Health and Social Care Bill

My Lords, I shall speak to several amendments in this group. Some have already been spoken to. Some that have been led by my noble friend Baroness Hollins have already been addressed. I emphasise the importance of their benefit to the NHS as a whole—in fact, the whole of healthcare—by professionals being able to participate in the broader standard-setting and educational functions that she outlined in her speech. It is also important that those from further afield are able to participate. It is quite easy for employees in the south-east to get to educational committees or colleges and participate in developing NICE guidance, but for those in rural areas, it may take hours to come down to committee. Even if they try to do video, links they do not necessarily work well. Those are the clinicians who will be the local leaders driving up the quality of services in their areas, so there is a direct benefit to the services in which they work, as well as to the broader NHS. However, their time has to be accounted for and unless it is recognised this is important national work, there is a real danger have some of these standards driven by those who happen to live and work in the London or Greater London area. I turn to Amendments 208, 209, 212, and 214, which concern the importance of commissioning for less common conditions. Earlier this evening Lord McKenzie of Culkein already addressed the different population sizes that are ideal for different groups for commissioning. I emphasise that a lot of people in the country have rare and complex conditions, rare to the GP, but not rare in secondary care. Take, for example, cystic fibrosis, or patients with neurological disease who will need non-invasive positive pressure ventilation. This will be completely outside a GP’s competence to establish and maintain. They need a highly specialized service within an area that they can access from where they live. Similarly with genetic services, the importance of good genetic advice at all stages, particularly when genetic conditions are diagnosed, is important. Sadly, many in primary care do not yet have a full understanding of the importance of such advice. Children with conditions such as diabetes may be seen quite commonly in a paediatric clinic, but insulin-dependent diabetic children under five will be a rarity for a GP who is likely to only ever have one on their list at any time. It will also be important that guidance is developed as to how commissioning for this broad range of conditions will occur. Otherwise, will have an increasing number of patients who cannot access the excellence that they know that they could—or even worse, they may just be excluded from it. It is not until they are running into major complications that they become aware of a service that should have had for many years. These are all probing amendments. I draw the Minister’s attention to Amendment 211, where we are trying to require an audit of the decisions taken and linking back to HealthWatch England and the CQC itself to see whether the guidance is being followed and implemented in practice. I hope that, when the Minister responds to this group of amendments, he will outline what will happen to the patient whose clinical commissioning group does not commission a service that that patient needs. I have already given the example of end-of-life care for patients in Southampton with motor neuron disease. Currently, those patients are moving house to go to Gloucester or they are just dying badly, never accessing the specialist care that they ought to get. Will the Minister respond by saying that it is up to the clinical commissioning group and therefore this inequity will continue, or is there a way that patients will be able to bypass their clinical commissioning groups and have a central point of appeal? Will it be through the Commissioning Board that they genuinely access the core clinical care that they should have? We have the skills in the country; we can provide it for people. The same sort of situation arises for children with diabetes accessing insulin pumps. We know that they are under-utilised at the moment. There are a lot of children whose diabetes could be better controlled if they were accessing insulin pumps earlier and if the support services were in place for it. If the clinical commissioning group do not commission them because they do not understand that, in the very long-term, to avoid complications much later, it is a priority in this child’s life, how will those people access the service? I look forward to the Minister’s reply.