Health Bill [HL]

In moving this amendment I shall speak also to Amendment 36, and in doing so bring us to a subject that is particularly close to the Minister’s heart, namely quality accounts. I should say immediately to him that I see considerable potential in the idea of quality accounts. Nothing that I say when speaking to these or the next few amendments is in any way meant to be critical of the concept. There are, however, a number of aspects of the practical implementation of the policy that we need to explore. The first question to be asked, as a number of noble Lords did at Second Reading, is what quality accounts are for. What audience are they to be aimed at? The answer is that they are for several different audiences. They are perhaps first and foremost tools for doctors and other clinical staff which, if used properly, will enable them to drive up the quality of their own performance. I buy into that concept completely. Any professional worth his salt is driven by a desire to do his job supremely well. That is what motivates him and gets him out of bed in the morning. Any benchmarking tool that helps him to do that, especially a tool which he himself has helped to devise, will be good news to him. So far, so good. Quality accounts are also for trust boards, as a means whereby directors can hold clinical staff to account for the quality of their performance. Again, I am supportive of that idea. However, it seems to me that the data that will be of practical use to doctors are not necessarily the same data that a board of directors will find most informative; or if they are, the data may well need to be presented and explained in a slightly different way. Who will be responsible for ensuring that that process of presentation and interpretation is done properly and fairly? The real question-mark arises over the data presented for public consumption. The public do not need and do not want to have the same quality data as clinicians. The information that they get needs to be simple, easily understood and, above all, meaningful to enable them to make balanced and informed choices. In some areas they need access to the detail; in other areas, they do not. There are several issues here. One is who will be responsible for packaging the data for public consumption. Another is who will decide what data are released into the public domain and what data are not. We know from what Ministers have told us, and from this clause, that some information in a set of quality accounts will be proscribed by government. However, a large part will not be. How are we to ensure that data published by different trusts are directly comparable? In various meetings, the Minister has spoken of the role of SHAs in acting as ““quality observatories””. I would be interested to hear a little more from him about how these observatories will function. Equally, how are we to avoid the tendency, which a number of noble Lords referred to at Second Reading, for organisations to puff-up their successes but draw a discreet veil over their failures? In general, how are we to ensure that the information that is published does not mislead the innocent reader, however unintentionally? One of the central features of any trust that claims to be a beacon of quality has to be that it is a safe place to be and to be treated in. The noble Lord, Lord Patel, will be speaking on this subject in a much more authoritative way than I can, and I will not steal his thunder. All I wish to say is that any areas of a trust’s performance where patient safety is decidedly lacking—and this could be in a whole range of areas, not just the ones that we immediately think of, like hospital-acquired infections—are not going to be things that a trust will naturally wish to advertise. Who will make them do so? There does not seem to be anything in the system to ensure that the public receive not just the truth but the whole truth and nothing but the truth. The RCN has spoken very cogently about quality in nursing and made the important point that quality of care extends well beyond the success of this or that medical intervention; it is also about things like avoiding pressure sores and reducing patient trips and falls. One thinks also of good nutritional care and the efficiency with which drugs are dispensed on the ward. There are aspects of care to do with patient dignity that are of huge importance. One can think of a whole host of indicators in this general area. At the same time, it is not feasible to collect and publish more than a certain amount of data without it becoming unacceptably onerous. How is the right balance going to be struck? I should like to ask the Minister to elaborate a little more than he did at Second Reading on innovation as a feature of quality. He said that there were all kinds of incentives for innovation already in the system, as well as innovation metrics which strategic health authorities will monitor. I hope that he can go a bit further than that because it seems to me that, when it comes to quality accounts, the public have an interest in identifying those providers where innovation and progress are high on the agenda. I do not know what metrics have been devised in this area. One could think of two or three reasonably good proxy measures, such as the number of clinical trials being conducted in a trust or the percentage of NICE-recommended therapies which the trust has actively adopted. I was particularly impressed with the Second Reading speech of the noble Lord, Lord Turnberg, who highlighted the importance of fostering teaching and research within the NHS and the need for patients to be aware that research is going on which they can take part in. My main worry with quality accounts is the quantity of data needed to feed them month after month if they are to be of real use to the different audiences. As I mentioned a minute ago, the information appropriate to each of those audiences will be subtly different, which makes the task more challenging. At the same time, there is a distinct risk that if we start expecting too much from quality accounts and pile more and more information into them, we will dilute their effectiveness. It would be very helpful to hear something from the Minister on that aspect of the matter, which I am sure will not have eluded him. I beg to move.