap and quick way that HSSIB does now. In future, there will be the same opportunity to use the CQC investigation function instead of needing a public inquiry as there is currently with HSSIB.

The review also found that too many recommendations are generated through reviews, inquiries and investigations, as the hon. Member said, without enough clarity on ownership, prioritisation, implementation and impact. This is the fundamental point: recommendations alone do not make patients safer; change does. That is why the Government have accepted all nine recommendations of the Dash review.

The hon. Member asked how the CQC will provide the same confidence that the safe space is not being compromised. The criteria for disclosing protected information outside the investigative function are set out in the Bill. Those criteria set a high bar for any disclosure—as high as it is currently with HSSIB—and the CQC will publish further guidance setting out much more detail. As the Bill sets out, the CQC will appoint a responsible person who will decide whether the case matches the criteria and whether it warrants information sharing outside the safe space. That person is likely to be the CQC’s chief executive officer.

The hon. Member asked why the Dash review and the Government have ignored the whole question of HSSIB’s value for money. Let me be clear: the Dash reforms are not about saving money; they are about strengthening patient safety and patient voice across the system. The abolition of HSSIB and the transfer of its functions to the CQC play an important part in making the system of patient safety much more effective. Safety is the issue, not money.

Accepting recommendations is the beginning, not the end. Patients who have suffered harm, families who have campaigned for years and staff who have spoken up do not want another report sitting on a shelf. They want evidence that the system can listen, learn and prevent harm from happening again. I want to be absolutely clear: every organisation in the system has a responsibility to meet that challenge. Patient safety cannot be something we support in principle but resist when it requires us to change.

No organisation, however established or well-intentioned, should believe that learning and improvement only apply elsewhere. That is why we are streamlining and strengthening the patient safety landscape. The hon. Member mentioned the National Quality Board. We have revitalised the board by giving it a stronger role in providing a single, authoritative view of quality across the system. That will help reduce duplication, bring greater clarity to recommendations and ensure that effort is focused where it has the greatest impact. All hon. Members recognise that we need fewer recommendations because we know that they disappear into the system. More recommendations are needed that are owned, tracked and delivered.

I recognise the concerns raised by the hon. Member in respect of the Health Services Safety Investigations Body. We had a constructive conversation earlier today. On his point about the accusations that HSSIB had expanded the scope of its work beyond its remit, he explained to me in detail how HSSIB’s inception came about. The Government have accepted the Dash recommendation that HSSIB’s role as a centre of excellence for investigation should continue, and clarified the remit of any future investigations. I think that the investigation function with the CQC will perform the role of a centre of excellence for investigations.

HSSIB has developed important expertise in understanding why things go wrong and identifying system-wide learning, and I acknowledge that work. The question before us is not whether investigations matter —of course they do—but how we ensure that investigations lead to action, because learning without implementation does not improve patient safety. The Dash review recommended transferring HSSIB’s functions to the Care Quality Commission, while maintaining a dedicated investigation capability. I understand why colleagues will want reassurance on that, because, as the hon. Member said, independence, transparency and trust are essential in patient safety investigations, but so is impact. The purpose of these reforms is not to weaken investigation, but to strengthen the link between investigation, learning and improvement. We need a clearer route from identifying problems to making recommendations and ensuring that someone owns delivery and that patients see change.

The hon. Gentleman asked if I could explain who will conduct future investigations into safety in the NHS if the Dash review is implemented. The investigation function in the CQC will have autonomy to launch investigations into any part of the health system and will be able to make recommendations on any part of the system, just as HSSIB does now. There will be no barrier to an investigator finding out that CQC inspections are causing unintended harm. If they are, and if the investigator feels that a recommendation for change should be made, they will make it. There will be no need for litigation through the courts, and insights gained from investigations will continue to inform recommendations concerning the Care Quality Commission’s regulatory functions.

The Bill also allows for the investigation function to make recommendations to the CQC in its report, and the CQC would be legally required to respond to such recommendations. I hope that the hon. Member is assured that we will work carefully with colleagues, patients, staff and system leaders as these reforms are implemented.

The same principle applies to patient voice. Patients do not share their experiences simply for the system to record them; they do so because they want to see things change. Listening matters, but acting on what we hear is what makes patients safer. That is why we are ensuring that patient experience is closer to where decisions are made, with commissioners and providers responsible not only for delivering services, but for listening and responding. The Patient Safety Commissioner will continue to champion patient voice on medicines and medical devices and report directly to Parliament.

Tobacco and Vapes Bill (Sixth sitting)

Debate between Preet Kaur Gill and Rachael Maskell

Committee stage
Thursday 9th May 2024 Public Bill Committees

[Preet Kaur Gill]

The amendment is very simple: it would amend clause 24, which introduces fixed penalty notices for retailers that breach age of sale, proxy purchasing and free distribution restrictions on tobacco, vapes and nicotine products, by doubling the fixed penalty notice from £100 to £200.

