Health and Social Care Bill

Baroness Northover Excerpts

Tuesday 25th October 2011 Lords Chamber

Amendment 2 withdrawn.

[Baroness Northover]

My Lords, given that there is no dinner hour business tonight, we have agreed that instead of breaking now, we will sit without a break until 9 pm and therefore have a slightly earlier night.

[Lord Bassam of Brighton]

Does that mean that we will finish at nine o’clock or when the debate on an amendment finishes? There is a practice whereby we can carry the debate over; we do not have to complete it by that time. Will the noble Baroness clarify that point?

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[Baroness Northover]

My understanding is that we will stop at nine. If that means that we are part way through the next group of amendments, so be it.

Amendment 3

Moved by

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[Baroness Cumberlege]

That is true up to a point, but can you imagine, when the Secretary of State receives that information, that he will do nothing about it? That would be extremely unlikely.

The other thing I would like to say is about the comments of the noble Lord, Lord Hennessy, on ambiguity and clarity. It seems quite strange to put a word into this Bill that is archaic and no longer used. It no longer serves a purpose, in that what is being done at the moment does not relate to the Secretary of State providing anything. If we are going to be really clear about legislation, surely we want to make sure that the words used are relevant to today. Including the word provide, which is no longer being used—the Secretary of State has powers to provide, but he does not actually provide services—seems a pretty irrelevant and an archaic way of producing legislation. I very strongly support the noble and learned Lord, Lord Mackay of Clashfern.

[Baroness Northover]

My Lords, as agreed earlier, it now being nine o’clock, I beg to move that the House be now resumed.

House resumed.

NHS Reform

Baroness Northover Excerpts

Monday 4th April 2011 Lords Chamber

[Baroness Masham of Ilton]

My Lords—

[Baroness Northover]

My Lords, I think that we have time for both speakers. It is time to hear from the Labour Party and then the Cross Benches.

[Lord Beecham]

My Lords, months after the Bill was launched upon an unsuspecting world—including, apparently, the Prime Minister—it seems to have been admitted to the fracture clinic if not to the intensive care ward. A number of questions arise from the Statement itself. For example, the Statement says:

“Some services, like A&E or major trauma, clearly will never be based on competition”.

Is not the implication that other services will be based on competition? Will the Minister comment on the predominant role of Monitor as a promoter of competition, as opposed to being simply an economic regulator?

On the GP commissioning groups or consortia, will the Government look again at the composition of those groups as well as their degree of local accountability? Will he also look at the powers of the health and well-being boards? Does he have any views about those in addition to the question of their composition?

As for the NHS being in a healthy financial position, does the Minister have any comment on tonight’s story in the Evening Standard about people who were made redundant last Friday having to be re-engaged by PCTs and other organisations, at considerable cost to the NHS?

NHS: Standards of Care and Commissioning

Baroness Northover Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Emerton]

I thank the noble Lord, Lord Turnberg, for raising this timely debate. Without doubt, corrective action is required to deal with these issues. They will not go away unless that happens. This fact is reflected in the 57 per cent increase on last year in referrals from the general public to the Nursing and Midwifery Council fitness to practice committee in the months of January and February this year. The total was 833—a dramatic increase.

On 3 March, I asked when the Government were going to respond to the report of the Prime Minister’s commission on nursing and midwifery, published in March 2010. I declare an interest: I am proud to say that I am a nurse and that I was on the commission. The Minister replied that he would check where the Government were on the formal reply. I raise this again as no response has been received and because a year was spent by 20 senior and distinguished nurses, midwives and health visitors looking at the problems that faced us.

Evidence was collected following meetings with the public, stakeholders and students, and left the commissioners in no doubt that a “care quake” was approaching—driven by healthcare trends, social changes, demographic changes, families outsourcing care, growing numbers of people with long-term conditions and the additional complex conditions resulting from the ageing process. The nursing professions are centre-stage to handle the care quake, but must be properly equipped and supplied to deliver truly compassionate care that is skilled, competent, values-based and that respects patients' dignity with clear, respectful communication to patients and relatives.

