Watching Andrew Lansley introduce MPs to his “nudge” white paper on public health, I was struck by how much it is still a first draft and by how enthusiastic the new generation of Conservative MPs is for bossiness.
It’s quite unlike the not so distant past when cries of “nanny state” and “social engineering” would have been far louder.
Media reaction was similarly modest, coverage quite overwhelmed by the WikiLeaks controversy, itself another interesting example of the difficulty of balancing liberty and responsibility. Local authorities are sceptical about Mr Lansley’s promises of “greater freedom” combined with ringfenced public health budgets. They fear it will lead to more interference from Whitehall. It’s one to watch.
Quite a different parliamentary exchange caught my eye during the week: a renewed attempt by backbench MPs to cajole ministers into imposing “a statutory duty of candour” on hospitals and GPs alike - as distinct from mere guidelines designed to encourage NHS staff to tell patients and families when they have made a mistake.
It’s always a bit of a shock to be reminded that this is still an issue. The campaign group, Action Against Medical Accidents, was founded as long ago as 1982 after Peter Ramsay (he co-wrote Angels) wrote a TV play called Minor Complications about a shocking hospital cover-up.
The National Patient Safety Agency battles inside the NHS family to raise standards, its Being Open initiative relaunched just a year ago. The National Clinical Assessment Service issued fresh exhortation, Back on Track, only last week.
Yet Tory MP for Poole Robert Syms and his allies, Lib Dems Tom Brake and John Pugh, and Labour’s Liz Kendall, were able to cite dreadful examples of professionals refusing to admit error or apologise, and refusing to reform procedures even today when we all live on a diet of openness and accountability.
Syms even cited the case of Helenor Bye, who died aged 13 after what looked like a bad mistake in 1978, but whose parents are still campaigning for redress. The grim saga is all on Wikipedia. The Byes suffered the further indignity of later discovering that soft tissue had been removed from Helenor and spread around the system.
In their debate MPs also heard of the mislaid X-rays which led to cancer treatment for the wrong woman. The lorry driver with hypertension who was prescribed Viagra (it raises BP), the “glandular fever” which turned out to be terminal leukaemia, we all know stories like this. Despite progress the NPSA hears of a million cases a year.
What emerged from Syms’ backbench debate was not what I expected but - like Lansley’s white paper - another example of government caution to offset its radicalism. In their coalition agreement ministers promised “to require hospitals to be open about mistakes”, a phrase lifted from that Lib Dem manifesto that has caused Nick Clegg so much student trouble this week.
But how to do it? Minister Anne Milton acknowledged that among those urging the statutory option has been former chief medical officer Sir Liam Donaldson, whose Making Amends report in 2003 suggested those reporting their own mistakes should be exempt from disciplinary action except in criminal cases.
Fear of legal liability is one inhibiting problem which the 2006 NHS Redress Act was designed to ease. MPs believe that compulsory candour would ease the litigation problem. Beefing up Care Quality Commission guidelines and a statutory requirement are not the only options, says Ms Milton. The simplest effective option may be to insert an openness requirement into NHS commissioning contracts. Another one to watch.