Health and Social Care Bill

Debate between Baroness Morgan of Drefelin and Earl of Listowel

Tuesday 25th October 2011 Lords Chamber

[Baroness Morgan of Drefelin]

My Lords, there is nothing like suggesting to a House of Lords Committee that we move on to encourage one to stand up and contribute.

The noble Baroness, Lady Thornton, mentioned the debate that took place at the start of the Committee stage of the Apprenticeships, Skills, Children and Learning Bill, now an Act, in 2009. I remember sitting behind the Dispatch Box next to my then noble friend Lord Young listening to the noble Lord, Lord Hunt of Wirral, make a very convincing case for the Opposition on the need to set out a clear definition of apprenticeships and the importance of a well thought through, principled preamble. I remember listening to my noble friend take the Committee through a detailed and well argued explanation of how all those issues were carefully covered throughout the very long Bill. However, both Her Majesty's Opposition and the Liberal Democrats were united in saying that they needed to be stated clearly at the start of the Bill. They won the day and there that statement is in the apprenticeships Act.

When I saw the amendment of the noble Baroness, Lady Thornton, it made me think about all the important legislation of the past, and it led me to the Children Act 1989, which I am sure the Government are still very proud of. An important aspect of that Act is the principle of paramountcy, whereby the interests of the child are paramount in any decisions taken about their health and welfare.

Listening to debates on this Bill, I have felt genuine concern about how we resolve issues around conflict of interest. The relationship between a health professional —a doctor, nurse or physiotherapist, but principally a doctor—and their patient is based on an extremely high level of trust and is one of the cornerstones of our NHS, and I was wondering how the importance of that trust and that relationship could be incorporated in some principles. Have the Minister or the noble Baroness, Lady Thornton, thought about whether it would be appropriate to have a principle under which the needs and interests of the patient should be paramount when decisions are made about them? Obviously, there are a lot of ways of thinking about that from a legal perspective, but it is something that we need to be very concerned about. How is the conflict of interest to be carefully managed where a GP refers a patient to a service that they own and profit from? How can patients—whether as individuals or a population—be absolutely sure of the decisions being made about them, at every level throughout the system, including commissioning? It is very important that we think about the principles underpinning the health service. This is a very important debate.

[The Earl of Listowel]

My Lords, I am most grateful to the noble Baroness for this debate on the primacy of patient care. It is very important. All noble Lords may well agree that this is fundamental, so I hope they will forgive me if I raise one concern with the Minister, which has been raised by people who practise in the NHS. The constant changes to the National Health Service over many years, particularly in England, have undermined, to some degree, our efforts to deliver the best to our patients. It is something I am familiar with from speaking to child mental health professionals in the past. They have complained that constant change undermines their ability to make relationships with other professionals work effectively around the child. Also, they get to know a commissioner who then changes. It is a different area, but social workers have also raised with me the issue of local authority changes. I remember speaking to a local authority social worker on a Friday evening who was despairing at yet another structural change to social service provision within the local authority.

In its briefing to Members of your Lordships’ House on the Bill, the Nuffield Foundation also expressed concern at the constant changes to the NHS and the short horizons. One Secretary of State may make changes but then a new Government arrive and there is another upheaval. I recognise what the noble Baroness, Lady Williams, says: flexibility and changes are needed, but my sense from speaking to the professionals and expert think tanks is that there has been too much change over a continual period. This was reinforced in the briefing that the presidents of the royal colleges gave to Members of your Lordships’ House this week, in which the president of the Royal College of General Practitioners finished with a very powerful plea: “Please, give us some stability; please stop changing the NHS”. She particularly alluded to the experience in Scotland. If I remember correctly, she said that for about the same investment Scotland has better productivity. She lays this at the door of the fact that over several years there has been some stability within the health service there. I take this opportunity to ask the Minister whether, in future, he will keep in mind the need to allow important changes to bed down. Perhaps we could build a bit more of a consensus on what needs to be done, recruit and retain the best professionals on the ground and allow them to evolve the best practices. Then we will see better outcomes for our patients, with a similar input.

Welfare Reform Bill

Debate between Baroness Morgan of Drefelin and Earl of Listowel

Tuesday 4th October 2011 Grand Committee

[Baroness Morgan of Drefelin]

My Lords, it is important that we in this Room remember that we are being observed by the world outside. How we respond to the needs of disabled Members of our House reflects more widely the respect that we show to disabled people in our society. Getting this Committee right is important, not just for noble Lords who wish to participate but for building confidence among communities outside this House that they are being taken seriously and that their concerns have been raised and heard within this House too. I am sure that the Minister is well aware of that. I know that there have been concerns about the way that we are conducting this Committee, and we are doing that in public, rightly so.

[The Earl of Listowel]

I hope that the Committee will forgive me; I omitted to declare my interest when I spoke about the work of National Grid Transco. I have received hospitality from them on a number of occasions and I have declared that.

Academies Bill [HL]

Debate between Baroness Morgan of Drefelin and Earl of Listowel

Wednesday 7th July 2010 Lords Chamber

[Baroness Morgan of Drefelin]

My Lords, I added my name to this amendment. From listening to the speech of the noble Baroness, Lady Walmsley, I think I have had exactly the same briefing as her. I simply wish to say “ditto”.

I am slightly concerned that in some things we need to rush ahead with, and in others to hang back from, reviews. It is very important for the Early Childhood Forum and the incredibly important organisations that make up the forum to have the kind of reassurances that the noble Baroness is looking for. The early years foundation stage was a very important step forward. The previous Government initiated it, and it has been well received. It is important that we build on the work of the early years specialists. I look forward to hearing what the Minister has to say.

[The Earl of Listowel]

Briefly, I support this amendment. The Government recently expressed some horror at the number of prisoners we now have in our prisons. It made me reflect on how many inquiries have pointed to problems within our families. When one does not provide good boundaries within families and a secure upbringing for children, and when schools are quite chaotic, it does not surprise me that there is so much offending among young people or that we have overcrowded jails. It seems to me fairly apparent that if one does not set boundaries early in life, society is left setting boundaries later in life, at great expense to itself. Therefore, it is imperative to get all the right support for children early on. This is an important area. I look forward to the Minister’s reassurance that the early years foundation stage will be delivered in these schools.