Queen's Speech

Lord Patel Excerpts

Thursday 3rd June 2010 Lords Chamber

[Lord Patel]

My Lords, I congratulate the noble Earl, Lord Howe, on his well deserved ministerial appointment. When it comes to health policy, he is undoubtedly the most experienced member of the health team, having done the job in opposition for over 10 years and seen off several Ministers in that time.

On several occasions I have heard the Secretary of State, Mr Andrew Lansley, speak of his vision for better healthcare, and I have had an opportunity to discuss with him how the quality and safety of healthcare can be improved. I believe him to be concerned about the poor quality of care and to have a genuine commitment to making it better.

The gracious Speech outlined several areas where government legislation is to come. The Coalition: Our Programme for Government outlined several areas of possible health policy changes, many of which I find myself in support of, including the creation of an independent NHS board, a department of public health and a greater voice for clinicians and patients. While we have to wait for the legislative details, I hope, as a Cross-Bencher, to continue to help to improve the legislation in these areas.

While I believe reducing administrative costs in the NHS by a third to be right and possible, I am disappointed not to see mention of specific cost savings in the coalition manifesto. I hope the Government will look again at the role of strategic health authorities, their current size and budgets, and their function, particularly following the creation of the NHS board, and at the National Quality Board, the Care Quality Commission, the role of Monitor, PCTs and other organisations. There is also a need to look at the number of PCTs, which is currently in the region of 152. The number could easily be reduced to 30 or 40 and, given enhanced powers, they would bring efficiency and cost reduction.

The coalition Government’s health programme outlines quality and safety of healthcare to be important in delivering better outcomes. The key driver to achieve this will be the quality of commissioning, so the first and foremost task will be to develop good commissioning for quality and safety. Currently both are woefully done. Commissioners should be expected to promote quality and safety improvement. They should ensure that provider quality accounts—published by healthcare providers—properly reflect the concerns of patients and the public, and are properly scrutinised. Commissioners should provide assurance that the services commissioned are of appropriate quality to detect early warnings of potential decline, and intervene where standards are not met. Commissioners should be responsible for improving the scope and effectiveness of quality and safety. They should also promote innovations, with financial incentives and penalties for patient-safety incidents defined as “never events”, similar to those operated by Medicare and Medicaid in the United States. Poor quality and unsafe patient care is expensive. The key to delivering high-quality, safe care is good documentation, as I witnessed recently in several hospitals in the United States.

The Government also intend to bring in GP-led commissioning and to improve the quality of general practice. I hope that, in doing so, account will be taken of lessons learnt from previous experience of GP-led commissioning to ensure that the prime purpose of commissioning will be to deliver benefits to the patients and efficiency savings; and to ensure accountability of public expenditure. Can commissioning GPs be accountable officers, as CEOs are in NHS trusts and PCTs? Does the Minister agree that greater clarity is required in the respective roles of regulators, commissioners and the National Quality Board in promoting and ensuring quality and safety?

The Government’s commitment to tackling health inequalities is very welcome. However, the key determinants of poor health are economic and social. To succeed will require effective working across several government departments—a key test for the coalition Government. There is in the Government’s programme for health a distinct lack of any mention of public health and preventive health measures, apart from the creation of a department of public health. Could the Minister comment on which policies the Government will bring in to reduce harm related to alcohol, tobacco and nutrition? Increasing obesity, related to the high sugar and fat content of foods, now affects nearly 30 per cent of children. The high salt content of ready-made foods accounts for significant health problems in the older population. What is the Government’s strategy in these areas?

I finish on a positive note. I find nothing wrong in the ambitions of the Government’s health programme. I hope we will now have appropriate legislation and policies to deliver it. Cutting bureaucracy and useless administration, and delivering safe patient care in a safe environment, with more of the care delivered by competent professionals, will—to borrow a phrase that the Minister may well recognise—deliver,

“some of the best health in Europe”.

I hope the Government commit themselves to that.