Clause 15 - Code of practice: improvement notices
Health Bill
10:00 am
Andrew Murrison (Shadow Minister, Health; Westbury, Conservative)
The issue of sanctions is fascinating, because they can mean so many things. In the professional sense, success or otherwise in achieving an outcome is sanction enough, as we all want the approval of our peers. In Parliament, for example, if do not have a good reputation we feel unhappy about it, and the same applies to health care professionals. We like to think that our peers appreciate what we do and recognise that we achieve good results. That, generally speaking, is the driver in the NHS. The problem with sanctions is that that driver is not sufficiently recognised.
Hospital-acquired infections have traditionally been seen as the responsibility of someone else, as supplementary to the main thrust of what a hospital does, which is carrying out successful hip replacements, for example, and ensuring that people admitted to a coronary care ward are well when they leave hospital. We need to ensure that that aspect of health care is at the heart of what the NHS and other health care providers do.
To give credit where it is due, the professions have begun to address the issue. I therefore hope that sanctions per se will not be such a big issue in future; the true sanction is that driven by the professions themselves, and it is related to the esteem or otherwise in which individuals within those professions hold one another.
I hope the Minister will comment on the difference in how the private and not-for-profit sectors in health care are dealt with in relation to the NHS. In a previous sitting, the hon. Member for Northavon, contrasting the sanctions that may apply to the two sectors, seemed to misunderstand the level of sanction and the penalties that may apply to the private sector—those bits of our health care system which lie outwith the NHS. If I got that wrong the hon. Gentleman will correct me. In truth, the sanctions that apply to the private sector are potentially very severe indeed because they are quasi-commercial, or commercial, in the sense that the HealthCare Commission could deliver an unfavourable report which could lead to contracts being removed. There are jobs involved, staff have mortgages to pay and so on, and their minds are heavily focused on the issue.
It does not happen in quite the same way in the NHS. In accordance with the 2003 Act, when a management problem is identified in the NHS, the individuals concerned are usually moved on, or moved sideways. We can all think of examples from our own constituencies where that appears to have happened. The level of sanction is not quite the same.
Nevertheless, what will be of concern to those at the front line, be they managers or health care professionals, is how they will appear to their peers. That, together with the altruism that goes with being a member of a health care profession and the desire to do good or, in the context of medicine and allied professions, at least to do no harm, is what will drive this matter. We need a recognition that that, rather than heavy-handed sanctions per se, is what tends to drive standards, particularly in the NHS.
I hope that the Minister will assure us that she would not be tempted to apply financial sanctions. We would have difficulty with that because we take the view that if there is a problem, removing resource is the worst thing that can be done. Part of the problem might be the need to use resource to improve things. The Liberal Democrats have tabled a later amendment that touches on this matter and I believe that the crux of it has to do with financial penalties that may apply, in the hope that any improvement might be funded centrally. To that extent, we would have similar sorts of concerns.
The notion that, having identified a problem, we need to fine the institution seems to be wholly inappropriate and a bit of a paradox. We want to rely on the powers that the Secretary of State already has under the 2003 Act to effect managerial change where that is necessary. We hope that there might be a bit more bite to that in the Minister’s handling of this serious aspect of health care in this country.