Health Bill [HL]

My Lords, I thank noble Lords for a lively and informed discussion. It has become customary to declare interests and I declare that I am an active clinician and work as an academic at Imperial College, a name that was mentioned earlier. I should also declare that many years ago I was a smoker. The incidence of smoking is higher in the medical community than in any other sector. I should also declare that, despite stopping smoking, I broke that vow on two occasions. I should probably leave the reasons why to the Committee stage. The proposals in the Bill break new ground in a number of areas, mostly in driving quality in healthcare in the NHS, an organisation that we all admire and which is a part of our moral and social culture. Many in this Chamber today eloquently described its 60-year history and where it is heading over the next decade. The purpose of the Bill is to ensure that the quality of healthcare, the product of the NHS, is improved in the next decade, that it is more personalised around the needs of those who use it and that there is further accountability within the system to meet the expectations of patients. Many valuable points have been raised in the debate and I shall try my best within the time that I have to address some of the main issues. I look forward to further discussions as we move to the Committee stage of the Bill. The first part of the Bill covers measures to implement the recommendations in the report High Quality Care for All, which I had the privilege of leading. I am grateful for the support of noble Lords over the past 18 months in producing that important work, in which many colleagues in the NHS across the country were involved and more than 60,000 people engaged. One of the fruits of the report was the NHS Constitution, on which we have had many contributions today. First, the noble Lord, Lord Naseby, and the noble Baronesses, Lady Tonge and Lady Meacher, raised the issue of the enforceability of the NHS Constitution. Every right in the constitution is already in law. The constitution itself is not a legislative document; most of the rights are in the different Acts to which the noble Baroness, Lady Barker, referred. She asked how the different Acts that we have in the system at the moment refer to the constitution. The rights are already enforceable in law. We have added three new rights, to which I referred in my opening speech, including the right to informed choice. The right to vaccination is the second new right. I reassure the noble Lord, Lord Rea, that ““having regard to”” is a well established phrase and means that bodies or individual providers covered by the legislation will need to demonstrate that they have given proper consideration to the constitution in their decisions. The duty also means that they must have good reasons for any decisions to depart from the constitution. As I said earlier, we did not want to create a lawyers’ charter, which is why the constitution will not be set in legislation, although its contents are already in legislation. As the noble Lord, Lord Walton, pointed out, no one wants an NHS that is constantly dragged through the courts. I hope that that explanation also addresses the issue raised by the noble Earl, Lord Howe, about the relevance of the constitution and why it should not be part of the Bill. I wish to assure your Lordships’ House, particularly the noble Lord, Lord Naseby, and the noble Baronesses, Lady Young and Lady Wilkins, that we envisage that there will be a wide-ranging consultation on any further reviews of the constitution, which will involve all key stakeholders, including trade unions, carers, the Care Quality Commission, local government and all other individuals and bodies that are interested in participating. The noble Baroness, Lady Tonge, highlighted the issue of choice with regard to maternity services. It is important to stress that the right to choose will develop over time as choice policy extends into other areas. When the right to choice comes into effect on 1 April 2009, it will reflect the existing requirements that patients have the right to choose the organisations that provide their NHS care when they are referred to the first out-patient appointment with a consultant-led service. That does not mean that maternity services will not be covered by the right to choice in the future. The noble Baroness also asked about integration of healthcare and social care. Several elements in the constitution relate to social care and its relationship to the healthcare system—for example, there is a commitment to make the transition as smooth as possible when a patient is referred between the two services. However, there are currently no plans to produce a constitution specifically for social care because, as the noble Baroness will be aware, the Government will be publishing a major Green Paper on the reform of social care and the support system in early 2009. I also reassure the noble Baroness, Lady Masham, that the duty to have regard to the constitution will apply to providers of NHS services including the independent third sector organisations providing NHS care. The noble Lords, Lord Naseby and Lord Stoddart, and the noble Baroness, Lady Knight, asked about the Government’s commitment to reducing mixed-sex accommodation. Privacy and dignity are key aspects of good patient experience. The quality framework will capture that and the constitution itself refers to it. As announced by the Secretary of State last month, the department has set up a privacy and dignity fund to the tune of £100 million to make swift adjustments over the next six months, with a central team to support local action. We have also had an interesting and informative debate on the proposals in the Bill to introduce direct payments for healthcare.