NHS Redress Bill [HL]

As someone who assiduously reads the trade journal press cuttings about health, the idea that most NHS staff are unable to speak out in an independent mind causes me some mild amusement. Clause 10(2) does not prescribe the provisions that must be made in the scheme about the functions of members of the scheme, but it lists provisions that might be made by the scheme. Clause 10(2)(h) is important because it provides that the scheme may require a scheme member to appoint an appropriate member of staff—for example a director, as I said earlier—with responsibility for overseeing the scheme, identifying patterns and advising the organisation about lessons that can be learned from cases. This is a similar provision to that in the National Health Service (Complaints) Regulations 2004. It ensures that someone in the organisation has overall responsibility for ensuring that things do not slip through the net and that appropriate follow-up action is taken. We envisage that scheme members will want that person to take responsibility for ensuring that cases are referred to the scheme appropriately and to make appropriate links within their organisations; for      example, between the clinical governance arrangements, the complaints management arrangements and linking that in with the NHS redress scheme. I accept the point made earlier by the noble Baroness, Lady Neuberger—the NHS culture will not be changed everywhere overnight as it takes time. I am a bit more optimistic than those who think that it might take 25 years, but I think that in this area we are already seeing a change of culture, such as notifying the MPSA about adverse incidents from which the organisation can learn and that it can share, so that organisations can learn collectively. That culture is changing. Professionals are becoming less defensive, as they did in the aircraft industry. These things do change. But it is important that someone at a senior level in the trust keeps an eye on all the aspects, whether the complaints procedure, lessons from clinical governance or cases from the NHS redress scheme. When I say independent, I mean independent of the episodes—someone who can stand apart from those episodes and consider the systems and organisational aspects to try to re-engineer some processes of handling and supplying care to patients in a way that all organisations have to do to learn from their mistakes. That is why we believe that Amendment No. 55, which the noble Earl, Lord Howe, did not move with huge enthusiasm, would be a bad one to pursue. It would remove an important provision in the Bill and at the heart of the redress scheme. Amendment No. 56 would make the advice on lessons learnt publicly available. As a long-standing supporter of open government, I must tell the noble Baroness that I have a good deal of sympathy with the thinking behind the amendment. However, we should reflect a little more about whether it is best to write that into the Bill or whether we should deal with it under good practice guidance after taking account of the views of stakeholders. Sometimes we are confronted in investigations with the business of anonymity of people and we may give away the identity of the people when a department is so small that it is clear who we are criticising in the lessons to be learnt. We have learnt with, for example, the MPSA scheme, that anonymity is an important aspect in people being willing to come forward, confess and acknowledge the mistakes that have been made. So I should like to reflect more on that. I am very willing to take the amendment away to see whether we can return with something that is not as absolutist but tries to capture the spirit behind it. It is important that a lot of this material is in the public arena. That is helped by the fact that most of the discussions of many trusts are in the public arena anyway. That is my response to Amendment No. 56.