Health Bill [HL]

My Lords, the Bill contains important measures to increase the quality of NHS care, to raise the performance of NHS services and to improve public health. I welcome the opportunity to set out the purpose of the Bill and the policies behind it. I also look forward to the contributions of noble Lords and I am sure we will have a lively and informed debate. I know that the Bill will benefit from the careful and expert scrutiny it will be given in this House. The key purpose of the Bill is to underpin the commitments set out in High Quality Care for All. My aim in that report was to set out a vision for an NHS sustainable in the 21st century—an NHS that gives people more information and choice, works effectively in partnership and has quality of care at its heart. I am proud that the next-stage review captured the views of around 60,000 people. This breadth of interest is a testament to our collective sense of pride in the National Health Service. The Bill will implement those measures in my report that require legislation. Just as importantly, it will help to embed the overarching theme of my review: that our approach to healthcare should be based on a drive to improve quality. From measures to improve performance and accountability to those that will improve quality of life and the personalisation of care, I believe that the Bill will help to foster a culture of quality in our health service for patients, the public and our staff, regardless of background and circumstance. To set the context, it is worth reflecting briefly on the purpose of my report. There is a role for the Government in defining and communicating a vision of quality for the NHS, in setting priorities and ensuring clear rules to tackle unacceptable performance. However, it is only by freeing up clinicians, managers and service users that we can really drive up the quality of care. I intended my report to be an enabling report, setting out the national policies that will empower clinicians, patients and the public to drive the changes that are needed locally. In the same way, I believe that this will be an enabling Bill, one that empowers clinicians, patients and the public to improve health—a Bill built on strong local involvement and engagement. I turn now to the specific provisions in the Bill. Part 1 sets out the framework for the new NHS Constitution. As noble Lords will be aware, the final constitution was published on 21st January, along with the handbook and other accompanying documents. It is this constitution to which the clauses refer. The Bill creates a new duty on all NHS bodies in England, as well as Monitor and the Care Quality Commission, to have regard to the constitution in their decisions and actions. The same duty applies to primary care services and providers of NHS services from other sectors. These bodies will all need to be able to demonstrate that they have given proper consideration to the constitution in their decisions and have very good reasons for any departure from it. The Bill also creates a new duty on the Secretary of State to review and republish the constitution every 10 years, to review the handbook to the constitution at least every three years, and to report on the impact of the constitution on patients, the public and staff. The Government carefully considered a number of approaches to the constitution. Options ranged from setting out detailed provisions in primary legislation to no constitution at all. The risk of the former is a rigid legislative framework in which complex decisions about NHS care become the prerogative of the courts. The risk of the latter is a missed opportunity. The approach taken by the Government will empower patients, the public and staff without creating a ““lawyers’ charter””. The constitution is separate from the Bill and sets out for the first time and in one place the rights to which we are entitled and the pledges which the NHS commits to deliver. It sets out the responsibilities which patients, the public and staff owe to each other to ensure the NHS operates fairly and effectively. The constitution also creates three new rights: to make choices about NHS care and the information to support those choices, to recommend vaccinations, and to expect local decisions on the funding of drugs and treatments to be made rationally following proper consideration of the evidence. I have been surprised at how much I have learnt from seeing these set out clearly in a single document. In an NHS where care is increasingly personalised, where the pace of change is rapid and where we draw on the expertise of organisations from small charities to large foundation trusts, I believe that there is a value in articulating these commitments in one place in securing the NHS for our future. Clear, transparent information on quality has the potential to drive improvement. It enables clinical teams and managers to understand where and how to change what they do, empowers patients to make informed choices about their care, and increases accountability. Chapter 2 of Part 1 will place a new duty on all providers of NHS services to produce quality accounts, starting from April 2010. Building on close work with the NHS, quality accounts will include both nationally comparable and local data. They will provide information on safety, experience and outcomes in relation to clinical services, making this available to all, to inform how we develop our services to the highest standard. This is a tremendous opportunity to generate a cultural change in how the NHS understands and drives the quality of services to make a real difference to patient care. The NHS of the 21st century will be one that puts people and their needs at the centre. My review showed clearly the importance that we place on care that is personal to us, and our desire to have greater control and choice over the services that we use. Drawing on our experience in social care, Chapter 3 of Part 1 legislates to enable the making of direct payments for health services. These are one means of offering people a personal health budget. We are working with the NHS, local authorities and other partners to design a pilot programme to test different approaches to personal health budgets. We want to understand the circumstances and conditions for which they are most effective and to ensure that we design appropriate safeguards. I believe that the potential for personal health budgets, including direct payments, is significant. The opportunities they present are exciting. For instance, they could be a powerful tool to address inequalities in the health service. However, I also recognise that this is new territory. We need to weigh carefully the benefits of personalised health services against ensuring that the comprehensive NHS we all value so highly is not undermined. Regulations under the Bill will limit the use of