Queen’s Speech

My Lords, it is a great pleasure to follow the noble Lord, Lord Dearing. I thank my noble friend Lord Darzi not only for his excellent introduction to this debate but for all his work on NHS reform, which will shape the nature of the service for years to come. It is on this that I wish mainly to concentrate in my brief remarks. I shall concentrate especially on the NHS constitution, which will have far reaching effects for patients and public involvement, which is one of my main interests in the NHS. I make at the outset two declarations of interest. First, I have been appointed as chair of the new Council for Healthcare Regulatory Excellence, an independent body accountable to Parliament whose main aim is to promote the health, safety and well-being of patients and members of the public. We scrutinise and oversee the nine health service regulators and work with them to promote good practice in regulation. Secondly, I chair the Specialised Healthcare Alliance, a coalition of 42 patient organisations which campaigns on behalf of people requiring specialist medical care. Wearing both those hats, I welcome the move to develop an NHS constitution. It is an important step forward for patients and public, and I look forward to working on the legislation as it proceeds to ensure that it is clear and non-confusing for patients, and as accurate as it can be legally. It is clear that simplifying and codifying the many interlocking rights, responsibilities, duties and pledges which relate to healthcare is a difficult task. For example, as other noble Lords have asked, how will the constitution be used in relation to services which are not provided by the NHS at all but by another agency or third party? The commitment to publish a separate statement of accountability is welcome, but patients must be clear about where accountability lies. The focus on quality of care, and reflecting the needs and preferences of patients, their families and their carers, is welcome and continues the excellent progress made in the carers strategy. The strategy set out that carers will be treated as expert partners in care. As vice-president of Carers UK, your Lordships would expect me to acknowledge how important that is, but it is important, too, to put in place support mechanisms to help carers develop their skills and confidence. Informed choice is important to all patients and has become a major determinant of treatment options, but choice is real only where alternatives are available. The formal recognition of patient choice in the NHS constitution and the placement of patient choice as a major determinant of treatment options are very welcome, but to realise this so far as, for example, specialised treatment is concerned, PCTs will have to provide information on the quality of clinical services. There is still a long way to go before accurate, reliable and meaningful data become available that enable patients, working with their doctors, to make fully informed choices about what is available to them. The new legal right to choice is therefore welcome, but we must remember that real choice includes services and treatments as well as providers, and is dependent on the provision of accurate information. It is also important to ensure that the constitution makes it clear that the Human Rights Act, which confers the right to dignity and privacy, underpins it. This would enable members of the public better to appreciate those rights and to know what to expect in practice when receiving services provided by professionals for or on behalf of—I emphasise ““on behalf of””—the NHS. This will empower patients to demand their rights and to seek redress when those rights are not upheld. I turn finally to the position of carers and I am grateful to other noble Lords for mentioning this. Many of their concerns fit more adequately into yesterday's equality debate, but their needs cannot, of course, be divorced from health and social care issues. Alarming new statistics recently published by Carers UK reveal that the nation's carers are under even more pressure as living costs rise and the economic crisis affects even more families. Nine in 10 of the carers recently surveyed say that their financial position is worse than 12 months ago yet they provide vital support, unpaid, to their elderly, sick or disabled relatives, making a contribution worth £87 billion a year to the UK economy. Half of all carers are cutting back on food just to make ends meet—more than double the rate of only a year ago—and 32 per cent of those paying rent or a mortgage say that they cannot afford to pay it. The draft NHS constitution mentions carers and states: "““NHS services must reflect the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment””." That recognition of the importance of carers is extremely welcome. The NHS must, however, start to view carers as partners in care and welcome their knowledge and opinions. As well as this legislative change, we need a cultural change at local level so that the training for professionals to recognise carers, for example, must proceed much more quickly than it has done hitherto. Improving complaints procedures for people who have arranged their own social care is welcome, as the impact of poor service has a significant impact on carers and their health, income and ability to work. It would give families greater power to demand a good service for the person they care for. I look forward to taking part in the debates as the legislation proceeds, particularly those around direct payments and personalisation, which will have tremendous significance for those caring families. They are very welcome developments, but it is important that we continue to take account of the 6 million people who provide by far the majority of health and social care provision in our country.