NHS Redress Bill [HL]

I am in grave danger of repeating myself on this issue, but nevertheless I will plod on. Good arguments cannot be made often enough in order to convince people of their merits. We are constructing here a scheme which has at its heart the idea that either the trust or the patient can themselves activate the scheme. Let us be absolutely clear about that. The reason why the trust can activate the scheme, although it must notify the patient, is that we are trying to change the culture of the NHS. The noble Baroness always indicates her agreement, but we are introducing a practical way of achieving it. The practical way to do this is to motivate the trust, the members of the scheme, to look into their practices when their attention is drawn to something that is going wrong—often from within the trust itself via a member of staff who may be discomfited about what has happened to a patient. Let us not assume that all the staff of the trust are seeking to conceal these things; they are not. The evidence suggests that a lot of trust staff would want to put things right for the patient. We are setting up a scheme and promoting a culture that will enable staff to come forward and start the scheme through the trust while at the same time saying that if it does not happen, belt and braces, the patients themselves can start the process of the scheme. To me that seems to be a pretty sensible belt-and-braces approach. However, it also lays a heavy emphasis on the trust itself being critical about where things have gone wrong and taking action to put things right. The noble Earl, Lord Howe, put to me the very fair question about whether this is to be an adversarial or inquisitorial process. One area in which I agree entirely with him is how important it is to establish the facts with the patient early on in the process. In our view, that can be done under a process still within the overall direction of the trust itself, but there is plenty of scope for the trusts themselves, as they do in relation to complaints, to appoint someone with a degree of independence within the trust to oversee the complaints process. They can also appoint someone to oversee the actual redress process—and we shall deal with that later. At the end of the day we are trying to achieve a settlement that satisfies the patient and is not an adversarial system. The fact that we have imported financial redress and remedy into this scheme does not make the whole thing a judicial, totally adversarial, system. The whole purpose of this scheme is to take cases that would otherwise go to the courts out of the courts where other values would be involved. There is no point whatever in this scheme replicating an adversarial court process. What we are doing is setting up a body, the NHSLA, which all sides in this debate acknowledge has certain standing and competence to oversee this process. It will have a great deal of experience not in deciding cases but in trying to achieve fair settlements without going through the courts. That seems to me to be a skill and competence which is appropriate for this particular scheme. I should tell noble Lords that we have heard a lot about having some independent oversight. I have still not heard a clear claim from either the noble Baroness, Lady Neuberger, or the noble Earl, Lord Howe, proposing an alternative body to oversee this. I am looking forward eagerly to a well-argued case for an alternative body to the NHSLA. The Government’s position is that we think we have a sound body. It behoves those who disagree with us to come up with an alternative proposal which is clearly better. I am waiting eagerly to hear the arguments for this alternative body. We hold our ground that the NHSLA is the appropriate body. With all due respect, I do not think that other noble Lords have come up with an alternative proposition that would clearly be a better scheme than the one we have in place. So, I disagree that Clause 6 should not stand part of the Bill. It is an integral part of the processes that we have established for running a well-thought-out-scheme that has patients at its centre. It is not adversarial in nature but enables the facts to be found; enables apologies to be made; enables explanations to be made; enables mediation to take place; and enables, where appropriate, financial remedy to be provided as well, under the overall aegis of a well-established and well-run body called the National Health Service Litigation Authority.