We gathered from extensive engagements with the public that they felt strongly that the public image of the nursing, midwifery and health-visiting professions is out of date and that a new story of nursing is needed. The clearest message was that the traditional image of the front-line sister or leader of a community nursing service should be restored to the former point of visible authority and clear leadership role, answering the cry, “Who is in charge?”, at front-line level.

The commissioners set to work to make recommendations for the largest single workforce in Europe. There are currently in excess of 625,000 nurses on the register. The NHS nursing and midwifery pay bill is £12 billion, with more than £l billion spent on pre-registration nursing and midwifery education. There is little research on the cost-effectiveness and cost-benefit of nursing-led services, and existing research is often ignored. A recent scoping review commissioned by the Nursing and Midwifery Council found that there were 300,000 healthcare support workers in the NHS that were unregistered, posing a potential risk to patient safety. Recently the Mid Staffordshire complaints officer stated in evidence to a public inquiry that the ratio of trained nurses to support workers had swung to 40 per cent trained and 60 per cent healthcare assistants over the period 2002 to 2009. That was a change to address the £10 million overspend in the trust.

The move to make nursing a degree-level profession by 2013 is an integral step in ensuring that registered nurses and midwives have an academic base to translate into high-level, quality compassionate care.

Of the nursing commission’s 20 recommendations, I wish briefly to highlight four. The commission said that the nursing, midwifery and health-visiting professions should deliver high-quality care and that leaders should accept full managerial and professional accountability for ensuring that the organisation provides high-quality, compassionate care. The boards should ensure that care champions strengthen the front-line managers—for example, sisters and charge nurses. There was a call for advanced practitioners and healthcare support workers to be regulated, protecting the title “nurse” and limiting its use to those on the NMC register. This would be equivalent to “enrolled nurse”, as has already been mentioned. Another recommendation was that nurses and midwives should contribute to health and well-being, reducing health inequalities.

I hope that Her Majesty’s Government will respond quickly and positively to the commission’s recommendations, which all go towards achieving an improved nursing profession that will meet the needs of the community with compassion and with respect for the elderly.

[Baroness Northover]

My Lords, perhaps I may remind noble Lords, as I did in the previous debate, that we have a very tight time limit in this debate. Therefore, when the Clock reaches “4”, noble Lords will have completed their allotted four minutes.

NHS: Global Health

Baroness Northover Excerpts

Monday 20th December 2010 Lords Chamber

[Lord Davies of Stamford]

I am extremely grateful to—

[Baroness Northover]

This is a time-limited debate and the Minister has 12 minutes to reply. There is no possibility of intervention.

[Lord Davies of Stamford]

I shall be extremely rapid.

[Baroness Northover]

I am sorry. I remind noble Lords that this is the case.

NHS: Reorganisation

Baroness Northover Excerpts

Thursday 16th December 2010 Lords Chamber

[Baroness Williams of Crosby]

My Lords, I, too, thank the noble Lord, Lord Touhig, for introducing this crucial debate in such an effective way. I strongly agree with my noble friend Lord Rodgers of Quarry Bank when he suggests there should be more opportunities for this House—which has a very substantial level of medical knowledge which is not so clear in another place—to debate and discuss reorganisation, an issue which is still very much in the making. The greater the discussion and debate, the more likely it is that we will get an outcome on which everyone can agree.

I should like to add a personal note, and I hope I will not in any way embarrass my noble friend in saying it. My noble friend Lord Rodgers of Quarry Bank is a remarkable example of the successes of the NHS. Anyone who knows what he has climbed back from will, I think, agree with me. On another personal note, my family and I have always been NHS patients and never private patients. I have to thank the NHS for, on at least two occasions, saving the lives of relatives in the most remarkable conditions. I can find very little to fault it with when it comes to critical illnesses and accidents as compared with other health services, some of which I know very well indeed.

