Queen’s Speech

My Lords, it is a pleasure to have the opportunity to talk about the progress of the NHS under this Government and to say something about what continues to need close attention. I shall concentrate on the delivery of NHS change and improvement, but first let me declare my interests. I am the part-time chairman of the NHS London Provider Agency which focuses on improving performance in London’s NHS providers. I am also an adviser to the General Healthcare Group, Perot Systems and Byotrol, all of which have healthcare interests, so I am reasonably in touch with the current healthcare scene. The Government are to be congratulated on their investment in the NHS to rectify what I regard as the gross underinvestment of the 1980s and the early 1990s. Alongside that investment they have introduced reform through foundation trusts, targets, choice, competition and political leadership to drive change. However, we need a continuing strategy of investment and reform. We know from the reports of the Healthcare Commission that access, mortality rates and care quality have all improved over the past 10 years. Only yesterday the commission published findings that show improvements in life expectancy at birth since the mid-1990s and a reduction in early deaths from cancers and coronary heart disease. The commission’s rankings of those trusts performing excellently have risen from 4 per cent to 26 per cent over the past three years. But overwhelmingly this improvement in excellence is shown in the foundation trusts rather than the non-foundation trusts. I now come to the point that those who are listeners to the ““Today”” programme might call the John Humphrys’s ““but”” moment: the improvements have not been evenly spread. For example, about 40 per cent of trusts are still classified as ““fair”” and ““weak”” by the Healthcare Commission. Overwhelmingly, as I have said, these are trusts that have not obtained foundation trust status and, in some cases, have no prospect in the foreseeable future of doing so. Some of the extra largesse has not been used as well as it might have been and the productivity increases between 2000 and 2005 are somewhat unfortunate and disappointing. The Government recognise, however, that further improvement is needed. They have announced, in difficult financial circumstances, a fair settlement for the NHS in 2009-10 and 2010-11 and are using sensibly the surplus that has been built up to help the NHS to continue to invest in good healthcare. As I understand the figures published by the Government, that allocation means that, on average, there will be a 5.5 per cent increase in both those years for primary care trusts. Even more significantly, my noble friend the Minister has provided a clear vision of the quality improvement for the future direction of the NHS to which, at least in principle, most people subscribe. The report he provided in London before becoming a Minister offers a real prospect for far-reaching improvement. However, we now need many parts of the NHS to raise their clinical and managerial game, particularly over the next two years before an almost inevitable reduction in all public sector allocations in order to reduce public borrowing. We have a window of opportunity for real change to continue over the next two years. The proposed NHS constitution is a helpful framework document and has some important aspects in the way it balances rights and responsibilities. I like the emphasis on quality, accountability and choice, which are important drivers of NHS improvement. I am not opposed to giving the constitution some legal underpinning provided that it leads to driving improvement and does not wrap us up in red tape and, much more importantly, does not put the NHS in aspic and makes it unable to respond speedily to medical advances and the inevitable increases in public expectations of our NHS. The only thing that is clear from the past 60 years is that medical advances have come thick and fast and that the public continue to expect the service to improve. We will no doubt explore further the issues I have mentioned when we come to consider the new health Bill. However, the Bill will have not such a great impact over the next two to three years, and the remainder of my remarks relate to some of the areas where the Government and the NHS need to secure real change before the funding flows start to slow considerably. It is explicit in my noble friend the Minister’s vision for the NHS that there will need to be a major reconfiguration of services, such as stroke and trauma, with many services being provided in different places from where they are now. This will, of course, take time. Quality indicators will make these changes inevitable. Changes of this kind require real clinical leadership and board and management commitment to change. It almost certainly means mergers of struggling trusts and, in some cases, an effective failure regime so that more competent organisations can take over those that fail. Not all our geese are swans in the NHS. This will require political courage and many elected politicians across the parties will need to cease fantasising about the sustainability of some of the services in their local hospitals. It will require courage from doctors and politicians to stand up and describe the benefits of the changes that need to be made if we are to carry forward the next stage review. Secondly, we will have to increase NHS investment in IT at the local level; it is no good the NHS continuing to moan locally about the national programme for IT. That programme, despite all the criticism, has delivered some major changes for the NHS. BT is to be congratulated on the work it has done in this country in putting in place a national spine; it is a major achievement of technology. Connecting for Health has brought enormous benefits for patients. Improvements in the transfer of imaging, in electronic prescribing, even in the much maligned choose-and-book system and in secure e-mails are among the advances that have already been delivered. A great deal of focus has been placed on the failure to deliver as rapidly as most of us would want the electronic patient record. But this is not the time for the Government or the NHS to lose their nerve; we need to press on with getting it delivered. There will inevitably be technical glitches, but they can be overcome. We must understand that the NHS at the local level also has to raise its game on IT investment. It was never the case that the national programme would pay for the training of staff at local level and re-engineer all local systems. Parts of the NHS have failed to step up to the plate in the way they have invested in IT. We lag behind other countries at the trust level in what we invest in IT for a modern healthcare system. There are two other areas in which resources can be freed up to benefit patient services and NHS development. The first area is in pathology services, where the Government and the NHS need to get behind the proposals of my noble friend Lord Carter of Coles, whose further report in this area is to be published shortly. When I was a Minister with some responsibility in this area I believed that the £2.5 billion or so that the NHS spends on pathology services had the capacity to deliver about a 20 per cent improvement in efficiency. Those kinds of sums would enable the NHS to adapt its pathology services to take advantage of the great advances in genomic medicine which are coming very fast. The other area is a rather Cinderella area, not only of the NHS but of public services—I refer to the way in which we manage our buildings and land and our facilities management. This has been long-neglected, is very unfashionable and is something in which most politicians do not like to get involved, but the NHS footprint could be seriously reduced to free up assets for other social uses and to secure a capital return for the NHS. In addition, we need to look at what we are good at in the NHS. We are in the business of providing patient care, not managing buildings. Facilities management needs the kind of professionalisation that outsourcing by, for example, the Department for Work and Pensions has used so successfully over the past seven or eight years. There are some real gains to be made which could help with patient services in times of shortage. I want to end, appropriately enough, with the end-of-life care strategy, on which the Government are to be congratulated. When we come to the health Bill I will want to look further at whether we can secure some stronger legal underpinning for health professionals to have regard to advanced decisions and to ensure that those decisions are incorporated in NHS medical records. We need a debate on that strategy before too long. My last point concerns the issue of assisted dying, which has been in the media a great deal and will not go away. I do not want to start a debate on that today but the present legal position is untenable and, in the view of some of us, cruel. I should like to see the Government oversee a more robust way of establishing independently what public and medical opinion is in this area, in the way that Professor Mike Richards did so skilfully over the equally emotive issue of top-up fees. This is an area where the Government could help to improve the quality of the public debate.