NHS Redress Bill [HL]

The clause sums up what is good about the Bill and what is wrong with it. It could be so good—equally, it could be nothing. It is very difficult to work out precisely what it means. I work in the voluntary sector, in Age Concern England. Consequently, in my day job, I spend lots of time talking to people such as hospital discharge scheme co-ordinators, advocates and mental health advocates. All of them could have a role under this scheme because all of them spend vast amounts of time challenging acute hospitals when things go wrong for older people. Anybody who worked in this field on a day-to-day basis would be astonished that PALS could be considered a suitable body for the sort of work being outlined. Going back to the discussions in this House when the PALS scheme was set up, I do not believe it was ever intended to be anything of this order. It was intended to be a readily available, very practical scheme staffed by people who knew their way around a hospital, knew the personalities involved and could sort out small issues very quickly. That is how it was explained to noble Lords at the time. That is a completely different order of work from that envisaged in the Bill. The CAB, which is the contract holder of the ICAS contract, has raised quite a number of questions about the expectations behind this. Some will have been partly reassured by some of the statements which the Ministers have made about extra resources. As the noble Earl, Lord Howe, said, ICAS has worked very well in some places under the initial contract but in other places, it has not gone so well. It would be a change in the degree of its work to include it. There is a question about the level of skills and training. There is another reason to spend time on this matter. Throughout our discussions, the noble Lord, Lord Warner, has talked about engineering a huge cultural change within the NHS. It is only fair that hard-pressed clinicians know that, when they are trying to resolve a matter, the person on the other side of the table has a sufficient level of understanding of what is happening. I am not saying that only solicitors, God-given though they are, can understand those things. There is a role for a different type of assistance but it would be wholly wrong to put that sort of responsibility on to ICAS without a great deal of investment, not least because there will be a huge upsurge in demand. If that upsurge in demand comes as a result of people not going to court, there is a cost saving. The Government ought to think about setting those resources towards the services doing the work. Finally, I do not believe that giving one contract to ICAS is the way to encapsulate the diversity of patients’ needs. Different providers with different skills for different inquiring groups may be needed.