NHS: Accident and Emergency Units

Baroness Masham of Ilton Excerpts

Wednesday 19th June 2013 Lords Chamber

[Earl Howe]

My Lords, Ministers are responsible to Parliament for the provision of the health service so I do not duck that responsibility for a second. Nevertheless, Ministers do not manage the health service day-to-day and have never done so. We are involved day-to-day in the plans to ensure that we have a health service that is properly configured to meet the needs of patients. My right honourable friend the Secretary of State could not be more assiduous in the work that he is doing to make sure that that happens. Responsibilities are not being ducked; nobody is being blamed. The fact is that demand is going up considerably, and has been for a number of years. We need to address that and we need to do it cleverly. It is not always a question of piling more money in; it is looking at how the services are configured and delivering care in the right place.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that drunken and aggressive people are putting great pressure on A&E departments across the country, especially at weekends? Can he do something about it?

[Earl Howe]

The noble Baroness is right. Quite a considerable proportion of people who attend A&E do so at weekends after heavy drinking, and in some areas, that has overloaded the system. I am aware of many hospitals that are working with the local police force and others to keep such people out of hospital if they do not need to go, but to make sure that they do not disrupt the work of an A&E department if they do go.

Health: Midwives

Baroness Masham of Ilton Excerpts

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, we are working hard on this. Officials from the department have been in discussion with stakeholders, including Independent Midwives UK, on an ongoing basis for at least four years with a view to identifying potential solutions to the issue. Arising in part from these discussions, independent midwives can now obtain affordable indemnity cover for the whole of the maternity care pathway either in the NHS or in the private sector. However, it is acknowledged that this is achievable only if they operate as part of some form of social enterprise or corporate entity. That is the issue that we have to get to grips with between now and October.

[Baroness Masham of Ilton]

My Lords, how independent are these midwives? Are they responsible to themselves?

[Earl Howe]

My Lords, in terms of their practice, they are responsible to themselves and of course to their patients or clients but they are registered with the Nursing and Midwifery Council as professionals.

Care Bill [HL]

Baroness Masham of Ilton Excerpts

Monday 10th June 2013 Lords Chamber

[Lord Sutherland of Houndwood]

My Lords, as has been claimed in the course of this short debate, this amendment should be seen in the same context as Amendments 23 and 23A. However, together they have one common difficulty, which I think has been highlighted. The first point they make is that there should be proper training and education in this area, which is absolutely right; it should be a matter for Health Education England. Secondly, there is still a residual concern, which is very real, that the presence of training does not always guarantee that the care will be of the level and quality that we reasonably expect. So there may be a separate question about imposing some degree of regulation on employers. It is hinted at in Amendments 23 and 23A that employers could suffer a liability were they to put into the field, be they agencies or statutory employers, someone who evidently is unable to provide a decent quality of care. So the separation of these two issues is what I propose.

[Baroness Masham of Ilton]

I would like to ask the Minister a question. I do so agree with the noble Baroness, Lady Browning, over Winterbourne; we do not want any more Winterbourne Views—and they can happen in any part of the country.

My question to the Minister is whether he would agree with me that, when it comes to crisis intervention and physical restraint techniques, all front-line staff should receive a national standard of training to deliver the best possible quality care and health services. Undermining best practice in this area is driven by three elements: a fragmented, unregulated training provider sector; procurement pressures, and commissioners’ and regulators’ roles in quality monitoring; and practice application. The people who have to be restrained are very vulnerable and, usually, mentally ill in some way. Is it really suitable for untrained people to do this job?

[Lord Hunt of Kings Heath]

My Lords, the noble Baroness takes us back to our debates last year on the regulation of health and social care support workers. We had some excellent discussions but, as the noble Baroness, Lady Browning, said, the Government set their face against the statutory approach without convincingly explaining to the House why they did not favour such a move. As far as I can see, the Government’s main objection appears to be cost; they are relying on better training and a voluntary register. But as the noble Baroness, Lady Greengross, pointed out, this may not be sufficient. As she says, unqualified care assistants are looking after very vulnerable people without the necessary training and support, and are being placed in a very vulnerable position. This is probably not the time to debate the loss of state-enrolled nurses, but my noble friend Lord Turnberg is absolutely right to say that the essential removal of the SEN grade has left a gap which needs to be filled.

My noble friend Lord Campbell-Savours points out that we are absolutely reliant on support workers to provide care. Many or most of them are actually very dedicated, but they are not being given sufficient tools to do the job effectively. One has to have great sympathy with the noble Baroness in her amendment.

