Health Bill [HL]

My Lords, I broadly support the Bill, although I believe that there are one or two areas where minor amendments would avoid potentially damaging unintended consequences. I come to the issue of quality accounts as chairman of a provider trust and must in that sense declare an interest. I want first to welcome the proposal for an NHS constitution, although I wonder whether the references to patients’ rights will in every case be pertinent. Will it lead to cynicism when patients realise the status of those rights? The constitution states clearly: "““All NHS bodies and private and third sector providers supplying NHS services will be required by law to take account of this Constitution in their decisions and actions””." I happen to support that wording. The NHS is being realistic about those rights and whether they can be challenged, if necessary, in the courts. That is important. I was pleased that the Minister gave us an assurance that this will not be a lawyers’ charter. However, rights generally imply that you really can make a challenge if they are not properly acknowledged and that, if necessary, you can take a challenge to the courts. Ministers may want to think about the precise wording in one or two cases. Some of the rights are quite straightforward, but others could lead to a lot of problems. I suppose that I have in mind rights to treatment and drugs recommended by NICE and, in particular, from my personal experience, rights to NICE-recommended psychological therapies. I know that those therapies are available in some trusts, but they are most certainly not available in all. If I were a patient and read that I had a right to those treatments, I would want to challenge any decision to deny them to me. I welcome the provision for handling complaints about privately arranged and funded adult social care. This will protect many frail, elderly people who, as we know well, do not have access to an independent complaints process. However, I endorse the point made by the noble Baroness, Lady Young, about the importance of the system of being accessible and simple. From my long experience in complaints processes, notably in relation to the police, I know just how complicated these matters can become without anyone intending that to happen. On prizes for innovation, I am sure that the Minister is well aware that the NHS already has an elaborate and rather splendid system of prizes for innovation, leadership and all sorts of other wonderful achievements. Indeed, I recently had the privilege of watching one of my staff collecting the national prize for leadership within the NHS. Will the Minister explain how the new prizes for innovation might relate to the existing system? I am sure that it has all been thought about, but it is not clear to me. I now come to the quality accounts. Again, I welcome the Government’s intention to require all providers of NHS care to provide quality accounts as well as financial accounts. However, as it stands, the innovation will cut across the accountability framework of foundation trusts, as the noble Baroness, Lady Murphy, said. I am sure that that is not the intention of Ministers. When reading the Bill, one has the impression that the drafters were simply not aware of foundation trusts. However, with minor amendments the Bill could take account of the very constructive reporting arrangements and accountability to local communities introduced by the Government for these foundation trusts, as the noble Baroness, Lady Murphy, mentioned. In particular, there is Monitor’s role in ensuring the efficient and effective financial operation and governance of foundation trusts. There is also the creation of boards of governors, the majority of whose members are elected by the local population. They ensure that the boards of foundation trusts are accountable to their local communities. I say from tough experience that these boards of governors are rigorous in representing their communities; they probe our board—and, I am sure, other boards—deeply if it is not providing the quality of service that the community expects. I will explain why I, as a service provider, am so concerned about this issue. I speak as one with experience of the rigorous Monitor regime for approval as a foundation trust and of the transformation not only of financial management but of the quality of services to our users achieved through that approval process and subsequently under the Monitor reporting regime. In my experience, these improvements are achieved, as they have been in my own trust, largely through the changes to the board that Monitor requires. We changed our chief executive officer and pretty much the majority of our non-executive directors and brought in much tougher and far more professional people who could challenge the executive directors. It is through the transformation of boards that Monitor, up and down the country, has secured tremendous achievements in the quality of service provided to users. The Bill requires quality accounts to be sent to the Secretary of State and allows strategic health authorities to require NHS trusts to correct their quality accounts. Again, this would make no sense in the context of foundation trusts. Those trusts no longer report to the Secretary of State or to the strategic health authorities. Instead, as I have said, they report to Monitor and to Parliament. Logically, the quality accounts should be presented by foundation trusts to boards of governors, which will certainly want to see them, and to Parliament, along with their annual reporting accounts. They should also be presented to Monitor with their financial accounts, thus enhancing local and national accountability. As a chairman of a trust, I would welcome that. In conclusion, this is a helpful Bill, which, with minor adjustments, will enhance the services provided to patients by the NHS.