NHS: Clinical Negligence

Lord Phillips of Sudbury Excerpts

Tuesday 20th January 2015 Lords Chamber

[Earl Howe]

The noble Lord makes a series of good points. He may be interested to know that part of the series of pledges that form the Sign up to Safety campaign, which hospitals can apply for, can include the principles of being transparent with people—including about any mistakes that have been made and what is being done to tackle safety issues—and collaboration, by taking a leading role in supporting local collaborative learning, so that the system genuinely can work together and learn together.

[Lord Phillips of Sudbury (LD)]

My Lords, is my noble friend satisfied—I am thinking, for example, of the scandal of whiplash claims—that the legal resources available to the NHS are sufficient for the task?

[Earl Howe]

Yes, my Lords, we are satisfied that the NHSLA does a very good job. Indeed, about half the claims it receives are rejected and it contests robustly any claims that are ill founded.

Care Bill [HL]

Lord Phillips of Sudbury Excerpts

Monday 10th June 2013 Lords Chamber

[Baroness Wheeler]

My Lords, I support Amendments 58 and 63. It is right for my noble friends Lord Warner and Lord Turnberg and the noble Lord, Lord Patel, to press the Government on this important issue. As we have heard, the Joint Committee proposed including the promotion of transparency in research and ensuring full publication of the results of research—consistent with the preservation of patient confidentiality—in the Bill and we strongly support this.

This is our first opportunity to welcome the establishment of the Health Research Authority as a statutory body and we do so wholeheartedly. We recognise the vital importance of research and innovation to the NHS, the very real progress that is being made in these areas and the scale and pace of change in medical science. The HRA’s objectives not only promote and protect the interests of patients and the public in health and social care research but ensure that it is ethical and safe research, which inspires the public confidence that my noble friend Lord Turnberg spoke about.



Alongside other bodies, the HRA has a key role in promoting transparency, and we acknowledge that its recent guidance on how it will undertake this role sets out important measures that will go some way towards underlining that it takes its duty seriously. These include: gaining approval from research ethics committees before clinical trials can go ahead; a new timescale for registrations; the commitment to work with research funders and sponsors to set the standards for the publication and dissemination of research outcomes; taking steps to facilitate further analysis of detailed data; and plans to look at how patient consent forms can be amended to provide early consent and understanding on how data will be used, as well as how the HRA will be informed of the outcome of study findings.

There is no doubt that the HRA is committed to working with others to overcome barriers to transparency and create a culture of openness. The amendment and Amendment 63, which provide for the publication of research findings “fairly and frankly” and transparency in the reporting of clinical trials, would enshrine the HRA’s commitment in statute, and ensure that clinical research benefits patients and that the findings are available for others to learn and benefit from. As we have heard from my noble friend Lord Turnberg, the advice of the Association of Medical Research Charities to its members to ensure that there is a requirement to publish in the terms and conditions of all their research awards has played an important role in providing greater transparency and would be reinforced by greater HRA authority in this matter.

Finally, like other noble Lords, I received a valuable briefing from the National Advisory Council to the Thalidomide Trust on the need for transparency and a change in the law for the disclosure of clinical and healthy volunteer trial data in relation to the drugs available on the market. The briefing states:

“Adverse effects caused by drugs that are designed to lead to a health improvement can be difficult to prove, and easy for the pharmaceutical companies to dismiss ... At the core of the problem is the fact that the safety assessments of a drug, undertaken in clinical trials done prior to the drug’s launch, remain hidden once the drug is on the market. A patient experiencing adverse effects therefore has no access to data that could be used to prove their claim … the onus is on patients to prove it was a drug that harmed them rather than the company that already holds that evidence”.

The Thalidomide Trust proposes changes to the informed consent form to allow sharing of anonymised data and making data from clinical trials available and accessible to the public once a drug has been released on the market. The trust acknowledges that this is a difficult issue. Have the Government had any discussions with the trust on this matter? I should be grateful if the noble Earl would comment on this, either today or in a written response.

[Lord Phillips of Sudbury]

My Lords, perhaps the noble Earl will tolerate a short intervention. I was for 30 years a trustee of the charity the Public Interest Research Centre. I think I am correct in saying that in the 1970s and 1980s it was the only independent charity carrying out extensive research on the matters under discussion here. I agree with every word said by the noble Lords, Lord Warner and Lord Turnberg, and the noble Baroness, Lady Wheeler. There is, to some extent, a disparity of arms between the huge pharmaceutical companies and the regulatory authorities. Frankly, I see no harm and some potential good in the amendments to try to rectify the balance of power and to avoid a repetition of the example given by the noble Lord, Lord Warner, which is extremely sobering but by no means unique. A number of instances that we confronted in the 1970s and 1980s mirrored that example, if not on quite the same scale.