Some noble Lords have said that it is not readily apparent why Health Education England ought to be the regulator. I certainly sympathise with that point, but no doubt the noble Baroness could easily substitute either the NMC or the HPC. We could no doubt come back to the question of which regulator it should be. The HPC has been somewhat acquisitive in past years in adding professions to its register, and would no doubt be keen to add healthcare and social care support workers to the large number of people whom it registers at the moment. As for the NMC, we understand that it has been through some difficulties in leadership and has a backlog of cases to be heard by its regulatory committees. But it has new leadership, and I am confident that it will be able to get through those problems—and, if it was chosen, it could also register health and support care assistants if that were to be required. So I do not think that there is an organisational issue in terms of difficulty in organising the regulation of support workers.

The Francis report has been mentioned by a number of noble Lords. This compelling report says:

“A voluntary register has little or no advantage for the public. Employers will not be compelled to employ only those on the register although they could be incentivised to do so”.

It concludes:

“It is not generally those who would seek voluntary registration who are the concern. It is those who will or would not seek voluntary registration but are still able to obtain employment who will be in contact with vulnerable patients”,

and those patients may not be appropriately protected. The Francis report says that this,

“need not be costly and can be self-financing”.

Amendments 23 and 23A, which we are going to come to, are very helpful but they do not do the job of regulation. Does the noble Earl think that the Government should reconsider their position in the light of the Francis report and of today’s debate?

Abortion

Baroness Masham of Ilton Excerpts

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

I am sure that those issues should be discussed very thoroughly. I agree that young people should be taught about relationships. However, I also believe that access to contraception is very important. Our data show that there has been no decrease in the number of women using contraception, and that more women are turning to extremely effective measures such as long-acting contraception. It is encouraging that the abortion rate for the under-18s is coming down.

[Baroness Masham of Ilton]

My Lords, how many late abortions have there been for babies who may have had a handicap?

[Earl Howe]

The vast majority of abortions are performed at under 13 weeks. The figure was 91% in 2011. There has been a continuing increase in the proportion of abortions that are performed under 10 weeks. Again, that is positive news. I do not have detailed information on the issue which the noble Baroness asked about, but I will write to her.

Care Bill [HL]

Baroness Masham of Ilton Excerpts

Tuesday 4th June 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I, too, support having a nurse on the board. It is vital because the nursing workforce is the biggest of all the professions, and training and recruitment is sometimes the problem that has to be faced.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we begin our Committee proceedings with a series of amendments that take us to the heart of the theme that permeates this Bill. The driving principle of reforming the education and training system is to improve care and outcomes for patients. Excellent health and healthcare require a training system that will deliver a highly skilled workforce, working together with compassion and respect for people.

Noble Lords will remember our debates of last year when, recognising the importance of education and training in the NHS and public health, we inserted into the Health and Social Care Act a clear duty on the Secretary of State to ensure that there is an effective education and training system. This Bill delegates that duty to Health Education England. This means that Health Education England will be clearly accountable to the Secretary of State for ensuring that there is an effective education and training system in place for healthcare workers in England. Health Education England will provide national leadership for workforce planning, the commissioning of education, training and development activity, and the quality assurance of the education and training that is delivered.

The backdrop to all that is the changing face of healthcare provision. The way health services are provided is expected to change significantly over the next few decades, with more care provided in the community and an increased emphasis on public health. This cannot happen unless we equip the workforce with the skills and knowledge to do this. To do it successfully, the local and national infrastructure needs to be in place to plan and commission effectively. That is why the creation of Health Education England and the local education and training boards is so important.

It is vital that the board of Health Education England has the necessary skills and experience to oversee the delivery of its important functions. In recognition of this, the Government have already strengthened the Bill, following pre-legislative scrutiny, to place an explicit requirement, in paragraph 2(1) of Schedule 5, on Health Education England to recruit members with clinical expertise. The specific nature and description of the expertise and specified numbers are to be set out in regulations. That amendment has been well received by stakeholders such as the Royal College of Surgeons. A similar requirement has been placed on local education and training boards to have members with clinical expertise.

