Health and Care Bill

Debate between Baroness Young of Old Scone and Lord Warner

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Warner (CB)]

My Lords, I support the amendment in the name of the noble Lord, Lord Forsyth. This is an unusual position for me; I do not remember in 22 years ever having supported an amendment tabled by the noble Lord. I am beginning my third decade in this House supporting change in the law. Who knows? I may have reached my fourth decade before we have got there.

During this time, I have watched many parts of the English-speaking world use their Parliaments to debate these issues and change their laws. This has now happened in Canada, New Zealand, five Australian states and 10 states in America and the District of Columbia. These changes have not been rushed through; they have been measured, considered and debated, and the populations have been consulted in the way described by the noble Lord, Lord Forsyth. It cannot be said to be right, if we live in a democracy, if the only way forward on an issue that is of great personal concern to many people is having to rely on Private Members’ Bills, which can be treated to wrecking amendments which make it almost impossible to progress a discussion and debate this issue. In the statesman-like way that the noble Lord, Lord Forsyth, has set this out, we should be impressed by the need to facilitate this debate within Parliament, as other countries have managed to do both in the English-speaking world and across Europe. Even countries such as Spain, with strong religious traditions, have allowed this debate to take place and changed their law as a consequence.

At the end of the day, this issue comes down to being a matter of personal choice. It is right that Parliament should be able to debate that issue of personal choice and facilitate the exercising of it by many people who are terminally ill if they wish to do so. They are not forcing anybody else down that path—it is a personal choice; it is a personal decision. Changing the law does not mandate anybody to do this; it is left to the individual, within the safeguards provided for in the legislation, to exercise that personal choice.

I have also added my name to Amendment 203 in the name of the noble Baroness, Lady Meacher. She makes it clear in that amendment that end-of-life issues are a matter of personal choice. We make many speeches in this House about patient choice, so why is it wrong to have more patient choice at the end of life when we have a lot of patient choice during it? We need to focus much more on patient choice. I support Amendment 203 as well as Amendment 297.

[Baroness Young of Old Scone (Lab)]

My Lords, I think I am about to score a historic double whammy. I thought that I had stayed tonight to let some momentous words cross my lips that I never thought would do so—that is, I agree with everything that the noble Lord, Lord Forsyth has said—but, and I never thought I would say this, I also agree with every word that the noble Lord, Lord Warner, has said. How is that for a double whammy?

I do not want to delay the Committee, because it is late, but let me touch briefly on Amendment 203 in the name of the noble Baroness, Lady Meacher. I sat on the Commission on Assisted Dying, and we heard endlessly and quite heartrendingly from medical professionals, patients and relatives of those who had already passed away about the inadequacies of the discussion about choices at the end of life. At the moment, the legislation makes it almost impossible for healthcare professionals to open up that sort of conversation—we are not talking necessarily about assisted dying; we are talking about any sort of choices at the end of life. The amendment in the name of the noble Baroness is therefore much needed.

However, for heaven’s sake, on Amendment 297, the whole process of Private Members’ Bills is doomed to failure for something as important as this, which has been tackled by legislatures across the world. Yet we are frozen in this grand old Duke of York scenario, where we march up to the top of the hill at Second Reading on a Private Member’s Bill, then absolutely sod all happens after that and we all march back down again. We cannot continue to do that on a five-yearly basis for ever. This is not asking the Government to nail their colours to any particular side of the debate but simply to open up parliamentary time. I very much commend the noble Lord, Lord Forsyth—good grief— on his foresight in seeing this opportunity.

Health and Care Bill

Debate between Baroness Young of Old Scone and Lord Warner

Lords Hansard - Part 2 & Committee stage
Tuesday 11th January 2022 Lords Chamber

[Baroness Young of Old Scone (Lab)]

My Lords, I support Amendment 60 in the name of my noble friend Lady Thornton on the need for ICBs to share innovations and good practice widely, in the spirit of collaboration. The NHS has for many years been rather poor at sharing and adopting innovations compared with, for example, local government, where several effective networks exist for the sharing of good practice and there is a real culture of such sharing.

The Science and Technology Committee, under the chairmanship of the noble Lord, Lord Patel, reporting on its inquiry into the life sciences, found that the NHS ought to be a unique opportunity for the spread of innovation across the system—that is what the “N” in NHS is all about—but that it was a long way from realising that aspiration. The evidence from NHS England’s director of innovation was lacklustre in the extreme, and progress from NHS Improvement was slow. The Select Committee report said that the current structure of the NHS “stifles innovation”.

When I was chief executive of Diabetes UK, I discovered how even getting innovations and improvements that would save the NHS substantial money was like pulling teeth. In frustration, I wrote to the then Chancellor—slightly tongue in cheek—to tell him how to save a billion quid by implementing the best practice patient pathways for diabetes patients. I am still waiting for a response.

In an effort to see how other countries’ health systems handled improvement and innovation in diabetes care, I went to Canada and the USA, and came to the conclusion that collaborative health systems such as Canada’s were better at sharing and then adopting improvement and innovation than competitive ones like the United States. My noble friend Lady Thornton’s amendment is highly necessary and sets the tone for a collaborative rather than a competitive approach, which should be at the heart of the NHS for the future.

[Lord Warner (CB)]

My Lords, I will say a few words about specialised services on the basis of a committee that I chaired about five or six years ago at those services’ request. It followed the demise of strategic health authorities under the 2012 Act. The one thing that this committee demonstrated very clearly was that population was significant and that, if you ignored population, you were not likely to get good outcomes. There was no magic figure on population but it was of a size common in the territories of most of the SHAs. That is not to say that the SHAs did a crackingly good job, but they were the organisations with the size of population necessary for good commissioning of many of these specialised services.