[Lord Campbell-Savours]

My Lords, I want briefly to intervene with a thought to which the Minister may have a response. When you have medicines prescribed under the National Health Service—indeed, when you buy medicines—there is a leaflet inside the package setting out the need for the product and the circumstances in which it can be taken. However, there is also a section that deals with risk. I have often wondered whether that section on risk assessments, which lays down varying levels of risk, dependent on the incidence of conditions that might arise under use of the medicine, is based on the original clinical trials carried out by the manufacturer. If it is, it may well be that there is an argument for more frank information to be made available. If the element of risk is linked to the original research, it would obviously be very interesting to the wider public. I wonder whether the Minister might be able to help us there. Is there a connection?

Health and Social Care Bill

Lord Phillips of Sudbury Excerpts

Monday 19th March 2012 Lords Chamber

This is not about the merits of the Bill but about a delay of, in my estimate, three weeks. Would the Minister please—there are no business managers alongside him on the Bench at the moment—put to us his estimate, if this amendment were passed, of the last possible date when Third Reading would have to be considered in order for the Bill to have the opportunity to become law during this Session? My estimate is three weeks but no doubt the Government have a more specific one. When he has given us that estimate, will he explain what damage would be done to the parliamentary procedures of this House or, far more importantly, to the health service should the amendment be carried? That is all that we have to consider today. If he gave us an answer to that question, that would enable those of us who intend to vote for the Motion, as I certainly do, a lot more justification for doing so on the basis of how he replied.

[Lord Phillips of Sudbury]

My Lords, I would like to add to the question well raised by the previous speaker and ask the Minister to go one step further. I reread the wording of the amendment of the noble Lord, Lord Owen, and I am not entirely clear what the effect would be if, when the Tribunal’s detailed reasons were made available, the Government then decided to appeal that decision. Would that put an end to the noble Lord’s attempt to have the risk register available before we finalise the Bill or would it mean, as I think from the wording that it would, that the matter was at an end and we would proceed to Third Reading?

[Lord Armstrong of Ilminster]

My Lords, I support the noble Lord, Lord Fowler, and my noble friend Lord Wilson of Dinton in advising the House not to support the Amendment to the Motion. I do not want to go into any more detail on the risk registers. They need to be comprehensive and candid; if there is a risk of publishing them, the compilers will be less likely to make them as comprehensive and candid as they need to be in order to be of value. When the Information Commissioner suggests that, even if this is published, people will be equally comprehensive and candid in future, I am afraid that I think he is guilty of wishful thinking.

There is a process with this risk register. I understand that we have not yet seen the reasons for the decision reached by the Tribunal. When that is known, the Government have the right to appeal. I hope that they exercise it because the considerations against publication, as they have been stated more than once today, are very cogent. That process is likely to take a great deal longer than the three weeks that the Amendment of the noble Lord, Lord Owen, gives the Bill. The only sensible course now is to disentangle the business of the risk register and the business of passing the Bill, to let the Bill go forward and not to support the Amendment to the Motion.

Health and Social Care Bill

Lord Phillips of Sudbury Excerpts

Thursday 8th March 2012 Lords Chamber

Moved by

[Lord Phillips of Sudbury]

220BA: Clause 164, page 160, line 24, leave out subsection (2)

[Lord Phillips of Sudbury]

My Lords, in moving this amendment I shall speak also to Amendment 220BB. If passed, they will amend Section 44 of the National Health Service Act 2006, which deals with private healthcare. I am supported in these amendments by three highly distinguished consultants: the noble Baroness, Lady Finlay of Llandaff, and the noble Lords, Lord Kakkar and Lord Darzi of Denham. Indeed, I would not have had the confidence to persevere with the amendments if it had not been for their support, which I did not canvass. Each of them volunteered to support the amendment and I am much reassured by that because, if I can put it this way, they know what they are talking about and I do not. They live in the health world and have a great deal of engagement with the National Health Service, and for at least two of them, I think, they have a private engagement as well.

