17CC. Nothing in, or done under, any agreement entered into under the provisions of section 17C shall be taken in any proceedings in any court or before any tribunal to deprive a medical practitioner or an individual who is providing personal medical or personal dental services in accordance with section 17C arrangements of his undoubted right to raise in whatever manner he sees fit any concerns over the clinical care provided to patients under those arrangements.".'.—[Ms Jowell.]
I beg to move, That the clause be read a Second time.
New clause 6 seeks to safeguard the right of medical practitioners, or those engaged in pilots, to raise issues of concern about their patients through whatever means they consider fit. It would protect the right of general practitioners to raise publicly in the media, rather than with their managers, concerns about the treatment and care of their patients that they feel cannot otherwise be properly addressed, and where the management or other clinical practice in the service has been found to be inadequate. We sought to raise the matter in Committee. Because of the strength of feeling among GPs and other health service professionals, we have brought it back on Report. I hope that even at this late stage the Minister may be persuaded of the importance of safeguarding this freedom.
It is a fundamental protection for health service staff to be able to speak out. It is impossible to describe the terror, the sense of conflict, that doctors and nurses feel before they speak out. We should think of the well documented scandals with hospitals and other forms of care. I remember especially some of the scandals with long-stay mental hospitals which erupted into public consciousness.
I am delighted that the hon. Gentleman has made clear his support for new clause 6.
I had a case several years ago in my constituency where there was evidence of brutality to people suffering from learning difficulties. It was also clear that staff in the hostel concerned knew what was going on, but because of the reign of terror prevailing there they felt unable to raise publicly the concerns that they felt defeated in raising privately. This provision would be part of any good legislation.
It would be much better if we could take it for granted that staff have this power, but we know that they do not. In Committee, I set out in detail the constraints on speaking out that different forms of contract place on staff. Many health service staff are expected to comply with a byzantine procedure. Often it is only after several weeks—a long time—that they can use the course of last resort and go public with their anxieties. Staff may feel unable to raise concerns about the care of their patients with the management in units that are badly managed or where the management is out of touch, or out of sympathy, with the clinical and caring objectives of the service. In those circumstances, the power to act independently in defence of patients' interests is very important.
It is essential that, where bad things are happening to patients, staff are able to take whatever steps they feel necessary to seek a quick remedy. One of the consequences of the Bill will be that following the expected increase in the number of salaried GPs, more GPs will be potentially compromised by being employed rather than being independent contractors. As independent contractors, they have the freedom to speak out. As salaried employees of trusts, they are denied that right.
In the interests of protecting patients, I hope very much that the Minister will support the new clause. If he fails to do so, it will send an extraordinary message to the people of this country—that, despite all that he said in Committee, he supports the gagging of staff, which has the highly undesirable effect of damaging the independent representation of patients. The Government should put the health and safety interests of patients before any other organisational consideration.
I will be brief, as I have little to add to what I said in Committee. I do not pretend that this is an easy issue to deal with, and it is extremely important. No one is suggesting that people should be inhibited in any way from raising proper concerns about what is going on in any organisation in which they work within the NHS, and I will show in a moment how we have reinforced that as an obligation on employees. These are not easy issues, but I repeat to the hon. Member for Dulwich (Ms Jowell) that she has overdone it somewhat. There are a range of examples, some of which she herself has cited, where important cases have been brought to the attention of the proper management—or if not the management, to the attention of Ministers or local health authorities.
We issued guidance to staff in June 1993 which not only stressed that staff concerns should be taken seriously by all managers and should receive full and sympathetic consideration, but made it plain that staff have a duty to raise these concerns in the first place. It is not a question of trying to prevent anyone from doing that, and I hope that there is a culture in the NHS in which people feel that they have a proper responsibility to raise matters of concern with a view to patient confidentiality, fidelity to the employer and, ultimately—if they are professionals—their professional obligation.
The hon. Member for Dulwich mentioned what will happen with salaried GPs. One of the interesting effects of one of her amendments is the strange suggestion that an independent practitioner will have the right to raise problems concerning the clinical care provided to his or her own patients which he or she is providing—a strange exemplification of a whistleblowers' charter. The fact that some may become salaried GPs takes them into the other arrangements and the guidance that we have set out.
I repeat that we take this matter seriously, and we are tackling the issue. We see no need for further legislation on it, and I urge the House not to support the new clause.
What is important is that clinicians have an overriding responsibility to their patients. We know that one of the undesirable effects of the Government's reforms has been, in many cases, to compromise institutionally their sense of loyalty. This culminated in the remark of one Roy Lilley a year or so ago, that the principal responsibility of clinicians in the NHS was not to their patients, but to their employer. The suggestion that fidelity to the employer has become the overriding obligation is what causes us great concern.
The Minister has no right to sneer at the comparison between the position of independent contractors and that of salaried GPs. GPs acting as independent contractors are perfectly free to raise concerns about the care that their patients receive in hospitals or other parts of the health service, whereas salaried GPs may feel compromised in raising such concerns. That is why we have tabled the new clause.
The Government's failure to support the new clause speaks volumes and will send out a clear message to staff in hospitals and to workers throughout the health service in this country about the Government's indifference to the protection of patients. Fortunately, for reasons that were stated earlier, that indifference will not persist for much longer and a Labour Government will be able to safeguard the interests of staff and patients in the national health service. In view of that, I beg to ask leave to withdraw the motion.