The need for the amendment is clear. In 2022-23, national trading standards identified that 20% of the 1,000 vape test purchases carried out with retailers resulted in an illegal sale. In 2019-20, 50% of councils that undertook test purchasing reported that cigarettes or tobacco products were sold to under-age people in at least one premises. Despite existing regulations, there is a big and widespread problem, which suggests that the current penalties and fines, which can end up as high as £2,500, are an insufficient deterrent. I strongly support giving trading standards officers the power to issue on-the-spot fines to retailers doing the wrong thing, but the current level of the fine is too low.

My amendment would increase fines to £200, precisely doubling the deterrent in the Bill. Under the Bill as drafted by the Government, offenders can be forced to pay only £50 if they pay off their fixed penalty notice within 14 days, and it is surely too easy for those breaching the law to factor that in as the cost of doing business. Stakeholders including the Association of Convenience Stores and the Local Government Association agree that £100 is too low and that £200 makes logical sense as the level at which to set fines, equalising it with the level for other, similar offences, such as that proposed in the draft regulations for the disposable vapes ban. In the Government’s consultation, £200 was also the most popular response—three times as many respondents supported £200 over £100.

The other reason why my amendment is important is that the penalties from fixed penalty notices can be retained by the local authority. I have raised my concerns, as others have, about the decline of local trading standards, and the amendment would increase the funds they have available to enforce other aspects of the Bill, including regulations yet to be made under it. All of that comes with a cost, and anything that we can do to give local authorities the tools they need to enforce the regulations, the better. I note that clause 26 would provide the power to amend the level of the fixed penalty notice by way of regulations, so the issue could be revisited if needed.

I urge other Committee members to support my amendment in order to strengthen enforcement and provide a proper deterrent to rogue retailers that choose to sell addictive and dangerous products to children.

[Rachael Maskell]

I rise to support my hon. Friend the Member for Birmingham, Edgbaston. I completely agree that when we set these figures, we often forget that the economy has moved on so much, and that the rise in inflation has meant that so many things cost so much more. Just £100 is a very small amount to many shops, which take their cut from these products. It is therefore essential that we move into the realms of reality, not least because the consultation advised the Government that £200 would be an appropriate starting point and would have public support.

Clause 26 says that the figure can be amended by the Secretary of State, should they choose to do so. So the amendment would not place a limit in primary legislation, but it would make this a more realistic deterrent to ensure that shopkeepers abide by the law. It is also really important to have an incentive for them to ensure that they are fully up to speed with their obligations. This change would focus their minds as regulations are introduced, as the Minister alluded to, and ensure that they keep themselves up to date, because they know that the penalty makes it worth doing that. I therefore urge the Committee to adopt my hon. Friend’s amendment. It is a simple measure that would not cause the Minister any grief as the Bill passes through its later stages.

Tobacco and Vapes Bill (First sitting)

Debate between Preet Kaur Gill and Rachael Maskell

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Preet Kaur Gill]

Q I think the Minister was referring to vapes and the evidence based around the impact on growing lungs and hearts. Is there anything you would like to say about that before we move on?

Dr Griffiths: As Deborah from ASH said, vapes are a fairly new product, so the research and evidence base, which we have in abundance for tobacco and smoking, is still forming for vaping. However, there are indications that it is not great for health. We are cautious and worried about the long-term implications. What we do know is that vaping can be an important cessation tool for those trying to quit smoking, and that many do want to quit, so we strongly encourage anything that stops smoking, but the people who are turning to vaping as an alternative to smoking for the first time is of deep concern to us. We do not understand the long-term health implications, but the addiction to nicotine deeply concerns us.

Sarah Sleet: We strongly agree. It is a very delicate balancing act between stopping the harm caused by smoking and looking to the long-term with regard to vaping. Quite clearly, smoking is far more damaging for adults and children. Anything that can steer people away from smoking will be healthier than continuing to smoke in the long run, but we do recognise that more attention and more research need to be put into vaping.

[Rachael Maskell]

Q Clearly, smoking is far more harmful than vaping, but research by UCL has shown that there are DNA methylation changes linked to carcinogens from vaping in the oral cavity, which quite probably translates to the lungs as well. Should we be looking at this legislation not with the naiveté with which smoking was looked at in the past, but rather as taking advance steps to ensure that we do not see an inducement of lung disease in the future?

Sheila Duffy: As I said earlier, it is a delicate balancing act. We need to move people away from smoking, and anything that does that is a good thing, but we need to look at the long-term effects of vaping. The balancing act in the proposals around restricting access to vaping—making sure that nobody under-age gets access to vapes, denormalising them by taking them away behind the counter and so on—all of those are good measures to reduce the number of children moving on to vaping, but they need to be enforced. We need to make sure that we have the right enforcement action in place to make sure that that actually happens.

Dr Griffiths: You gave a great example of early science that causes us concern, and it perhaps will not surprise you to know that as a body that is based in science and evidence, we at the BHF take statistics incredibly seriously. We are worried that the body of evidence will grow. We would hugely support and welcome a position where vaping was available to people as a cessation tool, but absolutely would discourage anyone else from taking it up as a starting point for nicotine consumption.