The fact is that there is an abuse which should be dealt with more effectively than it is at present: the abuse which some might call queue jumping. I am not in a position to say that it is widespread. I would like to think that it is not and that it happens only rarely. However, there is no doubt that there is queue jumping, and I know from many doctors—I have relatives who are doctors—that it is a phenomenon of the status quo. My position is that, on any reckoning, this legislation—this 450-page statute—is a major upheaval of the National Health Service. It seems bizarre that it should at no point include a clear statement of this fundamental principle of the National Health Service. I should say that the wording of Amendment 220BB is somewhat different from the wording in the amendment—Amendment 299B to Clause 162—that the four of us tabled in Committee. The amendment now talks of,

“equality of access to essential clinical care and treatment”.

As I say, that is a principle which I do not think anyone disagrees with. It is a paradox as clear as the nose on your face to have a National Health Service that actually favours private clients over national health patients. To be fair to my noble friend the Minister—who, as always, has been extremely accommodating in discussing this—he accepts absolutely that the Government wholly support the principle and wish to uphold it. The difference, I suppose, lies in how to do that.

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[Lord Phillips of Sudbury]

I did not want to leap on the noble Lord, Lord Warner, because that would do him an injury, but I wanted to assure him that the amendment does not affect his trotting off to the chap down at Waterloo station. He can buy whatever private patient care he likes, wherever and whenever he likes—

[Baroness Northover]

I remind my noble friend that he can reply on his amendment at the end. I am sorry to keep on intervening on my noble friends in defence of the noble Lord, Lord Warner, who wanted to continue his argument, as he did. My noble friend has the opportunity to respond at the end.

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[Earl Howe]

My Lords, I can give the noble Baroness that reassurance. This will apply to managers and leaders at every level in the system. It will not be confined just to a select group.

[Lord Phillips of Sudbury]

My Lords, I first thank the seven Peers who added their voices to the amendment. I thank my noble friend the Minister for an extremely thoughtful and comprehensive reply. None the less, it would be dishonest of me to say that he convinced me on all counts. It is perhaps asking too much on such a complicated business to have full satisfaction.

The one thing that I am bound to say is that the Minister’s interpretation of these various provisions in the various codes is different from mine. I am a lawyer extremely long in the tooth and I do not think that the provisions that he quoted, although they look helpful on the face of it, actually work in practice. That is evidenced by the total absence of any disciplinary measures—ever, as far as I can see—against doctors acting improperly in relation to queue-jumping. However, that is in the past.

I must quickly answer questions raised of me by the noble Baroness, Lady Murphy, and the noble Lords, Lord Warner and Lord Ribeiro. The noble Lord, Lord Ribeiro, is the easiest to answer: the amendment does not cover the existing NHS trusts, only the NHS foundation trusts. However, I think that the NHS trusts are going to be out of existence in a couple of years’ time. I saved the House by not including that; I would have had it at Third Reading if necessary. As to the noble Lord, Lord Warner, he can go to his private knacker any day, any place, any time and pay what he likes. To the noble Baroness, Lady Murphy, the answer is that, if you are having private treatment within an NHS hospital, the amendment would prevail, had it passed; namely, you could not then barge the queue because you were a private patient in respect of essential clinical care. It really is as simple as that.

I do not get the sense from the House that noble Lords want a Division on this matter. I do get the sense that they are impressed by what the Minister said, particularly in relation to the management code. That could make a very big difference. The only thing that I ask my noble friend the Minister—if he is with me—is that he just keeps an eye on the issue at the heart of this amendment and the debate, and, in the new regime that we are ushering in, on the concerns behind this amendment, shared by many in the country.

[Earl Howe]

Before my noble friend withdraws the amendment, I give him that reassurance. The NHS constitution will be monitored at every level in the system, from the Secretary of State downwards, as will the provisions within relating to access to healthcare for NHS patients. Of course, if there is any sign that that pledge in the constitution is being jeopardised in any way, appropriate action will of course be taken.

I am told that I should clarify what I said in answer to the noble Baroness, Lady Finlay, about to whom manager training will apply. It will apply to “leaders across the NHS”—it says here. It will primarily be aimed at very senior managers with a cascade of good practice down to more junior levels.

[Lord Phillips of Sudbury]

I beg leave to withdraw the amendment.

Amendment 220BA withdrawn.

