Health Bill [HL]

My Lords, I declare an interest as a member of the Equality and Human Rights Commission and a vice-president of Age Concern. I share the widespread support for the NHS constitution. I believe that it provides the prospect of a quality standard that patients will be able to expect from the NHS and, most importantly, a degree of redress when that standard is not delivered. I have, however, chosen my words of welcome carefully and used the phrase ““prospect”” rather than ““guarantee”” of quality standard. I should like to draw the Minister’s attention to the many concerns shared by a number of organisations that what is proposed does not go far enough, particularly for older people, carers and those with multiple health problems. The pledge to equal treatment for all patients is welcomed by older people, patients’ and carers’ groups and consumers generally. I echo the words of the noble Baroness, Lady Murphy, in welcoming the measures to improve in particular the situation of self-funders in purchasing care, and also the moving addresses by the noble Baronesses, Lady Campbell and Lady Wilkins, on direct payments. These provisions are overdue and necessary and I welcome them. However, I also echo the words of caution of the noble Baronesses, Lady Young and Lady Howarth, about direct payments, particularly when they are applied to vulnerable and frail people. We must be aware of the dangers of abuse, in particular financial abuse, by carers and relatives as well as by professionals. Unfortunately, that is not as rare as we would all wish. For too long, older people, in particular, have suffered a great deal of discrimination in healthcare. I fear that the pledge in the Bill will become a meaningful reality only when it is taken together with provisions that I hope we shall see in the forthcoming Equality Bill, which will make such discrimination unlawful at last. It is wholly unacceptable in the 21st century for healthcare to be rationed or for access to services to be denied solely on age. Indeed, according to research carried out by Help the Aged, 77 per cent of members of the British Geriatrics Society would support the introduction of legislation against age discrimination in the NHS. If the professionals responsible for healthcare for older people believe that this longstanding sore in our healthcare policy is wrong then I suggest that we, as parliamentarians who have already agreed that discrimination is unacceptable in British society, have a duty to ensure that it is effectively addressed where it remains. I hope that the newly announced dementia strategy, together with the Bill, will improve the situation of those suffering from that terrible disease. There are many examples that we can use as evidence of discrimination, when the disease is poorly diagnosed and treated and when the patient’s needs are often treated as social rather than making the NHS responsible for the services that are provided. If I fracture my hip, some of the pre-operative and post-operative treatment that I will need is social in character, but the NHS will take responsibility for providing it. In my view, that is discriminatory. The principles in the constitution are a worthwhile attempt to crystallise overarching expectations of the NHS and NHS-funded providers. Those expectations must meet reality. I have already stressed the importance of a service for all based on clinical need and sound diagnosis and prognosis, irrespective of age. For older people, I would also quote two other aspects of NHS provision that are already problematic and must be addressed: foot care and dentistry. The former is a service that older people need more than the young, but its provision is patchy. Dentistry is an aspect of care that in recent years has proven difficult for the NHS to provide, not just for older people but for patients of all ages. I hope that the Government will be able to reassure me that what they are now proposing will indeed deliver the services needed by patients across the age range but particularly by older people, and that everyone will be made fully aware of their rights and of how to access effective redress if the medical care they need is not provided for them. I turn to quality accounts. In 2007 the Joint Committee on Human Rights, following its inquiry into the human rights of older people in healthcare, demanded nothing less than an entire change in culture to protect the human rights and dignity of older people in the NHS. The Bill could go some way to meeting those demands but only, as many noble Lords have mentioned, if ““dignity”” is included as a specific domain within quality accounts and if the needs of older people, rather than targets that fit into speciality or organisational boundaries, are at the heart of the reforms. The same principles apply to maternity care where quality of care, not necessarily waiting time or throughput, should be the focus of the service. Lastly, I turn to the proposals for personal health budgets. There is widespread concern about aspects of those proposals, not least that there must be proper evaluation of the pilots before the concept is rolled out across the country. We must be sure that payments actually cover the costs of patients’ assessed needs and that the system will work for people who have multiple and complex needs. Many older people have a wide range of physical and mental health problems and they are worried that the proposed new scheme will not address all their needs. Carers are concerned that the proposals might add to the already significant burdens that they face, and people with a range of disabilities need to be reassured that their often individual requirements will be met. In all cases, once a thorough assessment has been made of a person’s needs, the funding of that assessment must be transportable if that person decides to move to a new area of the country, often to be with relatives in line with their human right to family life.