Clause 9
NHS Redress Bill [Lords]
12:00 pm
John Pugh (Shadow Minister, Health; Southport, Liberal Democrat)
I beg to move amendment No. 22, in clause 9, page 5, line 27, at end add—
‘(5) In making arrangements under this section, the Secretary of State must have regard to the principle that the persons providing services under subsection (1) should be able to demonstrate an appropriate level of expertise and experience in the provision of medico-legal advice in clinical negligence matters.'.
This is a probing amendment along the same lines as amendment No. 23. We are assuming that patients will be adequately, thoroughly and effectively advised so that the system can work as well as possible. The amendment would ensure that a provider of assistance and advice has expertise and experience.
In the statement of policy, assistance for those seeking redress is described as being provided through
“Patient Advice and Liaison Services (PALS) and Independent Complaints Advocacy Service (ICAS) type arrangements.”
Both of those organisations are commendable, and the people involved with them are doing worthwhile work, but neither is appropriate for empowering a patient to influence the outcome of an investigation that has to pass something legalistic such as the Bolam test. Patient advice and liaison services are not genuinely independent, being part of the customer care arrangements in the NHS, and ICAS is designed to help patients navigate the complaints procedure. Neither seems to fit the bill for the provision of complex advice in difficult circumstances, and they could not do so without changing radically their purpose, nature and set-up. That would be true even if the Government were to leave them alone for any length of time, which they rarely do, often being minded to abolish or change them or create different organisations in their place. The amendment would ensure that the advice available to individuals was appropriate and came from qualified people. I cannot see any fundamental objection to that, but other hon. Members might.
John Baron (Shadow Minister, Health; Billericay, Conservative)
The hon. Gentleman has made clear the aims behind the amendment. I have some problem with it, because our view of the McKenzie-type friend is that it should be an informed lay person, able to provide support and guidance on procedures and ensure that a patient does not feel at a loss within the system. The clause enables the provision of that sort of person. The amendment would introduce substantive legal and perhaps medical advice at all stages of the process, rather than at the end as is currently envisaged. I therefore return to points made on preceding clauses, upon which I shall not expand. The amendment would add complexity and potential expense and go some way towards replicating the courts system.
John Baron (Shadow Minister, Health; Billericay, Conservative)
I take the hon. Gentleman’s perfectly reasonable point. However, it is worth pointing out that the clause makes provision for a McKenzie-type lay person. I reiterate the view that if we start to import more legal advice along the lines suggested in comments on previous clauses, we will add complexity and potential expense and in effect replicate the court system. We cannot support the amendment.
Andy Burnham (Minister of State (Delivery and Quality), Department of Health; Leigh, Labour)
Clause 9 is important because it provides for a broad range of support to be offered to individuals seeking redress under the scheme. Judging by the tenor of comments throughout our proceedings, there is no will to limit that range of support. I find myself agreeing with the hon. Member for Billericay. It is right for us to allow a broad range of lay and other support to be provided; to restrict that to medico-legal advice would be a mistake.
Clause 9 imposes on the Secretary of State a duty to provide assistance for people to meet “all reasonable requirements”. It is intended to require the provision of support to patients whose cases are being considered, and is a wide duty, as I said. Our intention is that that service be based on those currently provided by PALS and ICAS to support patients through the complaints process.
Again, we intend to discuss and consult further on what type of services might best be provided, but we want the broad power to provide a range of support. On a number of occasions, Conservative Members have rightly drawn attention to the role of McKenzie friends. That would be a type of support with which people might wish to engage.
I have to say, I am not entirely clear on what is meant by
“expertise and experience in...medico-legal advice”,
but it suggests only someone with legal qualifications or experience. That, too, could bring unnecessary cost and resource implications to the scheme. Again, for the avoidance of doubt, our intention is not to import lots of legal advice into the scheme, but in many ways to limit such advice. So we hope that the broad support that people could get from other sources would limit the need for independent legal advice. I urge the Committee to resist narrowing the Bill in such a way.
If I understood the hon. Member for Southport correctly, he simply wanted advice of the highest possible quality to be available to people. That is a perfectly legitimate aim, and I believe that our provisions and the range of measures for legal advice, as we discussed earlier, are complemented and supported by clause 9. We would lose that if we amended the clause in the way that he suggested. The provisions will offer a broad range of support as somebody goes on the journey of seeking redress under the scheme. I do not blame him for tabling the amendment. It has allowed me to explain to him our intention behind the clause. As I said, it is an important clause, and I ask him to withdraw the amendment.
John Pugh (Shadow Minister, Health; Southport, Liberal Democrat)
I do not disagree with the thrust of what the Minister has said, but I think that the area is still a work in progress. There is one point that we have not dealt with, and which he has not answered. The organisations nominated as potential advisers would need to be changed in character in order to deliver effective advice. No doubt some consideration will be given to that.
I beg to ask leave to withdraw the amendment.