Health and Social Care Bill

Lord Phillips of Sudbury Excerpts

Monday 7th November 2011 Lords Chamber

Moved by

[Lord Phillips of Sudbury]

24: Clause 3, page 2, line 33, after “need” insert—
“(a)”

[Lord Phillips of Sudbury]

My Lords, Amendments 24, 30 and 299B are tabled in my name and those of the noble Baroness, Lady Finlay of Llandaff, and the noble Lords, Lord Kakkar and Lord Darzi. I hasten to state the obvious, which is that I am a relative ignoramus as regards the refinements of the delivery of health within a hospital. The other three noble Lords who have added their names to this amendment are by contrast as distinguished a trio of consultants as one could find. I must at once, as requested by the noble Baroness, Lady Finlay, give her apologies to the Committee for her inability to be here. She is well out of London.

Amendments 24 and 30 add to Clause 3 which in turn adds to Section 1 of the National Health Service Act 2006. Clause 3 is headed: “The Secretary of State’s duty as to reducing inequalities” but refers to NHS patients in different parts of England, not to differences between NHS and private patients within a single NHS hospital.

Other parts of the Bill which talk of equality of access and outcomes are similarly limited. Nowhere in this 445-page mammoth is there any clear statement, let alone requirement, as to equality of clinical treatment and healthcare between NHS and private patients within an NHS institution. Amendments 24 and 30 clarify that. Amendment 299B also clarifies that inessential care such as what one might call the hotel services—the quality of the accommodation, drugs prohibited by NICE standards and indeed treatment and care that is not a clinical priority—can still be provided privately on the basis of privilege. Those matters are, as I say, non-essential and we have put in—the four of us whose names are to these two amendments—Amendment 299B to make very clear that we are not seeking to row back on the status quo.

It was Aneurin Bevan during Second Reading on what would become the National Health Service Act 1946 who said:

“If people wish to pay for additional amenities, or something to which they attach value, like privacy in a single ward, we ought to aim at providing such facilities for everyone who wants them”.—[Official Report, Commons, 30/4/1946; col. 57.]

For example the state will provide a certain standard of dentistry free but if a person wants to have his teeth filled with gold the state will not provide that. It is in that vein that Amendment 299B stands in our four names but, and this is a big but, where there are two patients with the same essential clinical health needs—one an NHS patient, another a private patient; one in a public ward, the other in a private ward—the one with the fat wallet can buy priority and buy his way to the top of the queue. That cannot be allowed in our National Health Service. It would be fundamentally against the spirit of the NHS and directly contrary to the ideals on which it was founded.

In a Britain that is becoming more divided in terms of living standards at a rapid rate the maintenance of the ideals of the original NHS for many of us are absolutely integral to our sense of citizenship and sense of comfort in an increasingly differentiated and diverse society. We must not on any account allow under the new regime a—no doubt inadvertent—two-class service to develop in NHS hospitals with regard to essential care. In saying that, I want to make it abundantly clear that neither amendment will touch private institutions that have no NHS connection—they are free to carry on doing what they will, how they will. That is an aspect of freedom in this country on which I would not for a minute seek to trespass.

The dangers are that the privatising and commercialising, as they are fairly called, will, as I say, bring into the NHS a much wider and deeper engagement with the private sector and that could, and I again say inadvertently, develop into a two-class NHS. Let us be clear: the NHS and the private sector march to different drums. The NHS is concerned solely and only with equal free treatment and fair access to any of us who go to its institutions. The private sector, which I do not wish to unduly disparage—which is made up of public companies and many very commercial entities—is none the less first, secondly and thirdly in the business of profit. It is no good saying that doctors and consultants working within the private sector, unless they are sole traders so to speak, will be immune from that commercialisation, the managerialism that goes with it and the pressures that are inevitably engaged when working for a commercial entity.

Amendment 30 strengthens the original ideals of the NHS. Perhaps I may say to my noble friend the Minister what I have said to him previously: I believe that it will cement public support for what is good in this Bill. There is much that is good and I am not for a minute saying that extending the contact with the private sector is wrong. In many respects, it can be good and can bring new resources into the NHS. But that is all at risk unless we put firmly and clearly in the Bill that we will not allow a two-class service of clinical treatment and healthcare within an NHS institution.

I want briefly to refer to the deluge of letters, petitions and the like which everyone in this House has received. In my 14 years here, there have been far more letters on this Bill than any two others put together. My noble friend Lord Razzall mumbles that there were more for hunting. I have to say to him that I do not think there were, but be that as it may. I just mention the Coalition of UK Medical Specialty Societies, which saw the issue that my amendment is designed to address. It wrote:

“Choice must be for patients rather than provider; the provider choosing the simple cases and leaving the unprofitable, more complex cases (elderly, chronic illness, disabled) to fight for remaining funds will disadvantage patients”.