The trouble was—and it is the same trouble mentioned by the noble Lords, Lord Lansley and Lord Sharkey—that if you have a regional system, by definition you give it some degree of control over its priorities. It follows almost as night follows day that different regions will take different views about the significance of specialised services in their particular region. We have struggled with this issue for many decades and not found it easy to come up with a solution.

You can go the whole hog and put it on NHS England, but that poses the problems that the noble Lord, Lord Sharkey, honestly owned up to: many of the people with these conditions are getting a range of services outside that specialised commissioning service. I came to the conclusion that you have to have something that is of the size of, or of a similar size to, the former SHAs, but you do need a role at the centre trying to ensure a level of consistency of approach in those larger areas. I think we are still fumbling our way towards the right mix of that and I cannot see that we will be able to put in this legislation a definitive answer to that particular set of conundrums.

While I am on my feet, I shall speak to Amendment 215, to which I have added my name. To some extent, I reinforce the seriousness of the situation that Ministers and the public face with the enormous backlog of patients awaiting treatment that the noble Baroness, Lady Wheeler, drew attention to. I refer the Committee’s attention to the excellent report by the National Audit Office published about six weeks ago. This report made it absolutely clear that in September 2021 there were nearly 6 million people on the waiting list for elective care and that one-third of these people had been waiting longer than the waiting standard of 18 weeks. Some 300,000 rather unlucky people had been waiting in pain and discomfort for more than a year. The NAO made it clear that even before Covid-19, many parts of the NHS were not meeting the waiting time standard and that about one in five cancer patients was not meeting the waiting standard for urgent referrals by GPs—that is a pre-Covid situation that has simply got worse as time has progressed.

I recognise that the Government have promised to provide an additional £8 billion between 2022-23 and 2024-25, some of which they expect the NHS to use to increase elective capacity by 2024-25 by 10% more than its pre-pandemic plans. I have to say, as a former Minister responsible for reducing waiting times and implementing the original 18-week maximum wait, that Ministers need to realise that announcing the extra money is the easy bit; putting in place a system for ensuring that the NHS leviathan actually uses the money for its intended purpose and can demonstrate delivery of the promised outcome is an entirely different matter. It took the Blair-Brown Governments from late 2004 to early 2008 to deliver the 18-week maximum wait and the cancer targets, using a lot of different tools in the ministerial toolbox.

There is not one simple solution to delivering these changes. The regimes that were implemented by those two Governments used a lot of extra money; a relentless, transparent measurement; and a great deal of clinical and political management pressure. They used expanded patient choice, so that patients could drive change, and I have to say to the noble Lord, Lord Davies of Brixton, that they also used the private healthcare system to increase diagnostic and surgical capacity by about 10% to 12%, but they did so at NHS prices. So, there is not a single solution; there are a lot of solutions that have to be applied and measured.

A critical factor in this is keeping everybody honest through transparent information about how progress is being made. If that is lacking, you are probably doomed to fail. The strength of Amendment 215 is that it puts in place a system for regular reporting of progress being made—or not being made, in some cases. It is important, as my own experience has shown, to know which parts of the country are doing well and which are not doing so well, so you can actually ensure that some action is taken on the slowest ships, as they say, in the convoy.

It should come as no surprise from what I have said that I strongly support Amendments 6 and 19 and do not support Amendment 21. I recognise, as we were discussing earlier this afternoon—time flies; I mean this evening—the whole issue of health outcomes and outcomes frameworks. Those are very important. However, at the end of the day, you cannot secure good outcomes without speedy access to clinical services. You do not get them. Waiting times of the length we currently have can lead only to poor outcomes. We must put in place systems that measure the progress being made in driving these waiting lists down. Given the seriousness of the situation, we need something about this in primary legislation to ensure that people across the country and the NHS are moving in the same direction in driving waiting times down.

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

Debate between Baroness Young of Old Scone and Lord Warner

Wednesday 24th April 2013 Lords Chamber

[Lord Warner]

It is not a separate issue because there is considerable overlap between those who are providing adult social care from outside the public sector and those who operate in the NHS market. They are very often the same providers. It is that market in social care that in this country has built and run a whole nursing home sector because the NHS turned its back on nursing home provision more than 30 years ago. It turned its back on providing a pattern of services that might have been relevant to today’s needs. Alongside the NHS we have a market-driven service—and very soon we shall probably be discussing something called the care and support Bill, which I and a number of noble Lords have been considering on the Joint Committee. The bad news for some is that within that legislation are some provisions for market-making, and that is the term that was being used in adult social care. Even as we speak, the Local Government Association and the Department of Health are enhancing the skills of local government in market-making in this area. However, the NHS does not seem to want to play in that game. It does not seem to want to pursue—

[Baroness Young of Old Scone]

I am afraid I cannot resist interrupting. Does the noble Lord’s pride in the social care market extend to the number of fairly large companies that have either almost gone bust or indeed have gone bust in the social care market in the past 12 months, or indeed to the failure of a considerable proportion of the social care market to deliver standards that are acceptable to the Care Quality Commission? I wonder if the social care competitive market is actually delivering what he wants it to deliver.

[Lord Warner]

I do not think anybody in the private nursing home and residential care market has achieved the dizzy heights of Mid Staffordshire trust in the way they looked after patients.