Norman Lamb writes… How Liberal Democrats are promoting safety and openness in the NHS

nhs sign lrgAs a Liberal Democrat, my priority for the NHS is simple. I want patients to have the best possible care. When people are ill and vulnerable, they deserve safe and compassionate care provided by doctors and nurses with the best possible training and medical expertise. And people need to know that, when mistakes are made, doctors will be open with them – and that lessons will be learnt.

What happened at Mid Staffs Hospital was a shocking scandal. The stories of neglect sent shock waves across the country. This Government was absolutely right to announce a full public inquiry into the scandal. It was chaired by Robert Francis QC and was set up in June 2010, just weeks after the last election. Robert Francis reported on his findings in February this year, making 290 recommendations. This week, the Government published its full response, accepting all but 9 out of 290 of the recommendations that were made.

The changes we announced go to the heart of the culture of the NHS. There is so much to be proud of in our NHS. It is, for good reason, a national treasure. So many dedicated people doing such amazing work. But, anyone who loves the NHS knows that, when dreadful things happen, we have no alternative other than to confront them head on. We are proposing a radical shake-up of patient safety, accountability and transparency in our health system, to restore patient confidence and deliver better care.

The focus of the announcement this week is on promoting safety and openness. We are proposing that hospitals will have to publish monthly reports on ward staffing levels and other key safety measures and quarterly reports on complaints, safety incidents, and the lessons learned. Openness has to be the first step towards restoring confidence. The NHS will be the most open and transparent of any health system anywhere in the world. A new single hospital safety website will be developed, covering the key aspects of safe care in a form accessible to patients and the public, and the new Chief Inspector of Hospitals will play a key role in ensuring that failings are identified, publicised, and addressed.

One of the failures of the past has been a sense that when the standards of care fall to unacceptable levels, no-one is held to account. Too often senior people have been paid off with gagging clauses to ensure they remain silent. This cannot be allowed to happen. So we are introducing a statutory duty of candour – a duty to be open with patients and families when serious mistakes are made. Hospitals, care homes and other providers registered with the Care Quality Commission will be prosecuted if they cover up serious failures which lead to death or serious harm. We have also asked experts in the field to look at the implications of extending the threshold for this duty to include moderate harm. This was a Liberal Democrat manifesto commitment now becoming law.

At the same time, we will be working with the professional regulators to strengthen the professional duty of candour on doctors, nurses and other healthcare professions. This will mean that, if they cover up mistakes, they can be reported to their professional regulators with the ultimate sanction of being struck off.

We will be implementing a “fit and proper person” test to ensure that unsuitable board directors do not end up in positions of responsibility in our health system. And for the worst failures of care, a new criminal offence for wilful neglect will be created so that those responsible are held to account. We are sending a clear message to NHS Trusts and care providers that the culture of secrecy and denial that has sometimes existed in the past is simply not acceptable.

Other changes we are making include:

• We have agreed with the Royal Colleges and clinical leaders that every hospital patient should have the names of a responsible consultant and nurse above their bed
• a named accountable GP, responsible for overseeing the care plan for all older people and those with most complex needs
• more time to care, as all arm’s length bodies and the Department of Health have signed a protocol in order to minimise bureaucratic burdens on trusts
• a new care certificate which will provide assurance that healthcare assistants and social care support workers receive the right fundamental training and skills and consistent training in order to give personal care to patients and service users.
• a new fast-track leadership programme to recruit clinicians and external talent to the top jobs in the NHS in England

I have also sought to ensure that the government’s response to the Francis report did not just focus on hospitals. The same principles of safety, openness and accountability are just as important in mental health services and in care and nursing homes.

As a Liberal Democrat, I feel strongly that the way to ensure confidence in our NHS and in care services lies in promoting openness, creating a culture in which mistakes are admitted rather than covered up, and in which lessons are learned when poor care is delivered. And at every level of our health and care system, patients and employees alike must be empowered to challenge poor care and institutional failings. This week’s announcement marks a clean break from the secrecy and cover-ups of the past and is a significant achievement in delivering on our “better care” promise.

* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee

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  • Stephen Donnelly 23rd Nov '13 - 12:22pm

    As a liberal I have no quarrel with openness and transparency, but to be successful it must be apply at all levels, and be linked with an end to blame culture.

    Since the Francis report the government has engaged in a shocking exaggeration of the scale of the problems within the NHS. This has been led by Tories, but Liberals have not sufficiently distanced themselves from it.

    The coalition has introduced a major re-organisation of the NHS, with much management control being given to centralised bodies lacking track record. At a local level there is significant potential for conflicts of interest and little local input.

    This is set against a back drop of an organisation seeking to make large budget savings.

    This is going to be a difficult winter for the NHS. My hope is that the Mr Lamb will start to set out a distinctive Liberal position on the NHS rather than simply supporting Coalition policy. He could make no better start than calling for an end to blame culture, and asking that doctors and nurses be allowed to get on with their job in a depoliticized atmosphere.

  • FormerLibDem 23rd Nov '13 - 11:32pm

    My sister works as a nurse in the NHS and she tells me the coalition’s reforms are causing utter chaos in her area. Reforms which couldn’t have been passed without the support of Lib Dem MP’s. Including you, Mr. Lamb…

  • Margaret Rutter 24th Nov '13 - 1:36pm

    Once again I find myself in agreement with Norman but am concerned about the cost of these reports taking money and time away from front line services.

  • Simon Banks 24th Nov '13 - 5:09pm

    Recent scandals have been closely associated with target culture. I would not argue against targets, which are part of how any effective organisation pushes itself forward (though sometimes more formal than others), but Mid Staffs was obsessed with ticking the boxes necessary for trust status and the falsification of cancer records recently exposed in Colchester was no doubt motivated by a need to show targets had been met. We should review all targets against their actual and likely effects. Tool often they’ve been set top-down with little attention paid to people nearer the frontline who’ve pointed out the likely side-effects.

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