The noble Lords, Lord Hunt and Lord Turnberg, have tabled a number of amendments relating to clinical expertise on the board of HEE and the LETBs. I realise that Amendment 1 is a probing amendment. It may be helpful to explain our thinking around the Schedule 5 requirement. This sub-paragraph was added to the Bill following pre-legislative scrutiny to place an explicit requirement on Health Education England to ensure that there is clinical expertise on the Health Education England board. It also responds to responses to the consultation on the Bill, which touched on the importance of Health Education England having access to professional leadership. This will give Parliament and bodies representing the professions the necessary assurance that the Health Education England board has access to the appropriate knowledge and understanding in making decisions that impact on professional education and training. It also provides the basis for a clear duty in the Bill for both the Secretary of State and Health Education England to make appointments of clinical experts, which can be developed subject to regulations. For example, the regulations will specify what we mean by “clinical expertise” and allow greater flexibility to specify any detailed requirements. It will also allow changes to be made to those requirements as Health Education England matures, should circumstances demand it.

Amendments 3 and 4 seek to extend the requirement for members with clinical expertise by expressly requiring Health Education England to include in its board membership a registered nurse and someone with experience in staff groups that are not professionally registered. Similarly, Amendment 2, tabled by the noble Lord, Lord Turnberg, seeks to extend the requirement for members with clinical expertise by expressly requiring Health Education England to include one or more members with expertise in research and one or more members with expertise in medical education and training in the Bill.

It is undoubtedly important for Health Education England to have access to professional expertise, but having said that I need to make clear that the Government do not believe that it is appropriate for the Bill to mandate requirements for certain professions or particular areas of expertise. That is better suited to be set out in secondary legislation, as it may change over time, and Health Education England will need greater flexibility to recruit the expertise it requires and to specify any detailed requirements as circumstances demand.

One of the great strengths of Health Education England over previous arrangements is that it has a remit for all the professions, bringing a strengthened approach to multi-professional education and training. Although medical and nurse training, and an understanding of the importance of research, are extremely important elements of its functions, HEE has a much broader focus. It may be helpful to the Committee to have a sense of how the new organisation intends to do justice to that broad remit.

First, HEE will employ a director of education and quality at board level who is responsible for ensuring a co-ordinated multi-professional approach to education and training. Within the Health Education England special health authority, that post is filled by a doctor, and is supported by a medical director, a director of nursing, and other professional advisers for dentistry, pharmacy, healthcare science and the allied health professions.

Secondly, Health Education England has established professional advisory groups, bringing together employers and national stakeholders, to focus on profession-specific education and training issues covering medicine, dentistry, nursing, pharmacy, healthcare science and the allied health professions. These advisory boards will support HEE and its board in the decisions they make that impact on health professional education and training. It should also be remembered that Health Education England employs many health professionals that support the activities of the LETBs. In these ways it has direct access to a wealth of knowledge and expertise on the planning, commissioning, provision and quality assurance of education and training.

The Government understand the importance of considering the support workforce that is not professionally registered. Health Education England, with the networks of employers working through the LETBs, will provide a wider leadership role in the development of the whole workforce engaged in the delivery of healthcare and public health. This is emphasised in the Government’s mandate for the Health Education England special health authority. In making non-executive appointments to the Health Education England board, the Secretary of State will source the skills and expertise that are required to ensure the Health Education England board can function effectively. The chair and non-executive directors will do likewise in making executive appointments to the board. That approach has worked well for the recruitment of the current HEE special health authority board, which has three members with clinical expertise, including a doctor. I should also mention that two non-executive appointments are still to be completed. In recruiting for those, we are looking for a further clinician with experience of equality and diversity issues, and someone who can bring a strengthened focus on the patient perspective to support the development of education and training.

In the light of what I have said, I hope noble Lords will feel reassured that the Health Education England board is suitably clinically informed, and that they will feel able to withdraw those amendments.

I now turn to Amendment 5. The Bill already requires the consent of the Secretary of State to the appointment of the chief executive of Health Education England. That approach is in line with the appointment of other chief executive officers across the health system and seems proportionate for a body of this size and nature. In addition to approving the appointment of the chief executive, the Secretary of State will appoint the chair and non-executive directors of Health Education England. This approach has worked well for the HEE special health authority, which has a board with a good blend of experience and expertise.

As for the role of Parliament, the Bill makes provision for Health Education England to report to Parliament on an annual basis, with the requirement to publish an annual report setting out its achievements and to publish annual accounts. I am sure the Health Select Committee will rightly continue to take a strong interest in education and training and will have the opportunity to discuss progress with Health Education England whenever necessary. I hope that will reassure the noble Lord on this amendment.

