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NHS: Reform

Volume 728: debated on Monday 6 June 2011


Asked By

To ask Her Majesty’s Government how they will ensure that their proposals for the reform of the National Health Service do not lead to a break up of the service.

My Lords, the Government are currently pausing to consider possible improvements to the Health and Social Care Bill. However, our proposals will reinforce the NHS as an integrated system, joining up working between the NHS, public health and social care locally. A new NHS commissioning board will set national commissioning guidelines promoting greater consistency. All NHS bodies and providers of NHS services will remain bound by the NHS constitution, and the Secretary of State will remain accountable overall.

My Lords, I thank the Minister for his reply. Does he understand the issue of low morale within the NHS that is being caused by these proposals, as well as the concern and worry among patients? Let us be clear that the record of the Conservative Party on the NHS, now supported by the Liberal Democrats, is a great worry to citizens and to anyone who values and cherishes this House.

My Lords, I accept that a number of aspects of the Government’s proposals have caused concern in many quarters, and that is why we have chosen to pause in order to listen and reflect on those concerns. As I have said, we will be bringing forward proposals shortly to improve the Bill. I hope that those proposals will meet with widespread acceptance. I think that it is fair to say that it is not the main principles which the Government have laid out that have been the subject of controversy but rather the detail and the implementation, which we are looking at most closely.

My Lords, does the noble Earl agree that if we are going to make the proposed savings in the health service of £20 billion, some form of reconfiguration of how health services are delivered is inevitable? If that is so, which would he prefer: a market-driven reconfiguration, or a planned one that will contain costs in the future?

My Lords, the way we have set out the Health and Social Care Bill means that, wherever possible, decisions on service reconfiguration will be taken at the local level. That will mean that all stakeholders locally, not only the NHS but local authorities, social services and patient groups, will buy in to and contribute to whatever decisions are taken. So my answer to the noble Lord is this: it should be a considered process of decision-making taken locally.

My Lords, as we know, the NHS is the most valued public service in this country. It is one that we all rely on from the cradle to the grave. What are my noble friend’s views about the fact that it is still the most unaccountable public body delivering services that we have? It is still unaccountable to its users. What discussions have been taking place to ensure that the NHS becomes far more responsive and accountable to users?

My noble friend has made a key point. As she will know, patient and public accountability is one of the themes of the listening exercise that we have been conducting. I anticipate that Professor Steve Field and his NHS Future Forum will come forward with some substantive recommendations on how we can improve the arrangements for accountability in the service. I agree with her that it is in practice less than accountable at the moment, and our view is that it should be accountable primarily to patients in the local area but also, crucially, to Parliament as well.

My Lords, ought not the Government to pause and think before they introduce policies and not cause disharmony within the service?

My Lords, if the noble Lord remembers, we consulted extensively last year when we published our White Paper. However, as the Bill progressed though Parliament, it became apparent that concerns on the detail of the Bill gave rise to matters of implementation which could have legislative implications. That is why we have taken a second chance to look at that detail.

My Lords, would my noble friend care to cast any light on the fact that I have received criticisms of the Bill from virtually every health professional body but not one from a patient?

My Lords, the criticisms that my noble friend has received have no doubt been considered under the umbrella of the NHS Future Forum. I can tell him only that I have personally received many expressions of support for the key principles that we have outlined.

My Lords, the NHS makes a considerable contribution to the health of patients through its participation in major research projects, working with drugs companies and those concerned to improve the quality of care in hospitals and outside. What protection is there for this continuing?

The Bill states that the prospective NHS commissioning board will have a duty to promote research and continuous improvement in the quality of care. As the noble Lord will know, that duty will be underpinned by the role of NICE, which will be tasked with producing quality standards that are informed by the latest innovations coming through from the research agenda.

My Lords, I am sure that all of us await with considerable interest the outcome of the review that was recently undertaken and its proposals relating to the changes proposed in the Health and Social Care Bill. May I take it that, in addition to the bodies which the noble Earl listed, the universities which train doctors and other healthcare professionals and provide facilities for research will be fully consulted because of the importance of the training of those professionals in the NHS?

The noble Lord is quite right. The vital importance of education and training is one of the four main themes of the listening exercise. We have received some very interesting and significant proposals from the academic sector which Professor Field will no doubt reflect in his conclusions.

According to information provided in response to a recent freedom of information request, in Hull GPs have 17 per cent of the budget whereas in the East Riding they have 69 per cent; in Derbyshire there are 12 finance officers supporting GPs, whereas in Bristol there are none; and in London there are 10 executive directors, of which three are public health directors, but nobody knows to which of the 32 boroughs they belong. How will the Government ensure patient safety in what I hope the Government might recognise is possible impending chaos resulting from the de facto implementation of key parts of the Bill, the dismantling of the SHAs and PCTs, the patchwork of growth of new organisation and the leaching away of experienced staff?

My Lords, we are putting patient safety at the centre of the NHS by moving it to the NHS commissioning board. In that way, patient safety will be embedded into the health service through GP commissioning and their contracts with providers. We are strengthening the Care Quality Commission so that patients know whether providers are meeting minimum standards of safety. We are also developing outcome measures for patient safety so that everyone can see how organisations are performing and can be held to account by the people that they serve.