Health Bill [HL]

My Lords, I am most grateful to the noble Baroness, Lady Thomas of Winchester, for her kind words. I must declare an interest as a life president of the Muscular Dystrophy Campaign and as a former professor of neurology and practising neurologist. In general, the Bill should be welcomed. Last year, we celebrated the 60th anniversary of the inception of the National Health Service. At that time, in a debate in this House, I said that in the past 12 years I had lived through some 14 reorganisations, large and small, of the National Health Service and that the last thing it needed was more reorganisation. Having said that, I congratulate the noble Lord, Lord Darzi, on the major initiatives and the originality of the review he has undertaken which, in many respects, have led not only to changes in the NHS but to the Bill. Having said that, when I began to read the NHS Constitution, I felt more than a twinge of concern because, as the noble Baroness, Lady Murphy, said, the Patient's Charter, published 10 years ago, sank virtually without trace, and no one remembers much of what it said. The United Kingdom does not have a written constitution. I recall a very well attended lecture by a colleague of mine who was a professor of law in Newcastle. He gave a lecture on the law of conspiracy and, at the end, he said: ““My only conclusion can be: common law 2, statute law 1, after extra time””. The thought of having more constitutions imposed on the NHS caused me some concern. However, having read and studied it, I think that it is to be commended. The safeguard we have is that virtually everything that it includes has been enshrined in previous legislation; there is nothing new and restrictive about it. I was concerned by the remark in the handbook, which the noble Lord quoted and was referred to by other colleagues, that there is no appetite for a lawyer's charter, and that the consensus based on taking note of and having regard to the constitution must not lead to litigious individuals in society feeling that they can, because of the rights enshrined in the constitution, sue the health service for failure to fulfil those rights. I hope that the Minister can explain how he believes that that can be fulfilled. As many others have said, quality accounts are an excellent idea. I remember that we produced quality accounts in my former department and other departments in clinical medicine with which I had an association. One of the major tasks of the Care Quality Commission under my noble friend Lady Young will be to ensure that they are examined and analysed in detail. My only concern about the production of quality accounts is to some extent raised by the problems that have occurred in the higher education sector where, over the years, universities have been required to produce quality assessments of the quality of their teaching and facilities. Sometimes in university departments, the production of those figures has been extraordinarily burdensome. I said in a debate in this House last year that one problem that I had noticed in the NHS over the past 10 to 15 years was the continuing introduction of new regulations and new methods of assessment to such an extent that the NHS was being beset by an intolerable quangocracy. I am concerned about the burden of data collection in the quality accounts. I should like to be assured by the Minister that that will not add a major administrative burden that may distract staff, particularly in the clinical field, and divert their attention away from their primary concern of patient care. It would be helpful if he could tell us what redundant, intrusive and superfluous procedures resulting from other quangos in the NHS can be abolished to make it more appropriate for the material on quality accounts to be collected and analysed. That is important. Direct payments are an interesting development. Like everyone else, I was moved and much informed by the speech of the noble Baroness, Lady Campbell. I see no problem in how such accounts could be used and administered by health authorities and primary care trusts. That could be carefully controlled. What concerns me a little, however, is the idea of giving them to individual patients. It would be most helpful if the Government could indicate when the regulations controlling that activity are likely to be presented for consideration by the House. When are the pilots likely to be embarked on? I commend the principle of the public-private mix and recognise the great benefits that may, in certain circumstances, be derived by an individual with such a personal account from being able to purchase services from the private sector. However, I would be concerned—here I speak as the former chairman of your Lordships’ Select Committee inquiry into complementary and alternative medicine—if certain aspects of complementary medicine, not those that have been shown to be of patient benefit, but certain so-called disciplines of no proven value, were to be purchased by an individual using such a personal account. What safeguards might be introduced? The idea of innovation prizes is sensible. Again, I declare an interest as a past president of the Royal Society of Medicine. This morning I attended a meeting there about a major programme on innovation in medicine being developed in collaboration with the Department of Health. That is a very exciting prospect, because it is bringing together professionals innovating in a very broad field of medical activity. That development is greatly to be welcomed. The idea of producing prizes for innovation is excellent. I was not certain about the concern expressed by the noble Lord, Lord Turnberg. The idea of having an expert panel set up to assess the innovations and choose those who are to be given the notable rewards is excellent. I declare an interest by saying that I would not enjoy being on that expert panel; it will be an extremely difficult task to fulfil. I turn to trust special administrators. All of us who have worked in the health service have seen over the years the tortuous procedures and snail-like processes that have been used to remove trust administrators or chairmen in the very rare instances where the performance of the health service body concerned has proved to be inadequate. Are we thinking about a similar procedure by calling in an administrator in the same way as a failing company in danger of going into liquidation calls in administrators? What kind of person will be nominated as a trust special administrator? Will it be a judge, a noted lawyer, a senior doctor, a senior nurse, or an administrator? I would love to know the Government's ideas about the people who may be invited or nominated to fulfil that exceptionally burdensome task. After reading the Bill, there were times when I wondered whether that was not too much of a task for an individual and whether a tribunal, including, as a matter of course, an individual with health service experience, would not be a better arrangement. Again, I look forward to hearing from the Minister about the proposals. I am glad that the 2008 regulations, which have been carefully framed, ensure that those procedures would be used only sparingly and after all other relevant procedures had been exhausted. A lot has been said about tobacco control, and I do not propose to go into detail, except to say that I warmly commend the idea of removing tobacco products from display at the point of sale and the idea about vending machines. However, I am not enthusiastic about having tobacco products wrapped in paper that does not identify the nature of the content, if only because it might then be extremely difficult for people, once they had got through all the barriers, to identify which tobacco products contained higher levels and which lower levels of nicotine. That is an important issue that needs to be looked at. In passing, the proposals for pharmacy are admirable. I spoke just a couple of weeks ago in this House about the crucial importance of continuing the doctor-dispensing practices. That has been accepted, and I hope that no barriers will be put up against the possible introduction of new practices with similar facilities. I agree entirely with what has been said about the complaints procedure in adult social care and the crucial importance of having a mechanism that looks at private facilities. What the noble Lord, Lord Turnberg, said about research is absolutely crucial; everyone who has worked in medicine, medical research and clinical practice knows that today’s development in basic research brings tomorrow’s practical development in patient care. I warmly commend the NHS proposals to introduce the academic health science centres. I know full well that other medical schools such as my former school will compete with distinguished places such as Imperial College London, with which the noble Lord, Lord Tugendhat, is connected. I only hope that several of these centres will be established throughout the country, because their potential benefit to the future of patient care is substantial. Finally, the noble Lord, Lord Turnberg, is the chairman of the Association of Medical Research Charities. Are the Government satisfied that the charity research support fund, which was established to replace money that had been lost under the former dual-support system between the health service and the universities, is adequate to cover the cost of the fundamental needs of these research programmes? Many of us do not think that that fund is adequate.