Ensuring that non-departmental public bodies have robust governance and accountability arrangements in place is clearly essential. Schedule 5 to the Bill makes provision for the constitution of Health Education England and deals with the exercise of its functions and its financial and accounting obligations. A number of amendments in this group fall under that broad heading.

Amendment 6, which again I realise is a probing amendment, poses a question about the terms of remuneration of HEE’s employees. In establishing HEE as a non-departmental public body, it is important that it is given the appropriate levels of autonomy and independence to carry out its important education and training functions without day-to-day interference from Ministers or the Department of Health. Yes, it needs to be held accountable for the use of its resources, and the Government are committed to holding it to account in an open and transparent way, but I hope noble Lords would agree that it is important for a body of this nature to have the ability to determine the pay and remuneration rates for the people it recruits and employs, including its executives. That does not mean that it will not be subject to any constraints. I can reassure the Committee that as an arm’s-length body of the Department of Health, HEE will be subject to the rules and controls covering the use of its budget, and to procedures applicable to senior appointments and levels of remuneration. These are the very same rules that apply to other arm’s-length bodies and to all government departments.

The noble Lord, Lord Hunt, asked me whether HEE employees will be engaged on NHS terms and conditions. In fact, HEE employees are currently employed on NHS terms and conditions and there are no plans to change that when HEE becomes an NDPB.

Amendment 7 is another probing amendment. The provision which the noble Lord has questioned is important. It clarifies that Health Education England’s property is not to be regarded as property of, or held on behalf of, the Crown. This is a standard provision that applies to other arm’s-length bodies in the health system. It allows Health Education England to make arrangements for its own property and office needs. It needs to do so to support the staff it employs nationally and across the local education and training boards. It would not be practical for any other body to hold this responsibility. Of course, Health Education England will work with other bodies to look for savings on estates, information technology, human resources and in other areas. It is already doing that as part of the shared services programme which the Department of Health and all its arm’s-length bodies are signed up to.

Part 2 of Schedule 5 imposes a very clear duty on Health Education England to exercise its functions effectively, efficiently and economically. Part 3 of Schedule 5 sets out how the Secretary of State will fund Health Education England and includes restrictions on the use of resources. These are consistent with provisions made for other bodies in the healthcare system such as NHS England.

I make the same point as I did a minute ago—that HEE needs to be held accountable for the use of its resources—but it is right to give it direct responsibility for how it operates and manages its day-to-day business, including the ability to make arrangements for its own property and accommodation. In the light of that, I hope the noble Lord will feel sufficiently reassured to not press his amendment.

Care Bill [HL]

Baroness Masham of Ilton Excerpts

Tuesday 21st May 2013 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I thank the noble Earl for explaining this Bill so clearly. The idea of the Bill is good in theory but will it work in practice? Will there be enough resources to go round and will there be good communication and co-operation between professionals? Will this Bill eliminate the postcode lottery? As so much help is organised locally, this may continue to be a problem.

The Bill emphasises care for elderly people but one must not forget those people of working age who have disabilities. A little help can make all the difference. If eligibility is set too high, people will become isolated in their homes and unable to work. Children, if there are any, may have to help their parents, causing problems at school and putting a strain on their childhood. I am sure that care can become more co-ordinated and save resources if health and social care work in co-operation and co-ordination.

To give your Lordships an example, I speak as president of the Spinal Injuries Association. One of our members, who is paralysed from the neck down but is bright and motivated, goes out to work. The health service helps her with her toileting and the social services help her with dressing. It means that two lots of helpers come in for one person. I am sure that the skills of operational therapists can help with integration as they work in both health and social services. The wheelchair and equipment service needs improving, as does the speed of adaptations to people’s accommodation when they become disabled. This sometimes means that extra time is spent in hospital.

Part 2 of the Bill deals with the post-Mid Staffordshire NHS Foundation Trust. The aim is that no such appalling situation can arise again, but nobody seems to have taken responsibility for the failings. The people who knew about what was happening and witnessed the neglect and cover-ups were not listened to. I feel that throughout the health and social care systems, we need openness and honesty, and that a duty of candour would help. I would be grateful if the Minister would say what progress is being made, as this is a recommendation of the Francis report. A culture has developed among some nurses of doing as little as possible to make patients safe and comfortable. Not all staff are the same; some are exemplary and kind, which is what patients who are often worried and in pain need.

