HL Deb 16 July 1992 vol 539 cc315-6

11.6 a.m.

Lord Carter asked Her Majesty's Government:

Whether they will introduce legislation to prohibit confidentiality clauses in National Health Service contracts of employment.

Baroness Cumberlege

My Lords, the Government have no plans for such legislation. However, new staff guidelines for expressing views about NHS service provision will be issued for consultation shortly.

Lord Carter

My Lords, I thank the Minister for that reply. Do the Government agree with the Health Service Commissioner that NHS staff should not be inhibited from raising issues concerning the care of patients? Does she further agree with the NHS consultants' association that the priorities of NHS staff should be, first, to the patient; secondly, to the original concepts of the health service; and, thirdly, to the hospital unit in which they work?

Baroness Cumberlege

My Lords, all staff should have an opportunity to bring before their local management any grievances that they feel. Banning confidentiality clauses is not the answer. However, as the noble Lord said, there is a need to strike the right balance between the responsibility of staff to patients and loyalty to their employers. The guidance we propose to issue will help to ensure that the right balance is struck.

Lord Ennals

My Lords, does the Minister agree that a special situation exists in relation to those NHS staff who are directly involved in patient care? Therefore is not their first responsibility to patients? Will she accept from me my pleasure on hearing her say that there is no place for confidentiality clauses in such agreements?

Baroness Cumberlege

My Lords, the noble Lord misunderstands me. I said that I did not believe there was a case for banning confidentiality clauses in the terms and conditions of service. Staff have a duty to patients; they also have a duty to their employers. Open hospitals that are self-critical and generate an atmosphere of care and compassion certainly encourage staff to come forward with any complaints that they may have.

Lord Ennals

My Lords, as I misunderstood the reply given by the Minister, will she permit me to withdraw the compliment that I paid to her?

Baroness Cumberlege

My Lords, I am heartbroken.

Lord Carter

My Lords, if the Government are not prepared to ban so-called gagging clauses, will the Minister say how they are compatible with the aims of the Patient's Charter? How can the Government and the health service ensure that standards set for the charter are achieved if staff are silenced and prevented from speaking about the poor standards of care which sometimes occur?

Baroness Cumberlege

My Lords, it is up to local managers to manage. The NHS has invested considerable sums of money in improving management within the NHS. Aggrieved staff, or staff who feel that they have a case concerning patients, have the opportunity to go not only to their local manager, but to the chief executive, the non-executives and the chairman of the board. They can also go to the regional health authority and the NHS management executive. They can seek support from staff associations and professional bodies. As a last resort they can take their case to the Health Service Commissioner.

Lord Bruce of Donington

My Lords, will the noble Baroness clarify the position as regards aggrieved patients? As she well knows, there are cases in which patients have a legitimate claim against a particular institution for lack of proper care. Are we to understand from the Minister that a person in a hospital who knows that things are wrong is prohibited from communicating in any way with the patient concerned? Does she believe that the confidentiality clause that she proposes will override any subpoena served on the person concerned?

Baroness Cumberlege

My Lords, of course staff have a very responsible and prime duty towards their patients. I am saying that if the staff have a cause for grievance then their first port of call should be the local management. If that management is uncaring or does not listen, then there are the lines further up the chain which I mentioned in my previous answer.