NHS Medical Staff: Expression of Views (Hansard, 3 May 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, all National Health Service staff have a right and, indeed, a duty to raise with their employer any concern they may have about health care issues. The new code of practice on openness in the NHS aims to improve public access to information about health services. It does not alter the duty of medical staff to express views to their employers, nor does it change nationally agreed terms and conditions of employment which give them freedom to speak and write.

§ Lord Ashley of Stoke
My Lords, I am grateful for that reply. However, is the noble Baroness aware that I was hoping that she would include some reference to medical staff complaining in public rather than to their employers? Is she aware that the present code of practice in no way deals with the gagging of doctors and nurses? That is because of the increasing competition between trusts who regard public statements by employees as a betrayal. Does the Minister agree that the first loyalty of medical staff should be to the patients and that there are some—not many—occasions when they should speak in public? Would not a constructive way forward be to require all trusts to inform the Government of the details of the gagging clauses in their contracts of employment, to have those clauses reviewed independently and to have the findings reported to Parliament?

§ Baroness Cumberlege
My Lords, there are two issues here. First, there is the guidance sent to the National Health Service in June 1993. Secondly, there is the code of practice on openness published in April and to be implemented in June this year. Those are two different documents. The first deals with staff relations with the public and the media, the second with the rights of individuals to have access to information about the National Health Service.
The guidance for staff makes clear that under no circumstances are employees who express their views about health service issues in accordance with the guidance to be penalised in any way for doing so. It takes into account also the new contracts that are being drawn up by trusts for staff. It states that, any explicit confidentiality provision in an individual staff employment contract must be expressed in a way that does not conflict in any way with the principles and the advice set out in this guidance". The situation is absolutely clear. Staff have the opportunity to speak to the press and other media if they wish to do so. However, we believe that their first duty is to take up the matter through the local management system. They have opportunities to refer matters to Members of Parliament, to trade unions, to professional 1371 and regulatory bodies, and, in the case of detained patients, to the Mental Health Act Commission, and in some circumstances to the ombudsman. There is therefore plenty of opportunity.

§ Baroness Gardner of Parkes
My Lords, I must again declare an interest as chairman of the Royal Free Trust. The House must be getting rather tired of my saying that. As chairman of the trust, I should like to make this point clear to the Minister. Is she aware that, as in most well-managed trusts, there are no gagging clauses whatever in our contracts? Patient confidentiality is of course a different matter. Can the Minister tell the House about the access to information that the public will have? We have received the document on openness in the National Health Service, according to which no one can be charged for information unless over one hour is taken up when dealing with a query. That is rather a worry to any efficient trust, as lots of people could take up half-an-hour of one's time. I notice that under the code representatives and official bodies are required to provide information free of charge, no matter how much time is taken up. Will the Minister confirm that there will be an opportunity to review this state of affairs should it be found, as in courts and industrial tribunals, that some people become rather vexatious and constantly take up valuable time?

§ Baroness Cumberlege
My Lords, I agree entirely with the first part of my noble friend's question. It is up to trusts to have a very open regime so that the staff can raise issues. On charging policy, we think it reasonable that people who want information about their local health services should have access to it. If a small charge is made, we believe that that is reasonable. For example, when a schoolchild writes in and says, "Please can you send me everything you've got about the NHS?", that causes a problem. Indeed, sometimes our officials find that they are writing PhDs for people, given the way in which questions are framed. We think that it is unreasonable not to make a charge in such cases.

§ Lord Graham of Edmonton
It is a matter of degree!

§ Baroness Jay of Paddington
My Lords, can the Minister explain how both the codes of practice and the guidance to staff will apply to the new regional offices? As the House will know, they replace regional health authorities under the Bill which will presumably pass its Third Reading in this House tomorrow? As I understand it, the regional offices will be outposts of the Department of Health, and will therefore come under the Civil Service code. Presumably, the staff employed in those offices will have no rights to speak out.

§ Baroness Cumberlege
My Lords, the staff in the regional offices are civil servants and are therefore bound by Civil Service codes.