Health and Social Care Bill

Baroness Masham of Ilton Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords, we have before us a monster of a Bill. It is complex and confusing. Many people who depend on the NHS are concerned about what the results will be when it becomes law. There are improvements that should be made to the NHS but it will be a tragedy if good and excellent things are lost or downgraded.

Safety of all patients is my top priority. We do not have enough high-dependency beds. We are well down the European list, which is headed by Germany and France. We have many critically ill patients. There is a gulf between intensive care and the general wards. There is a dark cloud hanging over England, which must save £20 billion when the NHS has increasing lists of patients who need treatment and medication. With commissioning being done by clinicians who might have self-interests, perhaps I may ask the Minister if there are enough safeguards in the Bill. If patients become suspicious of their doctors and trust is lost, that will be a tragic disaster. There should be integrated healthcare, and patient and public involvement to help with commissioning. Many members of the public who have paid their taxes and national insurance feel that the National Health Service is there for them when they need it.

Many people, including professionals, think that healthcare assistants working in hospitals and care homes are registered. They are surprised when they hear that they are not. Many members of the public were horrified and dismayed when they learnt about the callousness and cruelty to patients over a long period at the Mid-Staffordshire NHS Foundation Trust, when the system within the hospital let them down; and likewise when they saw the “Panorama” programme about the care home, Winterbourne View. This sort of behaviour to patients just cannot go on.

It is welcome that the Government have recognised that unregulated workers supporting healthcare professionals represent a risk to patient safety that needs to be addressed through regulation. I strongly believe that only a mandatory regulatory model will be sufficiently robust to safeguard these workers who present the greatest risk to patient safety and public well-being. I believe that Clauses 225 and 226 of the Bill should be made mandatory.

Care assistants are often dressed up in uniforms that make them indistinguishable from nurses. When the national nursing research unit at King’s College, London carried out a review of models of regulation of support workers, it found that for the two types of healthcare support workers—healthcare assistants and assistant practitioners—there are no consistent UK-wide training standards. Healthcare assistant courses can range from an hour-long induction to NVQ level 3. Assistant practitioners undertake more complex tasks than healthcare assistants, but again there is no training consistency across the UK. The report demonstrates that both often undertake tasks for which they are not trained. The lack of regulation means that employment as a support worker may be obtained by people who have been dismissed from a previous healthcare post for misconduct, or who have been struck off the register as a nurse or a midwife. I will be moving or supporting amendments to try to help rectify this unsatisfactory situation.

I am sure that nobody would disagree with the importance of the patient voice in the reforms—no decision about me without me. Can the Minister, the noble Earl, Lord Howe, who is so hard-working and committed to high-quality healthcare, assure me that specialist care for patients who need it will not be affected during this period of upheaval in the NHS? The cuts are already causing concerns in various directions. Some of the expert advisers within the Department of Health have retired and have not been replaced. One is the microbiologist who advises on infection control. With the increase of drug resistance to various infections such as E. coli and tuberculosis, perhaps I may ask a question. There are many specialties of illness, disease and infection. Will the commissioners have advisers so that they will understand what they are commissioning? I hope that the Minister will have a positive answer.

With the increase in HIV/AIDS and other sexually transmitted diseases, what will the Government do to ensure that stigmatising views of HIV and of sexual health more broadly do not affect decisions about local public health services? Can the Government confirm how the NHS Commissioning Board will be held to account for the quality of its own commissioning, and by whom? I ask this in particular in relation to HIV treatment and care, and healthcare in prisons and other places of detention. Will the Government allow for a national tariff covering sexual health services to be applied to local authorities as part of the mandate for Public Health England? Will the Government specifically allow the pre-existing tariff for GUM and sexual reproductive health to be used? There is fear that the service might become fragmented.

How is the patient voice to be heard? It is important for special groups such as Diabetes UK, and patients’ groups such as the Spinal Injuries Association, the Patients Association and hundreds more, to speak out and be heard. The Government are setting up HealthWatch. It would have been helpful if Governments had built on community health councils, but this was not to be. Health forums were set up and then closed down. Then came LINks, which few people have heard of and are not well supported. It is felt that HealthWatch should be independent of local authorities and the CQC if it is to be an effective body representing the public’s interest in the NHS and social care. HealthWatch England must be an accountable and democratic body, and some of its members should be elected from local HealthWatch bodies. Local HealthWatch must be seen by patients and the public—and particularly by users of social care services—as being independent and serving their needs. If local HealthWatch is made accountable to its local authority the public will have no confidence that it will stand up for and represent them when things go wrong.

The lessons should be learnt from Mid Staffordshire NHS Foundation Trust and the numerous care homes that have become places of oppression and agony for the residents. HealthWatch cannot be both champion of the public and poodle of the local authority. It is essential that primary and secondary health work is done in co-operation, and that pharmacists are involved. They are concerned that currently in the legislation provision for clinical commissioning groups to obtain appropriate advice is too vague. I hope that your Lordships will be able to do what the House of Lords is good at, which is to improve this mammoth Bill for the good of the NHS and of those who serve in it and who use it.