A petition from more than 400 public health doctors and specialists from within the NHS and academe said:

“As public health doctors and specialists”,

we think that the Bill could usher,

“in a significantly heightened degree of commercialisation and marketisation that will … widen health inequalities”.

It is to prevent that widening that this amendment is put down.

Finally, the BMA, which has informally backed this amendment, in one of its key points states:

“Increasing patient choice should not be a higher priority than tackling fair access and health inequalities”.

We all say amen to that. I hope very much that the Government will accept these amendments. It may well be that on Report I will want to bring forward something to make clear that there should be some oversight of the provisions that these amendments seek to entrench, which might be through the monitors. But, for the time being, I hope that the Committee will warm to these amendments and the sentiments behind them. I beg to move.

[Lord Kakkar]

My Lords, I support this group of amendments and in so doing remind your Lordships of my interest as consultant surgeon at University College London Hospitals NHS Foundation Trust, an institution with private healthcare facilities that I would be entitled to use if I ever decided to do so. This group of amendments is very important because it deals with an area of anxiety with regard to potential consequences that will follow removal of the private patient cap. Removing that cap may well provide important opportunities for NHS foundation trusts in the future, opportunities that they may well need to exploit. But in so doing, we need to be certain that access to clinical facilities in NHS institutions for either NHS patients or those in private healthcare facilities in NHS institutions is based purely upon clinical need and that no other factor influences access to those facilities.

I believe that in the majority of circumstances that will always be the case, as it has been to date. But with the important changes in this Bill with regard to the role of potential private practice in NHS institutions, we need to be absolutely certain that any anxieties or opportunities for misunderstanding are dealt with at an early stage. So in bringing forward these amendments at this stage, one hopes that there is an opportunity for the Government to explore how they plan to deal with any potential tensions and what security the current Bill as we consider it, and any potential amendments in the future or well established working practices in the NHS to date, would protect against a situation developing where access to facilities was determined by anything other than absolute clinical priority. For this reason I strongly support the amendments being brought forward at this stage in the hope that the noble Earl might be able to provide some clarity on the approach that Her Majesty’s Government might take in regard to these matters.

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[Lord Patel]

I rise briefly to comment on this amendment. As far as declaring an interest is concerned, I have not seen private patients because my contracts were such that academics did not do private practice. I have a family member who is a consultant. My daughter is a consultant at the Marsden where I hear there is a high percentage of private patients. I have no idea whether she does private practice or not. I have not seen any benefits of it. Maybe they will come.

However, I remember when I was a student and was training in King Edward VII Hospital in Windsor, in Ascot and other places there were private wings in the same hospital. Yes, the care provided was equal for NHS and private patients. However, one difference today is that NHS patients now receive quite a significant part of their care provided by doctors in training. If we are to ask for equality in how patients are looked after, we must say not only that those patients in private wings cannot jump the queue but that there must be the same quality of care provided by all the medical staff who work in the NHS.

I have one other question, which I would like to put to the noble Lord, Lord Phillips of Sudbury. How would we manage his amendment when there are to be qualified providers, which might provide care not only for NHS patients but for private patients under their own terms and conditions? How would we manage those qualified providers to ensure that they behave in the same way in dealing with NHS patients?

[Lord Phillips of Sudbury]

On the question addressed to me, I do not know whether I can give an off-the-cuff precise answer to the noble Lord, but my apprehension is that, in NHS hospitals with private facilities or a private ward, there is an attempt to deliver comparable clinical care to private and NHS patients. As the noble Baroness has just said, there are cases where that plainly does not happen, but that is the ideal and it is achieved in many hospitals—I suspect that the Royal Marsden is one of those. All that the amendment seeks to do is to put that ideal into the Bill so that it is also law.

I do not want to waffle on now about the delivery of that ideal in practice—I say “waffle” because what I would say might not be impressive to you gentlemen who are treading the wards—but I believe that it is possible and can be done. I am encouraged by my three co-signatories to the amendments to believe that this can be done and delivered. As I said, that may require an amendment to the provisions of the Bill that deal with Monitor so as to give Monitor an explicit role in policing this requirement of equality of clinical treatment and care.

[Lord Hunt of Kings Heath]

My Lords, I hope that the noble Lord, Lord Phillips, will continue to waffle on, because it seems to me that he has put his finger on the real concerns that so many have about this Bill and why people are so opposed to it. The continuing puzzle is why we have this Bill at all when the NHS was in such good condition at the time of the last election. The noble Earl, Lord Howe, might get cross that I come back to this point, but that puzzlement is shared by almost everyone working in the National Health Service and certainly by most patients.