I should like to begin by considering the current position, and here I find myself in some agreement with the noble Lord, Lord Hunt of Kings Heath. If you read—as I hope every noble Lord will, especially those involved in health discussions—the quite remarkable report of the Commonwealth Fund, which is nothing to do with the United Kingdom but to do with the Commonwealth of Massachusetts, which is where the word comes from, you would be standing on the rooftops cheering—or at least you would if you were in any other country except our own. The report is remarkable. It shows that our NHS, along with the one in New Zealand, is almost certainly the most cost-effective system we know. Surprisingly—indeed, amazingly—it also shows that the gap between the service provided to those in very low income groups and those in very high income groups is less than in any other developed country. The gap here is 5 per cent whereas in other countries it ranges from 20 per cent in what one might call core Europe, to as much as 60 per cent in the United States. Perhaps even more amazingly, it also shows that the amount of time taken up in waiting to see a consultant or senior clinician in the NHS is very near the bottom of the list. In other services, some of which are much more inclined to be clinician-led, the time spent waiting is much greater.

We have to think very carefully about how to ensure that reorganisation improves the existing NHS and not try to indicate that the NHS has been a failure. By any international standard it is not a failure. It is one of the most remarkable, dedicated public services anywhere in the world.

There is another truly important point. It is clear that the NHS has, over more than 60 years now, won an astonishing level of public trust. The noble Lord, Lord Hunt, mentioned that. Anyone who cares to look at, for example, the recent study of social attitudes in the United Kingdom will see that the NHS is rated as being at the top of all the large public services. It is, rather sadly, ahead of education, but also ahead of almost all other public services. That means that we have to consider very carefully what we do to reorganise it. The bar has been set very high indeed in terms of public trust and public attitudes.

I should like to say one word to the noble Lord, Lord Kakkar, who is no longer in his place. There is a great importance in giving clinicians the widest public say and influence in the services that their patients can expect. I think that all of us in this House—some of us in this House are clinicians, although I certainly am not—would recognise the importance of their influence on the NHS and any other health service. Picking up on the words of my noble friend Lord Alderdice, I suggest that clinicians on their own will not be an adequate response to the need to change the health service for the better.

Wonderful men and women though many of them are, they are not, any more than the rest of us, completely immune from occasional selfish attitudes. I will give an example, which, in the spirit of a bipartisan approach to the problems of the health service, I hope even the noble Lord, Lord Hunt, might conceivably nod at. Many of us recognise that one of the things that went wrong with the NHS in recent years, apart from the increases in expenditure which were clearly good, was the unfortunate contract that enabled GPs to get very much more money and to do so without making any commitment at all to out-of-hours service. I have quite a lot of GP friends, including my own GP NHS trust, who are embarrassed at the way in which they got so much more money for less work at a time when almost all of us can expect not much more money for a great deal more work. The outcome of this debate would be improved if most of us were able to hang up for the moment our tribal loyalties and look at the responsibilities all of us owe to the NHS and to the reorganisation of the NHS. Those responsibilities are honesty, frankness and admission of our own mistakes.

I move on to what most worries me about the reorganisation, apart from the fact that it did not appear in the coalition agreement in any shape or form. Indeed, the coalition agreement specifically promised no more top-down reorganisation and, at least as important, there is reference after reference to PCTs, which would mean that anyone who read it carefully would think that PCTs were likely to survive and not suddenly to disappear.

I want to suggest to my right honourable friend the Secretary of State—and perhaps at least as much to the greatly admired Minister of State, my noble friend Lord Howe, whose devotion to the National Health Service is known to us and who we all, I think, trust and respect very deeply—that a reorganisation needs to carry with it changes that are seen by the public to be improvements. One of those was referred to by my noble friend Lord Alderdice and he is absolutely right. I suggest that clinicians look at the significance of accountability in a public service that is massively financed by the taxpayer.

