Health Bill [HL]

Briefly, I once again express my anxieties about quality accounts. The concept of quality in the NHS goes without saying. Everyone wants quality healthcare; we would all accept that. What I find so difficult with Clause 6 is that without the regulations we have no idea what we are legislating for. We have no idea what we are creating here. We like the idea of quality accounts but we do not know what they are. This frequently happens in government legislation as Bills are going through both Houses. In this case, it really is crucial, as the noble Earl, Lord Howe, said, to know what we are going to measure. Patient dignity is probably one of the most important things of all. How do you measure patient dignity? It is going to take an awful lot of work to do that. Safety, as the noble Lord, Lord Patel, said, is crucial. My concept of quality in the NHS has always been, as the noble Lord, Lord Darzi, said at Second Reading, the concept of clinical teams getting together on a regular basis to assess their progress, where they are going and how they could improve their performance. That has always been my idea, and I think that goes on all over the health service now, as I think the noble Lord said at Second Reading. We really do not know what these quality accounts are going to be. How can we insist on setting something up when we do not know how big it is going to be, what data we are going to collect, or what sort of organisation will be required? I know that I am always beefing on about NHS bureaucracy, but we have an awful lot of it. Maybe the noble Lord cannot see this, but I can see a department of quality accounts and a director of quality in the next couple of years being embraced with delight by health service management. The fights will go on about offices and filing cabinets and who is going to be shifted where, and the whole concept will be absorbed into the health service as another branch of its bureaucracy. Who will collect the data? The data will be collected by the clinical staff when they should be attending to their patients. That is my anxiety. I am sure that the Minister is going to reassure me that this will not happen, that there will not be such a department and that clinicians will be left to treat patients; but frankly I do not believe it. Finally, I do not want to labour the point, but I am not clear how quality accounts are going to be used. Are they going to be used internally? Apparently not, because they are going to be published. Are they going to form league tables? Are patients going to choose where they go based on the number of percentage points that a certain establishment gets for safety, or are we going to go more for dignity or for what percentage of patients live through a procedure? Has this been properly thought through? I hope that I am going to be reassured, but I had to reiterate my anxieties on the whole question.