We do not understand what this Bill is all about, unless the noble Lord, Lord Phillips, is right that, essentially, this is about taking the NHS on a journey to become a second-rate service for the poor and needy. One can see the building blocks that are being put in place. First, the Secretary of State seeks to downplay his or her responsibility for the provision of services. Secondly, we see the NHS starved of resources.

The NHS—I should perhaps remind the House that I chair an NHS foundation trust—is supposedly receiving a real-terms increase in its resources, but I can tell the noble Earl, Lord Howe, that that real-terms increase has not reached the service. I do not know where that money is. Either the money is being kept as a bung for GPs and clinical commissioning groups or for the costs of the reorganisation and redundancies that will need to be paid, or, perhaps, it is being held in a fund that will be let out when the NHS reaches crisis point this winter. I do not know, but I can tell the noble Earl that, up and down the country, NHS trusts are facing considerable financial challenges. It can be the only explanation for why the Government are putting so much less emphasis on dealing with waiting times. We had the amendment from my noble friend Lord Warner early on. I do not think the noble Earl was able to convince the House that this Government really are concerned about the waiting times for patients. The risk is, as my noble friend Lady Armstrong said, that we will go back to the bad old days of long waiting times, when consultants faced with patients encouraged those patients to go for private treatment. There are so many examples of this perverse practice that I fear we are going back to it again.

Another factor in where we are going is the noble Earl’s refusal to refer to NHS trusts and foundation trusts. All we hear from the Government is this generic term “provider”. Of course we understand that, because it is the mantra of Ministers that there is no distinction; the qualification is qualified providers. So the NHS institutions are simply to be seen as a provider, no different from private sector providers. No wonder Ministers are prepared only to talk about commissioning as being part of the NHS. It is almost as if the provider side has been completely written out of the script when it comes to the National Health Service. It is quite clear that, notwithstanding the fact that Monitor will also have to have a role in integration, its real emphasis is on promoting competition. When one considers the issue of the private patient cap, one has to do it in the context of where one thinks the Bill is going.

I must say that I disagreed for once with the noble Lord, Lord Walton. I have very great reservations about the removal of the private patient cap. I certainly understand that there is a need to review how it is working. If there is local support through the members of foundation trusts or the governing body, maybe even through the local health and well-being board, to remove the cap to that extent, I can see that there may be a case for it. However, there needs to be some control to ensure that NHS organisations do not go mad and seek to have a huge increase in their private patient income, because that would be bound to distort their whole behaviour and how they approach NHS patients. I well remember when I first worked at the Nuffield Orthopaedic Centre in Oxford, where we had a private patient ward—it was called the Mayfair ward, for some reason. I am sure that the doctors and nurses there would say that the clinical care was just the same, but my goodness me it was very interesting to see the succession of the matron, the senior physiotherapists and the senior consultants walking down to that ward and the amount of time they spent there.

Having a large amount of private care within an NHS organisation is almost certain to distort how that organisation approaches NHS patients. That is why this group of amendments is very important. I hope that the Minister will consider coming back on Report and taking part in our further discussions about the private patient cap. The noble Earl, Lord Howe, should be in no doubt that there is widespread suspicion throughout the National Health Service at the Government’s motivations in relation to this Bill. This is one of the core issues that lead to that suspicion.

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[Earl Howe]

I have no issue with the private sector acting to provide services for NHS patients, and never have had. My point was that it is a bit rich on the part of the noble Lord to attack the private sector in the way that he did. It is also a bit rich to say that the NHS has been starved of money. If the country had been foolish enough to elect the Labour Government at the election last year, the NHS budget would have been cut. It would not have been kept abreast of inflation, as we have done. It is absolutely monstrous for the noble Lord to pretend otherwise and the caricature that he has given us of this Bill, and what it does, does him no service whatever.

I would like to move on to my noble friend's amendment. Amendments 24 and 30, introduced by my noble friend, would impose on the Secretary of State a duty to have regard to the need to prevent inequalities of treatment and healthcare developing between NHS and private patients. To start with, it is helpful to have clarity around the definitions as there is sometimes scope for misunderstanding. I believe that the amendments are referring to the potential for inequality between services that are paid for by the NHS and those that patients can pay for privately within an NHS hospital. As my noble friend knows, that is of course not the same as the issue of NHS-funded services being provided by private or voluntary organisations. A patient funded by the NHS is an NHS patient, wherever he or she is treated.

