My Lords, I am pleased that this important Bill with its overarching aim of improving patient safety is before us today for its Second Reading. According to the 2015 House of Commons Public Administration Select Committee report, there are 12,000 avoidable hospital deaths and 24,000 serious incidents reported every year in the NHS. In 2018, NHS services reported 10,000 incidents resulting in severe harm or death. These are worrying statistics and must motivate all of us to take action. A barrier to full investigation of these incidents is, as we have heard from lots of people, that we have a blame culture rather than a learning culture.
The Healthcare Safety Investigation Branch, established in April 2017 under the control of NHS Improvement, had the aim of improving the learning culture. However,
as we know, this body lacked the independence and powers to make it fully effective. The Health Service Safety Investigations Body—HSSIB—established by the Bill will be independent of the NHS and have powers to investigate patient safety incidents that occur during the provision of NHS services.
The creation of a safe space, which we have heard much about, is modelled on the Air Accidents Investigation Branch, which we heard about from the noble Lord, Lord O’Shaughnessy. The safe space was a crucial part of the Joint Committee’s discussions and deliberations, and I know that the Ministry of Justice has been asked for advice on this aspect of the Bill. Having heard the noble Lord, Lord Hunt, ask whether the High Court will cherish confidentiality, as well as some of the other issues raised by Members in the debate, I would like to hear more from the Minister about the safety and security of the information and a little more about how the safe space will operate.
Some organisations have raised concerns that the work of the HSSIB would prevent other bodies such as the CQC carrying out their own investigations. However, the gathering of information by the HSSIB using the safe space should not impede any separate investigations by non-HSSIB bodies such as trusts, professional regulators and the health service ombudsman. The HSSIB should aim to work in parallel with them so as not to increase the burden on those giving evidence.
Another important aspect of the Bill is that there is clearly a need to improve the quality of death certification. I am pleased to see in the Bill the amendment to the Coroners and Justice Act 2009 giving the NHS the role of appointing medical examiners and placing a duty on the Secretary of State to ensure that the system is properly maintained. This is a major and essential improvement.
I fully support the recommendations in the Bill but would be grateful if my noble friend the Minister could clarify a number of points. As mentioned by others, it is of concern that the remit of the HSSIB does not cover all healthcare in England, including non-NHS provision. We have heard that the Paterson review will cause the Government to consider what should happen, but can we hear from the Minister whether it would be possible to extend the Bill to cover all providers—that is, NHS and private provision—so that we are all subject to the same patient safety standards? The noble Lord, Lord Scriven, made the rather stark point about the difference between people in adjoining beds where one was getting treatment considered to be necessary for safety and the other was not.
Will the Minister elaborate on the criteria for deciding on incidents that the HSSIB should investigate and on whether these criteria will be developed in consultation with professional and patient bodies? Will the scope of the Bill include safety incidents exacerbated by issues such as staffing levels? Will safe space investigations operate within a time limit? Will there be support for the clinicians involved, and will that support include access to mental health professionals?
During the Joint Committee’s deliberations on the draft health service investigation recommendations, the issue of the investigation of the large number of
maternity cases was raised. That has been touched on today, but will the Minister clarify precisely what has happened with those investigations, where they will go next and how the HSSIB might, in future, be able to investigate more maternity activity?
I share the concerns of the noble Lord, Lord Hunt, on the reports from the HSSIB and how the reports will be acted on, and I worry that there is a likelihood of limited action, if any, being taken. I have a vision of dusty reports on dusty shelves. I hope for reassurance from the Minister as to how lessons will be learned, actions taken and real, effective improvements made. I welcome the Bill and look forward to the improvements that it will bring.
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