The provisions for accountability are very weak and not clearly spelt out. I do not understand why it would not be possible with the White Paper to move towards a different system. PCTs are disappearing very fast, as the noble Baroness, Lady Masham, and others have suggested. Commissioning bodies should include not only clinicians but also representatives of the public, some from local areas. The noble Lord, Lord Hunt, was right when he said that there should be an executive lay chairperson whose responsibility would be to the community and not to clinicians or any other group which is bound to have its own concerns and special interests, rather than the wider interests of the public as a whole. The public would buy strongly into that kind of reorganisation. One which leaves that issue of accountability so vague and so little spelt out will not carry the trust that we need. My right honourable friend in another place who is today the Minister of State in the Department of Health, Paul Burstow, has suggested on several occasions the strengthening of accountability. The outcome has been existent certainly, but not strong. We need a much clearer system of accountability.

I will not detain the House for very much longer, but next I want to refer to my noble friend Colwyn who, in discussing the issues of NHS dentistry—I defer to him because he is much more knowledgeable on that subject than I could ever hope to be—referred to trial or pilot schemes.

[Baroness Northover]

My Lords, I hate to do this, but this is a strictly time-limited debate. When the figure seven shows, noble Lords have exceeded their time.

[Baroness Williams of Crosby]

I apologise. I did notice that it was not completely stuck to in several other speeches, but never mind. I will wind up quickly. First, if there were to be a trial period with an outcome that would be open to discussion and debate, I would support it. But that is not my understanding. I believe that these are called pathfinders and are the first wave of the reorganisation. Lastly—

[Baroness Northover]

I am sorry, but no one has got close to this length of time. I realise that this is very significant and I hope that we will come back to it in debate.

[Baroness Williams of Crosby]

I apologise. I said that I would wind up in two sentences and here is the second. I am very worried that if we do not think about the reorganisation thoroughly, we will be in real trouble with the public.

Public Health

Baroness Northover Excerpts

Tuesday 30th November 2010 Lords Chamber

[Lord Alderdice]

My Lords, no one who has listened to and observed noble Lords on the Front and other Benches opposite would think other than that they are passionately committed to the health service and to the health of the nation. However, as they look back over the past 13 years, they would also observe that at the end of that time issues such as obesity, smoking, sexually transmitted diseases, mental health and the increasing disparity in morbidity between people who live in poor areas and better-off areas were uncompleted in terms of what they wanted to see. It therefore does not seem unreasonable to ask whether that was partly because the approach had reached the limits of its validity.

That is why, in welcoming the Statement, I ask my noble friend to address two brief questions. First, as we move towards more local responsibility for provision of public health, and the undertaking of that responsibility by local directors of health and local health and well-being committees, is there a recognition that that transition cannot happen without real input and help from Public Health England and from those experienced in delivering public health? It cannot be adopted at the drop of a hat. Secondly, when it is adopted—and different approaches will be taken in different areas, quite properly and, in many ways, more effectively—is there a recognition that Public Health England will also have a role in liaising with and providing a network among the directors of public health and health and well-being committees so that they can promote health in the way that we all want?

[Baroness Northover]

I remind noble Lords that we have a very short amount of time and that they should be extremely brief, either with a question or with a comment. They can do either but they should be as brief as possible. I shall try to be as fair as possible in getting around the House.

[Earl Howe]

My Lords, my noble friend asked a series of important questions. He has put his finger on how, in many senses, the system will be joined up. He is right to say that Public Health England will be instrumental in supporting local directors of public health in their task. We envisage that Public Health England will create a common sense of purpose and values among a widely dispersed group of workforces. We will develop a workforce strategy with representative organisations and publish that next year. That, I hope, will help to support a smooth transition. At the same time, we do not want to cramp the style of local directors of public health. Much will be down to local decision-making and, in particular, the individuals now employed in PCTs will be looking to transfer across to local authorities as the size and shape of public health teams materialises over the months ahead. We are not going to prescribe from above in determining how public health teams should be configured in local authorities, but there will be considerable support in the advice and expertise available from the centre.

Healthcare

Baroness Northover Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Winston]

My Lords, I congratulate the Government on a wonderful, beautifully written document—the White Paper, Liberating the NHS. Finally, the NHS is to be freed. The document’s honeyed tones and warm aspirations are sweetness and light. Its expressions of good intentions will easily deceive less well informed readers. However, to leave aside the aspirations, to which I shall return, the one thing that the NHS does not need is another reform. That is why in opposition Mr Cameron promised to halt the merry-go-round of organisational change with which the NHS had been previously inflicted. This promise was countersigned by a pledge by Mr Clegg, the Deputy Prime Minister.