I am concerned that unacceptable practices are happening in many hospitals throughout the country; either they are unbeknown to management or it turns a blind eye. One foundation trust, which ticks all the boxes and always has a good review, had a hospital to which a friend of mine was admitted as an emergency. He had been chairman of the PCT and worked hard for the NHS. Time passed and he was given nothing to eat, so he asked if he was nil by mouth. “No”, said the nurse, “the last person in your bed did not fill in the menu card, so nothing was ordered”. He was then offered a sticky toffee pudding—the last thing his condition needed. He also said that the nurses chattered all night and did not help a critically ill patient in the next bed.

To make the situation better for patients there will have to be a huge change in attitude and practice throughout the health and social care systems. Only last Saturday the Yorkshire Evening Post reported appalling abuse of patients at the Solar Centre in St Catherine’s Hospital in Doncaster. There had been delays in the conviction of two care assistants who mistreated vulnerable patients. The newspaper stated that this was,

“an appalling abuse of trust and a violation of what society should be able to expect from people in the care profession”.

One of the problems seems to be that people who cannot get other jobs become care assistants. As there is such a demand they get work, even if they are undesirable and not fit for purpose. Should there not be better selection and vetting of those who work with vulnerable people? It seems vital that there should be registration of care assistants with adequate training. I am told that Australia is going back to state enrolled nurses. It has found that not having the practical, trained nurse has been dangerous to patients. There is need for a highly technical nurse, but also for a practical nurse to work alongside.

There seems to be an overall welcome for establishing Health Education England, and the Health Research Authority. Research is vital if progress is to be made. Resistance to much needed antibiotics is an example and new drugs and research are needed into such devastating diseases as motor neurone disease, neuroblastoma in children and all the rare conditions which need new and effective drugs. Some day a way may be found to join and regenerate the spinal cord.

I feel it was an unwise move by the Government to disband the Advisory Group for National Specialised Services—AGNSS. Will they consider reinstating this much needed service? I look forward to the Minister’s reply.

NHS: GP Dispensing

Baroness Masham of Ilton Excerpts

Thursday 16th May 2013 Lords Chamber

[Earl Howe]

My noble friend makes a good point. There is a special provision that allows a patient who has serious difficulty in getting to a pharmacy by virtue either of the distance involved or lack of means of communication to receive dispensing services from a doctor. Any patient is eligible to receive these services; they do not have to live in a rural area to do so.

[Baroness Masham of Ilton]

My Lords, does the Minister agree that some pharmacies do not have wheelchair access? Some have steps, including the one in my own village. However, surely it is the easiest place for a disabled person to receive their prescriptions.

[Earl Howe]

My Lords, the rules as they stand do not present a major obstacle for disabled patients. Many pharmacies, for example, offer a free prescription collection and delivery service if a patient encounters difficulty in getting into the pharmacy premises. Under that arrangement, the pharmacy collects the prescription from the surgery on behalf of the patient, dispenses it and delivers it to the patient. Patients can contact their local pharmacies to see whether they offer that service.

Emergency Services: Paramedics

Baroness Masham of Ilton Excerpts

Wednesday 15th May 2013 Lords Chamber

[Earl Howe]

The noble Lord is quite right that certain areas of the country have seen unacceptable delays in ambulance response times—I am aware of two trusts in that regard. However, this is not an issue around a lack of trained paramedics. Projections by the Centre for Workforce Intelligence show that there is a secure supply of paramedics until 2016. The College of Paramedics has stated that training posts on courses are always filled and, currently, 900 ambulance technicians are training to become paramedics. We are seeing an increase in paramedic numbers, which is encouraging.

[Baroness Masham of Ilton]

My Lords, does the noble Earl agree that first aid ought to be taught in all schools mandatorily, so that as many people as possible in the community can learn first aid, help when there is an emergency and save lives?

[Earl Howe]

I agree with the general thesis that the noble Baroness has advanced. As many people as possible should know first aid. That is how we will ensure that we can save more lives, particularly among those who suffer heart attacks in public places.

NHS: 111 Telephone Service

Baroness Masham of Ilton Excerpts

Monday 13th May 2013 Lords Chamber

[Earl Howe]

My Lords, I hope the noble Lord will understand that I cannot comment on Lewisham because it is sub judice. I do not accept that the advice that Sir Bruce gave was ill founded.

[Baroness Masham of Ilton]

The Minister said that there had been confusion in the past. There is even more confusion now. Does he not agree that there should be some publicity for the general public so that they know where to go?

