Health Bill [HL]

My Lords, today the quality of contribution from what has been called the ““mobile Bench”” has reached new heights with the speech of the noble Baroness, Lady Campbell, which I regret that I have no hope of emulating. The Minister and Government are to be warmly congratulated on their initiative in producing the first NHS Constitution. I welcome the single source of clear information about what citizens can expect from the NHS, and what the NHS should expect from its staff and from the people who use its services. The constitution has the potential to empower both patients and staff to drive improvements in the service. I look forward to it securing for the NHS an even firmer position as the UK's best loved public service, and one of the most significant achievements of any Government. However, I support many organisations that have suggested that the constitution be given more backbone. Both RADAR and the National Council for Independent Living have argued for a more explicit statement in the constitution of Disability Discrimination Act rights, to ensure that the NHS is fully accessible to disabled people as equal citizens, with equal rights to use healthcare services. I welcome this proposal, which would send a clear signal to all healthcare providers that more of the same is not acceptable under the constitution. Damning reports, such as Mencap’s Death by Indifference, have shown that people with learning difficulties and people with mental health problems have been denied equal access to healthcare. In its formal investigation into primary healthcare services, the Disability Rights Commission found that primary care trusts were failing to make ““reasonable adjustments”” to provide accessible services for disabled people, as required by the DDA. Reasonable adjustments include, for instance, the need for information to be made accessible. In 2004, the Guide Dogs for the Blind Association found that 95 per cent of visually impaired people never receive health advice, letters or prescriptions in the format that they need. The RNID has shown that one in four deaf or hard of hearing people has missed an NHS appointment because of poor communication. I ask the Minister to look again at the draft constitution and to make a clear statement of disabled people's rights under the DDA to ensure that all citizens have equal access to the NHS. I greatly welcome provisions in Chapter 3 to pilot direct payments in healthcare services. This is an immensely positive commitment from the Government. The National Centre for Independent Living has stated that direct payments, "““have delivered higher user-satisfaction, better outcomes and often greater cost-effectiveness””," in social care. There is no reason to suspect that the same cannot be achieved from the NHS—except that a much greater culture change will be required from the NHS than was needed from social care professions, because user independence is not one of its top values. Research on direct payment programmes in the social care sphere has identified ignorance and confusion among healthcare partners as factors impeding greater user independence. This challenge needs to be recognised and addressed from the outset if direct healthcare payments are to work effectively for service users. The guidance for the pilot schemes makes it clear that direct payments will be given in accordance with a care plan only after an assessment of needs by the PCT, or by another organisation acting on its behalf. The problem is that PCTs have insufficient knowledge of specialist healthcare conditions. Does the Minister agree that it should be a requirement on PCTs to include specialist advice in creating care plans for people with specialist conditions and more complex cases? I declare an interest as someone who has been spinal cord injured for more than 40 years, with increasing pressure-sore problems. Two years ago, I had an inflamed bursa—where a pressure area tries to protect itself—that was misdiagnosed by my GP practice as an abscess. Fortunately, despite being urged by her colleagues to cut it out, which would have made my skin viability much worse, the GP decided to treat it conservatively, and I spent more than two months confined to bed on successive high doses of antibiotics before referring myself to my spinal unit, where it was immediately diagnosed correctly. I am now told that my PCT will be charged £500 for referring someone to the spinal unit, which will certainly deter it from doing so. Does the Minister agree that specialist input needs to be a requirement for developing a direct payment care plan if scarce NHS resources are not to be misused and wasted? I welcome the provisions in the Bill to enable the involvement of voluntary sector organisations in providing assistance to people who will use direct payments in healthcare, and I declare an interest as an officer of HAFAD, my local user-led disability organisation, which provides direct payments support. The legal obligations on direct payment users to act as responsible employers mean that it is a false economy, and totally counterproductive, to expect people to manage them without adequate support. This is too often the case, and it is vital that access to support, advocacy and information be a requirement of the NHS pilots. As the Bill progresses, I hope that the Government will clarify how the direct payment approaches in social care, welfare reform and now healthcare are being interconnected across departments, so that we do not just create new silos of funding and more bureaucracy and service duplication. Unified funding streams for public service support for disabled people will be one more step along the road to fulfilling the Government's aim of independent living for disabled people. A fully integrated system of individual budgets, underpinned by rights to choice and control spanning all public service support and specific enforceable entitlements, is the purpose of the Disabled Persons (Independent Living) Bill introduced by my noble friend Lord Ashley of Stoke, which will receive its Second Reading later this month. I hope the Government’s Health Bill and its provisions for rights, choice and control will succeed in taking one more step in its direction.