In addressing the issues raised by my noble friend, I feel that I have to begin with a basic point. I am not sure, although my noble friend may yet convince me, that it is a matter for public policy to have a target of narrowing the outcomes between NHS and private-funded healthcare. I understand that many people feel uncomfortable at the idea of private-funded healthcare, especially within an NHS hospital. It has always been a controversial subject for Parliament yet the truth, as we heard from my noble friend Lord Ribeiro, is that private healthcare has always coexisted alongside the NHS. Some people will always wish to pay to be treated in more comfort or more quickly than a publicly funded healthcare system can afford and, at the margin, there will always be some treatments that are clinically available but which are not considered cost-effective for the NHS to fund. Some people will want to pay for those and, in a free country, I do not believe that it is the role of the Government to stop that.

However, I do not believe that there is a gaping chasm between the types of clinical treatment offered by the NHS and by private healthcare. The NHS aims to offer a comprehensive health service and, by comparison with many other countries, the private-funded healthcare sector here is relatively small. This illustrates the high degree of public confidence in the NHS as an institution, in that relatively few people decide to pay for a private alternative. Furthermore, rather than making comparisons with private healthcare, we believe that the Secretary of State should be focusing on improving the quality and equity of the services available to those who use the NHS. That is why the Bill introduces for the first time a duty to have regard to the need to reduce health inequalities, and that clearly emphasises our commitment to fairness across the health service. It also recognises the reality that there are many stark variations in quality and access within the services that the NHS funds before we start looking at the comparison between NHS and private healthcare.

In addition, the Bill places a new duty on the Secretary of State to exercise functions with a view to securing continuous improvement in the quality of services. The Secretary of State will therefore be responsible for doing all that he can to ensure that the NHS provides the best quality care to all its patients, no matter what treatment they are receiving or when they are receiving it. The aim of the Government and the Bill is to create a system that delivers world-class healthcare and healthcare outcomes for all NHS patients.

I understand that there is some residual concern that private healthcare might represent a better deal for patients treated by NHS providers but we do not believe that this is the case. Ethically and professionally, clinicians are required to treat all their patients to the same standard and should not discriminate in any way. It would be wrong to suggest that the vast majority who provide an excellent standard of care would do that. We have in place a robust system of service quality regulation that the Bill strengthens and makes more accountable. Fundamentally, the GMC’s Good Medical Practice states that the overriding duties for doctors include making the care of patients a doctor’s first concern and never discriminating unfairly against patients or colleagues. This means that if a doctor were treating private patients to a better clinical service, they would be in breach of these principles and could therefore be putting their registration at risk.

Similarly, any doctor who inappropriately attempts to persuade patients to use private services for their own gain would be in serious breach of medical ethics. For example, the department guidance on NHS patients who wish to pay for additional private care says this:

“NHS doctors who carry out private care should strive to avoid any actual or perceived conflict of interest between their NHS and private work”.

Indeed, the GMC’s own guidance states:

“You must give patients the information they want or need about … any conflicts of interest that you, or your organisation, may have”.

It makes the point again, in Good Medical Practice:

“You must not put pressure on patients to accept private treatment”.

[Lord Phillips of Sudbury]

If the Minister is correct in his description of the status quo, why does he think that three distinguished consultants, who are in the thick of it, asked to add their names to my amendment?

[Earl Howe]

My Lords, I have yet to hear from at least one of those consultants. Clearly it is for them to explain why they added their names. I am trying to explain to my noble friend that I see grave problems in accepting an amendment of this kind because in practice it is a non-issue, and because the idea that this is a matter for public policy is one that we should perhaps have a further conversation about. I am not convinced that my noble friend is introducing a matter that should go into statute. It is probably best if we defer further debate on this subject. I have listened carefully to my noble friend and other noble Lords who have spoken. I am happy to have a conversation with him after the Committee stage. I understand the issue that he has raised and I hope that he will accept that, but I see considerable difficulties in trying to frame an amendment in a way that will do precisely what he wants.

[Earl Howe]

I shall be happy to look at that. Of course, Monitor has a role in making sure that a foundation trust adheres to the conditions of its authorisation, one of which is that its principal purpose will be to serve NHS patients. There could be mileage in that and I would be happy to look at it.