[Earl Howe]

I agree. NHS England and clinical commissioning groups are engaged in that publicity. I think it will be a while before the general public are fully aware of what NHS 111 has to offer, but I have in my brief a series of very complimentary testimonials about 111 that show that many members of the public are already enjoying its benefits.

National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013

Baroness Masham of Ilton Excerpts

Wednesday 24th April 2013 Lords Chamber

[Baroness Jolly]

My Lords, many noble friends have already addressed the main issues of the debate and I do not intend to delay the House for long. I will confine my remarks to guidance—currently in preparation by Monitor—the role of Monitor in the process, and what the effect would be if the Prayer to Annul by the noble Lord, Lord Hunt, were successful. When we had our first meeting with the Minister about our concerns, we expressed our anxiety about the language. Laws they may be, but they did not have to be impenetrable and we improved the situation with the second draft, in particular, Clause 2 and Clause 5. I thank my noble friend Lord Clement-Jones.

The key issue, which my noble friend Lord Howe picked up earlier, is that we insisted that the guidance needs to be absolutely clear and unambiguous. It is written by Monitor, but it is signed off by the Secretary of State. We said that it needed to be a product not just of Monitor’s work, but also of various stakeholders’.

It also needs to contain a worked series of case studies so that people could see how things pan out in certain situations. During the Recess, the Secretary of State and my honourable friend the Minister, Norman Lamb, met some of the stakeholders and I understand that further meetings are in hand. But, of course, there is an open consultation as well. This has meant that the guidance is not published with the regulations. That is seriously to be regretted. However, if the end result is a workable set of guidelines with real case studies, time is the price that has to be paid.

What of Monitor’s other role, that of regulating and policing contracts? Until 1 April, much of NHS commissioning covered by procurement law was undertaken by PCTs. That meant that a supplier could take a PCT to court if they lost a contract unlawfully, and seek compensation and damages. That could be a waste of time and taxpayers’ money, damaging in one way or another to patient care.

After 1 April, PCTs, which could be ordered to do anything by the Department of Health, were replaced by CCGs, which could not. If we want to continue to keep the NHS out of the courts, something needs to have the same power over CCGs in relation to procurement as the Department of Health had over PCTs. That something is Monitor.

However, Monitor is not a body under the control of the department. Instead, it is directly under the control of Parliament. Instead of the department being able to tell Monitor to continue to enforce the PRCC—principles and rules for co-operation and competition—Parliament must do it for Monitor. Thus we arrive at the furore around the Section 75 regulations—Parliament’s way of telling Monitor to enforce the PRCC within the NHS. The regulations, like the PRCC, reflect the overarching requirements of EU procurement law.

I now come to a point that was picked up by the noble Baroness, Lady Hollins. In the general debate until today, much has been made of the opinion of this or that lawyer. Often, any one lawyer gives an opinion that reflects the view of whoever instructs them. We end up with as many views and opinions as we have lawyers. Therefore, with due respect to noble members of that profession, we need to inform our own opinions on this debate.

Without these regulations, all we have is EU competition and procurement law and the courts. There is no direction about the nature of services to be commissioned, and CCGs are completely unprotected and unsupported. What the regulations are not is a signal that the NHS is up for sale. The NHS will still be free to all at the point of need.

The purpose of these regulations is twofold. First, they are a legally binding tool, along with detailed guidance, to be used by the CCGs and NHS England when commissioning the best possible services for their patients and facilitating an integration of those services—services which put patients first. The regulations enforce that patient care is about competition and they outlaw cherry picking and vested interests. Secondly, to put it bluntly, they are to keep the NHS out of the courts. When we decide whether to support this Motion or not, those two conditions are precisely what we would do well to keep in mind.

[Baroness Masham of Ilton]

My Lords—

[Lord Adebowale]

My Lords—

[Noble Lords]

Minister!

[Baroness Masham of Ilton]

Could I ask the Minister just two questions on behalf of patients? I had a postcard today from someone whose mother was a Minister in your Lordships' House. She has had cancer twice, so values the skills of the NHS. I quote from the postcard. It states:

“I honestly believe patients will suffer if all services have to be put out to tender. This wastes valuable medical professional time and removes patient choice”.

I would like to ask the Minister, will patient choice be dispensed with? There are many concerned people. I hope their fears will be allayed tonight. The other question is: will this regulation become a gift to lawyers?