My Lords, it is a great pleasure to follow the noble Baroness, Lady Cumberlege, and to support what she is saying. At the heart of her argument is the concern that, although the Minister said earlier in Grand Committee that the Government are weighing it up with all “seriousness and intent”, the Government are not going to run with the core of the noble Baroness’s recommendations. Because the Government have been so reluctant—very unusually—to respond immediately to the thrust of her report, there remains a lot of uncertainty about how far the Government are prepared to implement it.
Of course, the opportunity given to us with the medicines Bill enables us really to press the Government to be more detailed about what they are going to do. On Tuesday, we had a very good debate on the recommendation for the appointment of a patient safety commissioner. The Minister made a very extensive response, which essentially set out the measures that the Government are taking to embed patient safety throughout the NHS. I shall just mention a few: promoting a positive learning culture at the heart of the NHS; taking steps to help staff to speak up when things go wrong; establishing the Healthcare Safety Investigation Branch to examine the more serious patient safety incidents and promote system-wide learning; appointing medical examiners to provide much-needed support to bereaved families and improve patient safety; introducing a duty of candour, so that hospitals tell patients if their safety has been compromised, and apologise; and commissioning the NHS national director of patient safety, Dr Aidan Fowler, to publish a strategy, which, of course, has been done.
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I do not seek to underestimate in any way the work that the Minister referred to, which has already been undertaken, but two things are missing. First, that is not a system-wide approach. I would like to hear how the Care Quality Commission, instead of making patient safety one of the five criteria by which a trust can get the top rating, will make patient safety the sole criteria for the top rating. I would like to hear much more about how we will ensure that equipment, buildings and services have safety designed into them right from the start. When we set up the NPSA nearly 20 years ago, we knew that one of the best approaches is to design safety in the system. In many hospitals, you could have medical equipment for the same purpose but of different makes and with different controls, leading to confusion. There are many other examples. All that should be driven out by someone at the centre who understands that safety is a system issue above all else. We do not see that; the patient safety strategy talks about a system but does not mention how it is going to be done in a systematic way.
It is the same with the issue of independence. The noble Baroness, Lady Cumberlege, was a Minister in the Department of Health and she has said that the department does not like independence, and I can confirm that as a former Minister. But to have credibility, you have to have an independent approach. The task force is one example, and the patient safety commissioner is another. At heart, we want to hear from the Minister, before the Bill reaches the end of its stages in the House of Lords, what the government response is. I am afraid that we are not going to get it, which of course then leads us to push amendments at Report. But I hope that the Minister, with his colleagues, will reconsider their approach and, before we reach Report, set out what they will do with the noble Baroness’s recommendations.