I have absolutely no desire to embarrass the noble Earl, Lord Howe, for whom I, like so many of us, have genuinely a huge regard, but we have already learnt how trustworthy this Government as a whole are. So this merely minor change—no merry-go-round—means a reorganisation in which all primary care trusts are to be liquidated, all hospitals will become foundation hospitals, strategic healthcare authorities are to be abolished and the responsibility for public health will become part of the remit of local authorities. This does not seem to be so minor after all—more of an amazing big dipper. In this battle for the NHS, more than three-quarters of the £100 billion NHS budget will be devolved to general practitioners for administration.

Over the past few months, we have heard a great deal about the legacy left by the previous Government. Forgive me if I feel angry at this; it is not often that I do and seldom have I felt as angry. The negative tones have been the cornerstone of an excuse for the severest cuts in public spending in living memory. This Government’s pronouncements, on the whole, are not to be trusted. If their pledges on the NHS reforms are void, so are their promises on the ring-fencing of NHS funding. If we want to consider a legacy, perhaps we might recognise that the Labour Government left the NHS in its healthiest state for decades—a position that this Administration have inherited.

In spite of the Government’s assurances, the NHS is already being cut. Managers have been told to find £20 billion in efficiency savings if widespread closures are to be avoided. To give just one other example, in London the deaneries are threatened. Perhaps the Minister can confirm that, where so much healthcare is needed and where the cream of our young professionals is trained, junior hospital posts are facing a cut of 14 per cent next year. As I understand it, 70 key training posts in general medicine out of a total of 300 are to go—perhaps the Minister can confirm this—and another 70 posts from the other specialities are to be cut by 2014.

If the King’s Fund has calculated correctly, the reorganisation will cost the NHS between £2 billion and £3 billion, which will be taken from patient services. Consider this for a moment: the pressure of population change, the incidence of chronic illness, the rising age of our population, inflation and the rising expectations of patients mean a real cut in resources. The biggest problem will almost certainly be in chronic care. The massive cuts proposed in social care and welfare services will inevitably result in increased pressure on what we can now see is becoming an already underfunded NHS.

What about research? Here is another unbelievable sleight of hand by the Government. Some of the so-called ring-fenced NHS research budget will almost certainly come from the other research councils. I declare an interest as a member of the Engineering and Physical Sciences Research Council. We already fund a huge amount of healthcare research, as does the BBSRC. We will be asked increasingly to contribute substantially, at the risk of other research. We will be heavily pressured on our own so-called ring-fenced budgets. Meanwhile, regarding NHS R&D carried out by the NIHR, if we are talking about assessing outcomes, how is its performance to be evaluated? That will certainly not, it appears, be anything like as rigorous as the superb work of international quality, funded by the research councils, in our top research universities. Here, surely, is a case for government scrutiny.

Front-line care is already threatened. The dulcet tones of the White Paper with its emphasis on patient choice and outcomes are a smokescreen. Of course patients would like choice, whatever that means, but what they really want is competent, efficient medical care. I recently went to a maternity ward in one of the most famous maternity hospitals in the country to visit a relative of mine in her 20s, an NHS patient, who had recently given birth to a premature baby at 35 weeks. Her GP had given her the choice of three different hospitals and she had chosen this hospital. She was four days post-delivery and she had not seen a doctor. Her blood pressure had been 200 millimetres of mercury—a situation in which she might even have had a stroke or a seizure—but she said that she had not been seen by a doctor. She was sitting there trembling with worry. She was scared stiff. What she wanted was a doctor to listen to her and to talk to. Even though it is some time since I left the health service or have done any medical practice, I felt obliged to examine her. I went to see the nursing staff and asked whether I could speak to the house surgeons. None was available, so I asked to speak to the registrar. They did not know the name of the registrar. I had to phone the central switchboard to find out who the on-call registrar for obstetrics and gynaecology was. It was only when I left the hospital that there was suddenly an outpouring of care and three doctors visited my relative in about five minutes.

