Health Bill [HL]

My Lords, it gives me great pleasure to take part in the Second Reading of the Health Bill. Last year I had the pleasure of taking part in several of the working parties. I realise how much work has gone into the Bill and offer my congratulations to the Minister for the way that he has led this work and got us to the point where we have enabling legislation before us. At the same time, there will be areas, as has already been pointed out, that will be discussed fully and taken into account. I speak as a retired nurse and a former chairman of an NHS trust. Noble Lords will be familiar with my saying on every occasion that I rise to my feet that I am passionate about improving the delivery of care and reaching high-quality care, summed up in the review as an improved clinical outcome, improved safety for a patient and an improved patient experience. The Health Bill encapsulates the principles by which this can be achieved. As the Minister said, there is evidence of excellent practice in the NHS, but I regret that there are still areas where poor practice is in evidence. It is essential that these areas are eradicated so that the public can feel assured that not only will clinical outcomes and safety be of the highest standard but patients will experience the highest quality of care and compassion at the most vulnerable times in their lives. We may feel that all is well with clinical outcomes and safety, but we know from various reports that all is not well in some circumstances. I was amazed in the last few weeks, when listening to the radio and reading the newspaper, by an edict about checking theatre instruments and swabs before completing an operation. I could name many former theatre superintendents who would turn in their graves if they had witnessed this edict. It is as though it were necessary to remind everyone in the operating theatre to check the number of instruments and swabs. This principle has been the bedrock of working in theatres. To have to be reminded of this again is surely to go full circle. There is also the issue of trying to reintroduce protected meal times, when the ward is closed while the patients are prepared for their meal, supervised, assisted and given supplements if necessary. This is followed by a rest period, leading to good clinical outcomes and safety in preparation and serving, thus preventing infection and improving patients’ experience as they enjoy their meal. We live in a world of constant change, and one can hear the cynics saying that this is yet more legislation that will cause further changes for an already overstretched staff. However, there are always patients or clients who require treatment and care, which need constant review and vigilance to ensure that appropriate high-quality care is delivered with compassion. I support the principles of the introduction of the NHS Constitution, which sets out the rights and pledges and responsibilities of patients, members of the public and staff by law. However, there is a question over how effective this will be with just the phrase ““duty to have regard to””. The Royal College of Nursing also supports the NHS Constitution concept but questions the fact that there is no statutory definition of duty to have regard to and no sanctions where there is no enforcement. I support the Royal College's view; all healthcare professionals are subject to a code of conduct set by the regulator, with sanctions. Would the Minister consider this point? I know that Her Majesty's Government do not wish to be prescriptive in legislation, but without such a definition the constitution may not be effective in its intent. My second point relates to the bodies listed as having a duty to have regard to the constitution under Clause 2(2). I note there is no mention of education and training institutions. While I expect that subsection (3) covers these, I stress the importance of listing education and training institutions. The NHS Constitution is a foundation building block, and it is necessary that everyone is aware of it, especially when they begin as a student and all through their professional career development. I fervently believe in the correlation of theory to practice; there have been many instances in which a wide gap has emerged between the educational establishment and the practice area. I know that the Minister took account of this in his review and work is continuing on implementing changes, but inclusion of education and training institutions in subsection (2) would underline the importance of the part they play in ensuring that the NHS Constitution is understood and complied with. Clause 3 relates to the review and revision of the NHS Constitution. Could representatives of the staff organisations and unions be included in the list of consultees? I am saddened that throughout the Bill there is an omission of the role of informal carers, of whom there are 5 to 6 million in the country. I am engaged as a formal carer at the moment. They play an important part and need mentioning. The introduction of quality audits is a very welcome step forward. Much work has progressed in the past year to define methods of measurement, and their inclusion in this legislation emphasises the importance to everyone of measuring and recording delivery of care. I began this afternoon by emphasising my passion for improving the quality of care, and quality audits certainly represent a major step forward. However, while these audits go a long way to focusing attention on the quality of care, it could easily become a tick-box process without addressing the fundamental issue of the care and compassion required for patients. This is not easily measured and, therefore, not recorded, but it is very much part of the patient experience. It is fundamentally a matter of attitude and having respect for patients’ dignity and their often hidden anxieties at a most vulnerable time in their and their families’ lives. Addressing this issue is fundamental to high-quality care and requires sufficient resources in workforce supply, allowing time not only for tick-box recording but also for the compassion and support required. This is not easy to put into legislation but requires a culture change from the trust board members and the authority down to the front line of delivery of care, to ensure that there is a full understanding of the components of high-quality care. When good governance is in place, it usually indicates a high quality of care and great patient satisfaction. I hope that in some way this culture change can be achieved, in the interest of making quality audits more than a tick-box exercise. I trust that the Minister will view these recommendations as a constructive and helpful way to carry out further consideration. I look forward to taking part in further stages of the Bill.