direct payments to pilot schemes initially so that we can test our approach. Chapter 4 of Part 1 gives the Secretary of State a power to make payments as prizes to promote innovation in relation to health services. I know from speaking to stakeholders that the NHS is recognised as a leader in the development of innovative techniques and technologies, but the adoption and spread of these new ideas is variable. Innovation prizes will reward those who have excelled and encourage others to do likewise, helping to foster a culture of innovation in the NHS. Part 2 focuses on policies to improve the performance and accountability of NHS services. The majority of hospitals and trusts are performing well, providing high-quality services to patients and managing resources effectively. Where they are not, a series of local interventions is available to improve performance. However, in the rare cases where a challenged trust fails to turn itself around—despite commissioners, strategic health authorities and, in the case of foundation trusts, Monitor intervening—it is important to have clear processes to resolve that failure. The regime for unsustainable NHS providers, as set out in Chapter 1 of Part 2, is, in practice, the very last step for a provider which has been subject to previous actions aimed at recovery. As a practising surgeon, I am aware that the reasons why providers or services may fail are complex. However, I am also acutely conscious that such failure has an unacceptable impact on the quality of care provided. In the rare circumstances where all else has failed, we need to ensure that there is a clear and transparent process to take these difficult decisions. The Bill provides for the appointment of a trust special administrator to take control of the provider, consult on the next steps and make recommendations to the Secretary of State on its future. These measures will protect patients and staff, and underpin the NHS performance framework and the NHS foundation trust regime. Chapter 2 of Part 2 extends to strategic health authorities and other NHS and relevant health bodies powers for the Secretary of State to suspend public appointees. Currently, if a concern arises, the options are to allow an individual to continue in their role, to seek a resignation or to terminate the appointment. The new powers will allow time for a considered investigation, strengthening the way in which the healthcare system holds its leaders to account. A personalised NHS goes hand in hand with a focus on the prevention of ill health, with individuals supported in making healthy choices. Part 3 of the Bill sets out measures to take forward the Government’s aim to reduce the incidence of illness and death caused by tobacco, and in particular to reduce the number of children and young people who take up smoking. As a result of government action, we now have the lowest smoking rates in England on record—one of our proudest achievements. However, smoking remains the main cause of preventable morbidity and premature death in this country, accounting for 87,000 deaths a year in England alone. It is the primary reason for the gap in healthy life expectancy between rich and poor. The Bill makes provision for removing displays of tobacco products. It also provides powers for the Secretary of State to control the sale of tobacco products from vending machines, so that only people aged 18 or over can use them; or, ultimately, to prohibit such machines outright. I am aware that some noble Lords have expressed concerns about whether these measures are proportionate in current circumstances, and about the impact that they might have on small retailers. The Government also recognise that, despite the harm to health, some adults will choose to smoke. However, we have an important responsibility to enable and empower young people to make informed and healthy choices. The Government have consulted extensively on these proposals, and rigorously reviewed the evidence base. Implementation of these proposals will be pragmatic and subject to further consultation. Measures on display will not come into force until 2011 for larger shops and 2013 for smaller businesses. This will allow smaller retailers time to adjust and refit their shops when old gantries would anyway need to be replaced. Restrictions on vending machines will come into force in 2011, and their effectiveness in reducing underage sales will be reviewed over at least two years to see whether a full ban would be necessary and proportionate. The proposals in the Health Bill form part of the Government’s new tobacco control strategy, which will be forthcoming this year. I know that there are a range of views, which I am sure we will debate fully. Part 3 contains a number of other important measures, including new provisions to require PCTs to undertake assessments of pharmaceutical needs locally. We will reform the current control of entry system, replacing that test with new powers for primary care trusts to commission providers based on those local needs assessments. Along with new powers for PCTs to address poor performance and to provide local pharmaceutical services, the measures in the Bill will encourage pharmacies to strive consistently to provide the highest quality services. They will also enable PCTs to shape primary care services as a whole around the needs of their populations. Not only will these measures ensure community pharmacy services are brought within our world class commissioning programme, they will also help to secure pharmacy's place in the programme that I set out in High Quality Care for All. Part 3 also extends the remit of local government ombudsmen to deal with complaints from those users of adult social care who arrange to pay for their own services. This is in direct response to the views of this House during the passage of the Health and Social Care Act 2008. I am delighted that we have been able to bring forward these measures at the first legislative opportunity. Finally, Part 3 corrects a gap in the current legislation to enable Her Majesty’s Revenue and Customs to continue to share anonymised and aggregated information on GP and dentist pay within the UK health departments. This information is fundamental to the pay system for both professions and our proposal is to have the support of the relevant professional bodies. The Health Bill includes a number of important measures to embed quality at the heart of the health service. It empowers clinical teams and managers to drive improvement in NHS care; it enables us to take more control over our own health and well-being; and it introduces measures to improve the performance and accountability of key NHS services. I look forward to further discussions as the Bill goes through the House, and to an informed, interesting and, above all, high-quality debate. I commend the Bill to the House.