What about outcomes? Outcomes depend so much on social circumstances. Equity and Excellence: Liberating the NHS mentions cancer, stroke, asthma and so on, but the outcomes of treatment depend on the circumstances of the patient. What we learn more and more, certainly with epigenetics, is that what happens to us in early age also plays a part. What happens in a child aged two or three can have far-reaching effects on whether that child is more prone to diseases such as stroke in 60 years’ time. How do you measure those kinds of outcomes with the possibility that this White Paper offers?

Finally, to leave the—

[Baroness Northover]

My Lords, I think that I need to remind noble Lords, as the noble Baroness, Lady Farrington, would always remind us, that this is a time-limited debate. When the clock reaches four, noble Lords’ time is finished.

[Lord Winston]

My noble friend Lady Thornton and I have agreed to split our time, which is why I went on for the extra time. I shall finish with one sentence. If we really want to improve the health service, we should make certain that doctors have enough time to listen to patients and that nurses are not involved with so much paperwork that they cannot speak to patients, we need to improve training by better investment, we need to renegotiate the EU working time directive and we need to make certain that hospital doctors work in teams so that there is proper continuity of patient care.

--- Later in debate ---

[Baroness Hussein-Ece]

My Lords, I, too, will focus on what we mean by patient-led healthcare, which others have mentioned before me. In November 2005 a best-practice document called Now I Feel Tall: What a Patient-Led NHS Feels Like was published. It said:

“I strongly encourage all NHS organisations to take a close look at how they deliver their services and to ask their patients if their emotional needs are being met as well as their physical ones”.

It goes through what patients should look for. This includes,

“getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way … having information to make choices, to feel confident and feel in control … being talked to and listened to as an equal; and … being treated with honesty, respect and dignity”.

The core and developmental standards for the NHS were set out in seven domains, the fourth of which is patient focus. It says:

“Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations … whose services impact on patient well-being”.

It therefore requires,

“healthcare organisations to have systems in place to make sure that staff treat patients, their relatives and carers with dignity and respect”.

Healthcare organisations must monitor their performance with regard to treating patients and carers with dignity and respect. The evidence has always been clear that if the NHS listens to what patients are saying, it can result in new ideas, better value for money and better care. How do you measure targets in an area such as patients being treated with dignity and respect, and being listened to, when trusts will point to the often relatively low number of complaints as a measure?

There have been numerous inquiries and other pieces of legislation setting out how to empower both individuals and communities in shaping health and social care services. Since community health councils were abolished in 2003—a great mistake in my view, and I declare an interest as I previously worked as the chief officer of a community health council—we have seen numerous attempts to make the NHS more meaningful and accountable. The establishment of local government overview and scrutiny committees with new duties went a long way to bringing accountability to healthcare services and in my view, as a previous chair of an overview and scrutiny committee, shone a welcome light into areas of healthcare services that had not previously been scrutinised. It brought about the need for greater partnership and collaborative working between local government and health. However, again, it relied on local PCTs and other healthcare trusts welcoming and being open to this scrutiny and accountability.

I welcome the Government’s plans to create local government health and well-being boards, but there have been problems on the ground in the way local government and the NHS have to work to bring about greater public and patient involvement in the NHS. In my own area, the local PCT last year took the decision to close a much loved and important health centre, in the most deprived part of the borough—the Finsbury Health Centre. The health and well-being committee scrutinised this decision in some detail and at considerable length, hearing evidence from patients, the public and clinicians. Eventually, after careful consideration, it presented its findings to the PCT, which fairly quickly rejected them. It found itself at loggerheads with the whole health and well-being committee, the council and the overview and scrutiny committee. It did not allow, for example, the chair of the committee to address or present its findings to the PCT board. As a result, the relationship between elected councillors and an unelected board of rather anonymous people, led by the chief executive, who had no accountability to the public, suffered. So, too, did local community confidence in the PCT.

