There has been a lot of talk and commentary around the health and care bill, which has its second reading in the House of Commons earlier this month. Indeed, the legislation represents some of the most significant changes to the NHS since the Lansley reforms in 2012.
Much of the bill is focused on structural reform and integrated care, with NHS England and NHS Improvement formally merging, while establishing integrated care systems (ICSs) on a statutory footing, thus giving them greater permanence.
While there is certainly a debate to be had about the timing of this legislation and the importance of supporting the NHS through the next phase of the pandemic, there are aspects of this bill that the Medical Defence Union (MDU) welcomes and supports – the most notable being the formal inception of the Healthcare Safety Investigation’s Branch (HSIB) as a statutory, independent arm’s-length body, retitled as the Health Service Safety Investigations Body (HSSIB).
We have long championed this move. Putting the HSIB on a statutory footing will give it a much greater sense of permanence, enshrine its independence and elevate the status of its investigations.
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Improving patient safety
We want the HSSIB to be seen as the organisation best placed to develop investigation methodologies that are designed to improve learning from patient-safety incidents. In that spirit, it is particularly welcome to see clause 94 of the Bill make it clear that the purpose of an investigation is to identify risks to patients and mitigate those risks with improvements in systems and practices.
Clause 94 also makes it clear that an HSSIB investigation is not there to assess or determine blame or liability, and clause 97 explicitly prohibits the naming of individuals providing information to HSSIB (unless they consent).
The task of fostering an open, learning culture in the NHS is a constant journey, not a fixed destination. The MDU is committed to playing its part in nurturing this culture, and we will support legislative measures we believe will help achieve that.
GMC and GDC reforms
The health and care bill also includes provisions relating to healthcare professional regulation. One particularly striking feature is to be found at clause 123, where the secretary of state for health and social care would be given the power to abolish, merge or delegate regulatory bodies.
The government has already stated that it is minded to reduce the number of regulatory bodies for health and care professionals from the existing nine. The MDU’s position is clear: the GMC must remain the dedicated regulator of medical professionals, and the GDC the dedicated regulator of dental professionals. We will make this case strongly during the bill’s passage.
The bulk of the government’s ambitions to reform the GMC and GDC are to be found in its recent consultation, Reforming healthcare professional regulation, protecting the public. The MDU submitted a comprehensive response to this consultation.
In short, doctors and dental professionals have waited a long time to see their regulators reformed. Reforms must deliver a regulatory regime that is fair, proportionate and timely. We now want the government to proceed without delay. Given the complexity of the health and care bill, we believe the government is right to have committed to consult on separate, secondary legislation to reform the GMC later this year, with a view to that coming into effect early in 2022. We are urging the government to stick to that timetable and also ensure that the GDC is not far behind.
The MDU is committed to championing members’ medico-legal and dento-legal interests, so we will be monitoring the progress of the health and care bill very closely.