Health Bill [HL]

I was very gratified to hear this debate. It should reassure noble Lords to know that this is the type of debate that I wanted to create in the NHS. If you go out into the NHS, that is what it is talking about at the moment. I said in High Quality Care for All that I wished quality to be the organising principle of the NHS. I wanted to use any lever that I may have to create that debate. It is working here, and I have no doubt that it will work in the NHS, too. Most noble Lords have expressed concern about what the quality account is. I will try in a fairly long speech—I will go sideways sometimes—to explain what the quality accounts are and how we envisage them improving patient care. I have no doubt that some noble Lords have said in the House that the quality of care that has been provided has not always been central to the discussion of the performance of the NHS or on the agenda of boards that lead NHS organisations. I have sat on a board for 18 months, and at every board meeting most of the discussions have been about the financial health of that organisation and intermittently about where the threats were from neighbouring organisations in relation to services. In the last half hour of these discussions, someone mentioned quality indicators, which were the minimum requirements that the regulator was required to measure. That is not what I see as quality in the NHS; I see the culture of every clinician, organisation and board as very much the driver of quality improvements for the future. Some noble Lords asked why we have picked these three domains of quality, as there are seven domains of quality. We have picked safety because we strongly believe that safety is paramount. The noble Lord, Lord Patel, very eloquently referred to that. We also picked effectiveness. Clinicians have always been accustomed to that. The noble Lord, Lord Walton, referred to audits. Historically clinicians measured audits. The third one, which I believe is the most important and which historically we have not had much regard to as clinicians, is patient experience. I am not referring to patient experience as patient satisfaction surveys, as that is a tick-box exercise. It is not uncommon with patient satisfaction surveys not to get that information until about a year down the line. It is meaningless. It rarely gets down to those providing the service learning from that experience. Therefore, we are talking about sophisticated tools in which we will measure patient experience. What about the other four domains? We need to start walking before we run. Other domains include productivity, cost-effectiveness and value for money, which I have no doubt are extremely important, certainly in the current economic climate. However, this is a good start to defining what quality is. The next issue is what should be in the quality account. Whichever way you look at it, the regulator in this country has had a huge impact on improving the quality of services. I am not sure how many more weeks there are. The noble Baroness, Lady Young, always reminds me of the number of weeks, but I am sure she will refer to that later. The Care Quality Commission will maintain the wonderful quality improvements that have been introduced throughout the system. We have seen many quality improvements by the regulator and, let us not forget, we have also seen many quality improvements on the back of the operating frameworks. Some have described those as targets. Some of the high quality care targets have worked. You just have to look at the mortality rates for cardiovascular disease. We have had a 48 per cent drop in death rates following coronary artery disease. The Care Quality Commission will measure all the indicators in the system as it stands, which will be part of the quality account that a provider will have to take ownership of and publish. Also, mostly tier 1 operating framework indicators will be in the quality account. The bit that the Committee may feel is still blurred is the question: ““What else?””. It is the ““What else?”” that excites clinicians. Clinicians come to work not because they think that they are meeting the core standards that the system requires them to achieve but because they want to excel. They are ambitious and really want to push the frontiers in the quality of care that they provide. They are the experts in what they measure. It is not for us sitting in this House to decide what these measures should be as long as the framework is correct. That framework is, as I described, for safety, effectiveness and patient experience. In my line of practice, a number of well established national and international indicators reflect the quality and effectiveness of the care that I provide. I want to add newer indicators that reflect the experience of the patients receiving care through my team. That is also very important. We should not forget the safety requirements when working in a very complex health environment in which the risks are constantly increasing. The legislation in front of us would create that broad framework. I hope I have reassured the Committee about the good work that the Care Quality Commission and the NHS operating framework have done together. MRSA and other infection rates were also mentioned. That will be there. That is a must, but that is not what we are discussing here. We want to encourage further quality measures. We must ask why. It is not just an ambition; it is quality improvement, and there is a science behind quality improvement. People measure things not only for the sake of measuring them but for the transparency that comes with that, which is what drives people to improve the services that they provide. When we come back in the autumn with the secondary legislation, we will debate what will be in the quality account. I remind noble Lords that a component of the quality account will not be discussed in this House. This will be discussed on the front line, where people are delivering those indicators, which could include audits and other parameters. Some noble Lords have suggested—