Health and Social Care Bill

Baroness Jolly Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Jolly]

My Lords, we have heard well-argued speeches, as we would expect, from my noble friend Lord Howe and from the noble Baroness, Lady Symons, the Opposition Front Bench health spokesman—

[Noble Lords]

Thornton!

[Baroness Jolly]

Apologies to the noble Baroness, Lady Thornton. I have that name written down but the wrong one came out. They have provoked thought. At the debate on the Future Forum, called by the noble Baroness, Lady Wheeler, before the conference recess, I flagged up many of my concerns with this Bill, but time did not allow me to share them all. I fear that I will have the same problem today, but I am sure that my noble friends on the Benches behind me will be happy to fill in any gaps I may leave; in particular, areas of inequality, mental health, and the role of Monitor in competition and integration.

For the record, my areas of concern which I flagged up in that debate were the accountability of the Secretary of State—this needs to be right from the beginning and completely unambiguous, and he or she needs to be hands off and responsible at one and the same time; the need for clarity within the local government and clinical commissioning groups and democratic accountability; the role and status of the director of public health within local government, which will be critical and will need work; and the need for clarity about education, training and workforce development within local government.

I am delighted that this Bill is designed to promote integrated care—acute and community services working as one with social care. The patient and carer must be totally woven into these new networks and clinical senates. In future, patients and carers should not have their care packages worked out in isolation.

As I was working out how I was going to come up with this speech, I realised that it is nine months to the day since I was introduced to this House. In the maiden speech I made two days later, I told the House about my time on various NHS trust boards. From that time, I offer your Lordships an example of why the Secretary of State must be hands off.

We needed extra capacity to deal with cataracts in my area and made the appropriate arrangements through a local hospital. Before this could be finalised, we had the project pulled and replaced by a new treatment centre, run by the private sector, which would also offer terminations and endoscopic diagnosis. This would be based in a new build—not particularly where patients wanted to go—and we were given patient target numbers not only to meet but to pay for whether they were met or not. We did not need all that provision and it was in the wrong place. We respectfully told the powers that be that we were happy with our original solution, thank you. We were then told, in very blunt language, that it would happen with or without our decision, and that if our board did not approve it, another would be found that would. So that is a result of the Secretary of State with a power to intervene. Fortunately, under this Bill, this proposal would come before Monitor and the privately run hospital would be deemed not to be in the best interests of local patients and it would not proceed.

I must have sat through hundreds of board meetings, not to mention audit committees, clinical governance groups and remuneration committees. They were all about the structure of the NHS. There were times, as we discussed systems and processes, that the patient never got a mention and was certainly rarely there at the table.

By their own admission, the Government want to put the patient at the centre of the NHS—“No decision about me without me” is a laudable and catchy strap line. We welcome that, but I fear that at times this patient is still sidelined. Care will have to be taken to embed a serious culture change.

I fear that this Bill, as it stands, has areas which are about process; engineering the system for desired outputs and outcomes while Mrs Smith or Mr Patel is forgotten. Just how much within the Bill needs looking at again from the perspective of individual care and not making the individual fit what is being designed?

There are three distinct areas for patient involvement. First, at the time of a consultation with a professional they need to be involved in their care plan and look at any options. There is evidence—there has been a lot said today about evidence—that 75 per cent want involvement and that if they become involved they do better. Incidentally, that goes some way towards reducing health inequalities. This needs to start upstream and it needs to be built into commissioning.

Secondly, we can look at a patient as an expert patient, offering insight and refection in how their experiences can help the care of others, as can patient organisations. Again this needs to be built into the commissioning process, into senates and into local networks. Finally, as a member of a local healthwatch or HealthWatch England, these replaced the old LINks groups and, as yet, do not have a sufficiently robust structure with the ability to challenge. Here I disagree with the Minister. They do need more clout.

We are faced with two amendments to the Motion, one tabled by the noble Lord, Lord Rea, and the other by the noble Lord, Lord Owen. I will take them separately and explain why I am not supporting either. First, on that of the noble Lord, Lord Rea, as a Liberal Democrat I know only too well that many areas of this Bill, for the most part, fall outside the coalition agreement, which I voted to support in May 2010. In fact, it drives a coach and horses through the agreement. This leaves us the opportunity on these Benches to revert to our manifesto and policy document in deciding amendments. When I arrived in this place, the Bill was already printed and starting its passage through the other place. History will tell us whether there was a Blue Peter here's-one-I-prepared-earlier moment and who the main players were. I expect it to be silent on the matter of wire coat hangers, cereal packets, and sticky-backed plastic.

It is the Government's Bill and it is not without fault. One of my early lessons here was that it is our role to improve and not to reject Bills. We need to take those faults and work to take them out. As a junior member of the coalition, I have found Ministers' doors have been open, and there has been a willingness to listen and engage. I welcome the invitation of the noble Baroness, Lady Symons, to work together in the interests of the public and the NHS.

[Noble Lords]

Thornton.

[Baroness Jolly]

Thornton—I beg your pardon. It is the first time I have made that mistake. You know who I mean. I apologise to the noble Baroness, Lady Thornton. I welcome her invitation.

Next, the amendment of the noble Lord, Lord Owen, is more nuanced, but puzzling. The noble Lord calls for those issues raised by the Constitution Committee report dealing with powers and responsibilities of the Secretary of State to be extracted and given to a Select Committee to work on while the remainder remain within the House in Committee in this Chamber. Thanks to the hard work of the noble Baroness, Lady Thornton—I have it right—in pulling together a really well attended series of fascinating seminars about all aspects of this Bill, followed by a similar series arranged by noble Earl, Lord Howe, the opportunity to question think tanks, Royal Colleges and senior civil servants was made available to all Peers and was taken up by many. Peers are well informed about this Bill and are able to deliberate, scrutinise and amend in the usual way—in a Committee of the whole House. This is the general custom and I see no reason to do otherwise.

I ask noble Lords to reject both amendments. Let us get on with doing what we are praised for doing worldwide: scrutinising difficult and complex legislation as a House, with a view to producing a better, workable Bill.