People increasingly want to be able to exercise choice and control over their care. To do this it is clear that people must have the right to reliable information to help them make choices. Things have improved dramatically in some areas over recent years but what has not improved is the consistency across the NHS. My family’s experience of the NHS has been patchy. Three years ago my father spent seven weeks in hospital, suffering from terminal cancer. I saw at first hand how this 87 year-old man was gradually stripped of his dignity. While some of the nursing staff were enormously professional and provided excellent healthcare, others did not. He was not treated with the respect and dignity he should have expected. He was left in pain, with bed sores, little personal care, and alone on the floor after a fall in his room. This was a proud man, who would not leave the house without a shirt and tie, reduced to tears of humiliation just days before he sadly died. After my father’s death, I decided to complain formally about the senior member of nursing staff who had been so unprofessional to my father and my family. I was perhaps not surprised to learn that there had been a number of complaints about this individual, but none had been taken very far, due to the sheer difficulty, time and bureaucracy involved. This is not an easy time for families and carers.

I welcome the fact that patients will have more choice in terms of their GP. I hope the reforms will underpin not only greater choice but more consistency across healthcare services, so that people like my father have a better experience of the NHS.

[Baroness Northover]

I remind noble Lords that this is a time-limited debate. There is another important debate following ours. We need to give noble Lords in that debate the courtesy of being able to start and finish on time. I remind people that when the clock reaches four minutes, noble Lords have spoken for four minutes. There is also somebody who wants to speak in the gap.

NHS: White Paper

Baroness Northover Excerpts

Monday 12th July 2010 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Lord for his questions. He will know that our plans do not constitute reorganisation for its own sake. The only purpose of the reorganisations that we are proposing is to embed higher-quality practice and better outcomes for patients, and for no other reason.

The noble Lord asked several questions about GP commissioning. As he will know, the previous Administration introduced practice-based commissioning more than five years ago. Some consortia are doing an excellent job, but many GPs have been frustrated by not having clear responsibility and control. They find very often that PCTs get in their way rather than help them. I think that it will be music to their ears that they will be able to create structures and management systems for themselves that will help them rather than get in their way. We are going to enable them to learn from the past. We are engaged in talks with the profession about how we implement the change, which will, I emphasise, be bottom up.

The noble Lord also referred to GP fund-holding, which as the House will know was a policy introduced by the Conservative Government. There were good points and bad points about fund-holding. The good points were that it empowered GPs and, in many cases, delivered good quality care. But the criticisms revolved around high transaction costs, bureaucracy and, in many ways, inequalities that resulted. We want to avoid those pitfalls. The support that GPs will get will not be prescribed from the centre. A range of support is already available for commissioning, including PCT teams, local authorities and independent commissioning support organisations. There will be no shortage of help out there.

[Baroness Northover]

My Lords, perhaps I may remind the House, as invited, that this is a brief Statement. We have 20 minutes all together and we are already five minutes in. Many people want to intervene on this extremely important Statement, so if people can be brief we will be able to cover as much as possible.

[Baroness Morgan of Drefelin]

My Lords, the Minister talked about an NHS that was stifled by top-down bureaucracy. Given the impressive outcomes that we have seen with improvements in cancer treatment, I do not think that many people would recognise that story. Does the Minister accept that medicine is a fast-changing field where innovation needs to be translated into practice on the front line as quickly as possible? Does he further accept that there needs to be leadership in a complex system like this if patients are to have access to the improvements in innovation and care? How does he see that leadership working?

How will patients be represented throughout the system? For example, how will they be represented at the NHS board? How will GPs ensure that they can access fairly and without bias the views of all their patients, not just those they see regularly? How will GPs translate those patient perspectives into commissioning in line with this new strategy that the local authorities will be responsible for developing? I want to hear the Minister answer that important question in some detail.

--- Later in debate ---

[Baroness Northover]

I am sure that we will return to this subject, but I am afraid that we are past time.

[Lord Campbell-Savours]

My Lords, does not what has happened today indicate what the problem is over Statements? Are the Government now going to sort it out?