Health Bill [HL]

My Lords, I declare an interest at the outset as I work in the National Health Service. Before saying anything else, I pay tribute to the many thousands of other people working for the NHS who have kept it going over the past few days of intense weather. The schools may be closed but the hospitals and surgeries are open, and the doctors and nurses, support staff, ambulance services and those who are often forgotten—the managers—all deserve a considerable vote of thanks from this House and, indeed, from the nation as a whole. I have some first-hand experience of what is being achieved because I am chairman of the Imperial College Healthcare NHS Trust. This is the partnership between Imperial College, one of the finest research universities in the world, and the union of the former Hammersmith and St Mary’s hospital groups. It is, I think, one of the most exciting initiatives with which I have been connected and a very important initiative in the National Health Service. That brings me to my first point related to the Bill. We were delighted last year by the references to academic health science centres in High Quality Care for All, from which the Bill is derived. However, as an institution that aims to become one of the first academic health science centres, we feared that progress towards designating them might not be possible until the Bill was on the statute book. I am therefore delighted that that is not the case and that the procedures for the designation of these centres have been launched and are in progress while the Bill is going through its parliamentary processes. The aim of an academic health science centre, towards which we are already working, can be simply stated. It is to improve patient care by closing the two gaps in the translational research pathway identified in the 2006 Cooksey review of UK health research—namely, the translation of basic and clinical research into ideas and products, and the translation of new medical advances into everyday practice. To achieve that, we at Imperial College Healthcare NHS Trust have adopted a unified executive structure of a type common in many other countries but unique in this one. One individual, Professor Steve Smith, heads both the faculty of medicine at the college and the hospitals, and there is a corresponding degree of integration of appointments and work programmes below him. Other potential academic health science centres have adopted different models, but we all share the ambition to provide and stimulate far reaching improvements in the country’s healthcare. In that connection, I welcome the provisions in the Bill for quality accounts, as did the noble Baroness, Lady Wall. The National Health Service needs more objective and transparent criteria against which to judge performance and outcomes. Above all, quality accounts will enable patients and carers to make informed judgments about the absolute and relative performance and standards of those responsible for providing healthcare in all its many forms. Clinicians and those involved with them already have that information. Quality accounts will give the rest of us access to that knowledge. The result will be to put upward pressure on standards. The best clinicians are always anxious to learn from the success of others, and quality accounts will provide an additional stimulus to that process. They will also help boards and senior management to focus more effectively on quality improvement. For this reason, and because of the pressure from better informed commissioners, the allocation of resources will be improved. At a time when the availability of resources is likely, for obvious reasons, to be very restricted, that is an important attribute of which we should not lose sight. I am glad to see from the supporting documents issued with the Bill that it is the Department of Health’s intention to involve representatives of patients in developing detailed proposals for quality accounts. I believe there is more to healthcare than medical and nursing care. How people are treated as clients and customers as well as as patients is important. As the noble Baroness, Lady Wall, said, they need to be treated as individuals and accorded respect and dignity. They deserve that as of right, and I emphasise that point, but it is also true that the better their patient experience—to use the jargon phrase—the more likely people are to have confidence in the medical and nursing care and treatment they receive. For that reason, I chair the patient experience committee in my trust because I believe it should be at the centre of the trust’s activities. I shall conclude with a few brief remarks on other aspects of the Bill. I welcome the constitution. I do so not just because I agree with its contents and think that it is clear and well written, but because I think that those who sniff at it and say that there is nothing in it that is particularly new or that we did not already know are on the wrong track. Codifying can be a useful exercise in making people aware of the values, rights, duties and purpose of the National Health Service. It can provide a basis on which relations can be conducted and the values shared and understood. I was interested to hear the Minister say that, in looking at the codification, he found that he had learnt things that he did not know before. He has vastly more experience of the National Health Service than I do, but if a man of his experience can find that he has learnt from studying the constitution, that shows the potential it has, through the simple process of codification, to increase understanding of what underlies the service, of what the relationship between the different parts of it should be, and of the relationship between those who provide healthcare and those who receive it. It is basically a good thing and I welcome it. I am also pleased that the Government are willing to adopt the essentially Conservative idea—conservative in the party-political as well as the philosophical sense—of direct payments. Much will depend on how the initiative is implemented and what it covers. I shall watch with interest to see how that is done, but it is an important development and I believe that many people in this country will benefit from it. Finally, I say a word in praise of innovation prizes. Their introduction is very much in line with best management practice in the private sector to encourage, identify and reward staff who come forward with ideas. Although people are already willing to come forward with ideas, prizes such as those will help to encourage that process. The fact that those who come forward with ideas that are adopted receive prizes will generate publicity, which will encourage other people to come forward. I certainly look forward to many people in Imperial College Healthcare winning prizes, but I am sure that there will be many other winners in other trusts—I hope including in that of the noble Baroness.