National Health Service

Lord Hunt of Kings Heath Excerpts

Tuesday 17th June 2014 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to wind up on this side and to respond to the noble Lord, Lord Crisp. I am sure that we are all very grateful to him for the work that he has done and the initiative that he has taken today. I very much echo his point that there seems to be a global movement in health where there has been a move from what he described as professional development to patient and citizen development. That is to be warmly welcomed. He also referred—and the noble Baroness, Lady Murphy, backed him up—to the power of technology. None of us has really woken up to the impact that technology will have in the future and its ability to give individuals much more control over their own destinies. We are just on the edge of a revolution that will force the pace of change, even in the most conservative reaches of the health service.

Early this morning, I was at a meeting of regulators to discuss whither the Law Commission Bill. It was interesting that the chief executive of the GDC referred to one of its new roles as being to pick up complaints from patients on Twitter when they had just been to a dental surgery. That was an interesting illustration of how we need to change to adapt to new circumstances.

The noble Lord, Lord Crisp, also made the point that our main clientele for the future will be people with complex conditions, yet we still seem to find it very difficult to organise services around those patients. A recent paper by the NHS Confederation looking at the challenges for 2015 says that,

“the health service largely operates as it did decades ago, when the predominant need/expectation was treating episodic disease and injury rather than providing long-term, often complex, care”.

I have been very interested in the work of the Royal College of Physicians in looking at the new hospitals of the future. Essentially it is saying that we need to build those hospitals around people who have complex conditions and that, instead of the ever increasing drive towards specialisation, we need general physicians to look at the patient in the round. The question I put to the noble Earl, Lord Howe, is: to what extent can the Government encourage the health service rather to re-engineer some of its services so that it is built round the patient, particularly the patient with complex health needs?

My noble friend Lady Pitkeathley referred eloquently to carers and the noble Baroness, Lady Brinton, made very good points about expert patients. My noble friend used the term “patient leaders”; I would love to see more on that idea and I hope that the Government can give some support to it. The noble Baroness, Lady Masham, referred to the very unfortunate events concerning one of my noble friends. The problem with that is that the noble Baroness herself has experienced similar issues, so these are lessons that we have to take to heart.

On the structural issue raised by the noble Baroness, Lady Murphy, I understand the point that she is making about consumers having a stake. She referred to charges and then made the point that not many pay them. This is always going to be one of the issues about charges: their administrative complexity and the fact that the people she is trying to get at are those who will probably not pay because, one way or another, they will be given a dispensation. In any case, I gently remind noble Lords that, whatever the faults of the NHS, in its latest 2014 comparator of all the wealthy healthcare systems in the world the Commonwealth Fund has today moved the NHS up to number one from number two. There are obviously lots of issues relating to the ways in which it makes those comparators but this shows that we have something going for the service. If we could only add more patient involvement, it could be a very fine service indeed.

I ask the noble Earl three things. The noble Lord, Lord Crisp, mentioned the citizen but other noble Lords did not really follow him. However, I wonder whether the noble Earl could, in three ways, encourage more involvement of the citizen in health decisions in the future. First, in relation to Healthwatch, can he say how far it could be encouraged to move beyond the individual patient issue to acting as, perhaps, a representative of the public when it comes to problems with health systems in its patch? This is a real issue in the current, fragmented health service: it is very difficult to find out who is in charge and Healthwatch can play a role.

Secondly, perhaps I may raise the issue of foundation trust members. I think that well over a million people could, one way or another, count as members of foundation trusts. We have not yet made enough of their own role in holding the people who run foundation trusts to account. For instance, my own former trust had more than 100,000 members and I always thought that was a powerful way of letting patients get through to the heart of decision-making in a trust.

Finally, I come to clinical commissioning groups. I admit that I am waiting for the first letter to be received from my own CCG saying that it is in business and feels somewhat accountable to the public. CCGs may have set up token patient groups but I do not get a sense that they feel accountable to the public. I want to hear more about how we can encourage CCGs to do that.