NHS: Reform

Lord MacKenzie of Culkein Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

I was interested by my noble friend’s comments about waiting until the following Monday when she has been in hospital. That is a good illustration of why we want to bring in seven-day services. My noble friend might be interested to read the report in Future Hospital, written by the Royal College of Physicians, that came out a year ago. I think that we will see over the next few years a significant change in the way that our hospital consultants are trained and deployed, and more generally what is called in America hospitalists, who can have a broader range of disciplines.

When it comes in, the new contract will enable us to differentiate payment for those consultants who are working more anti-social hours, such as A&E consultants who will have to work much more regularly out of hours than others. It will enable us to identify those consultants who may be on call but are more likely to be summoned in, like those that my noble friend just mentioned, at short notice. Depending on the surgical specialty, the on-call requirements can be much more demanding than others. For example, this is more the case if you are a vascular surgeon than if you are a dermatologist, who do most of their work in normal time. I take on board what my noble friend says.

[Lord MacKenzie of Culkein (Lab)]

My Lords, no one will disagree with the concept of a seven-day-week health service. I was at the wrong end of a catastrophic surgical error that meant instead of one night in hospital I was there for six months. I dreaded weekends, and I dreaded them even more if there was a bank holiday attached, as has already been mentioned.

If we want to deal with party politics, can I explode the myth that has been peddled that the Labour Government were responsible for the five-day-week approach, because of the consultant contract? For many years I was a theatre nurse. I never scrubbed on a Saturday or a Sunday in the 1960s or 1970s. Hospitals ran on a five-day-week then, so it is quite wrong to suggest that this is all the fault of the consultant contract a few years ago.

I agree with my noble friend Lord Hunt of Kings Heath. If we want to have endoscopy suites open, radiography, radiologists, and nurses manning theatres and recovery rooms on Saturdays and Sundays, we must have more of these professions. If we do not, we shall diminish them on Mondays, Tuesdays and Wednesdays, and we will not be much further forward. Will the Government commit to increasing training places for all of these professions, together with consultants such as radiologists, as I suspect that we have many fewer of those than in most other developed countries?

[Lord Prior of Brampton]

Interestingly, the number of consultants has increased very significantly over the past 15 years across not all but most specialities. The noble Lord refers to dreadful weekends, and how he dreaded them, particularly bank holidays. That is really why we are here today, so that in future patients like him do not dread them.

If I indicated earlier on that I blame the 2003 contract for the difference between five days’ and seven days’ working, and if that was the implication of what I said, I withdraw it. What I meant to say was that I felt that that contract to some extent de-professionalised the profession.