[Lord Phillips of Sudbury]

My Lords, I thank the Minister for his careful response to the debate. I also warmly thank all noble Peers who have taken part in it. It is worth putting on the record that not a single person spoke against the amendment; I think all but one spoke warmly for it. My noble friend said twice that I sought to introduce an inappropriate policy matter into the Bill. This is not a policy, it is a principle—a very fundamental principle. Indeed, the Minister himself, earlier in his response, talked with some pride of the fact that the Secretary of State has to reduce inequalities. That is the same principle, although the area of the Bill that deals with it is not about inequalities between NHS patients and private patients but about those between NHS patients in different parts of the country. It does not cover what is covered by the amendment.

However, I am grateful for the Minister’s offer of conversations afterwards, which I will happily take up. I will certainly want to co-ordinate not only with the three noble consultants who have added their names to the amendment but with others in the House who I know feel strongly about this. I feel sure that the wish and will is that this matter should be brought back at the next stage of the Bill, perhaps with better wording—several Peers referred to that. With that, I beg leave to withdraw the amendment.

Amendment 24 withdrawn.

Health and Social Care Bill

Lord Phillips of Sudbury Excerpts

Tuesday 25th October 2011 Lords Chamber

[The Earl of Listowel]

Is the noble Lord aware of the report commissioned by the Government and published last year, led by Sir Philip Green, which looked at improving government efficiency? He argued very strongly for improved procurement practices and, in particular, for using the collective strength of all government departments together to improve procurement, perhaps appointing two or three very senior civil servants to procure this. Does the noble Lord recall that, and does that not support what he has been saying?

[Lord Phillips of Sudbury]

My Lords, I shall not detain you long. I cannot resist—given that the noble Lord, Lord Owen, was in reminiscing mood—recollecting that my Welsh father was personally appointed by Aneurin Bevan to be responsible for the inauguration of the health service in what was then the county of West Suffolk. My infancy was taken up with traipsing around hospitals and surgeries in his wake. I am as totally committed to the National Health Service as any man or woman on earth. Indeed, one of my daughters was admitted last night as an emergency patient to an NHS hospital.

Perhaps I may echo the words of the noble and learned Lord, Lord Mackay of Clashfern, because I think that he spoke from great experience and with great wisdom. I am sorry that that flies in the face of what the noble Baroness, Lady Thornton, said, in what was one of the most radical charm offensives towards these Benches in the history of charm offensives. However, as others have said, the notion of incorporating resolutions of party political conferences into legislation is a short road to legislative anarchy. I want to make two points in relation to that.

First, I absolutely concede that an upfront statement of principles makes legislation more comprehensible and more friendly to the layperson. I do not deny that for a second, and that very much draws me to such a statement. But then one comes to the hard, unaccommodating realities of construing statutes. We already have here a Bill of 445 pages, with at least that number of pages to come in secondary legislation, with—as I counted the other night—DHS documentation in support of the Bill in excess of 1,000 pages. I put it to the noble Baroness that principles, however well drafted, may give even more room for manoeuvre and obfuscation to my profession. There is room enough already in this Bill.

If noble Lords do not know what I am talking about, I offer an example. There is no reference in the amendment as drafted to an absolutely fundamental principle of this Bill, which is the subject of an amendment in the name of the noble Baroness, Lady Finlay, the noble Lord, Lord Kakkar, and myself—namely equality of clinical treatment and care for NHS patients with private patients. That is but one example of an omission in the present statement of principles. I am sure that many Lords in other parts of the House could say, “What about this?” or “What about that?”. We could argue until the cows come home. All the while, as the noble and learned Lord, Lord Mackay of Clashfern, reminded us, we have that historic, catholic and satisfactory statement in the 1946 Act of what it is all about. Therefore, I add my voice, with a degree of reluctance, to the voices of those who feel that the amendment, although good in intention, might not achieve its purpose but sow inadvertent mischief.

[Lord Newton of Braintree]

My Lords, I begin a very brief set of remarks by apologising to the House, and especially to my noble friend Lady Williams and to the noble Lord, Lord Hennessy, for not having been here at the beginning of the debate. The reason is perhaps apposite and might help to calm down the noble Lord, Lord Peston; I was at an NHS clinic in Braintree at lunchtime.

On the basis of this debate and looking at the amendment, I am with my noble friend Lord Mawhinney and a number of other noble Lords who have no objection to a preamble or general statement of principle. I will come back to that in a minute. However, if we need one, this amendment is not it, as the noble Lord, Lord Bichard, said. There is a case for the Government looking at a possible preamble or broad statement of principle, partly because, in my judgment at least, the views that the noble Lords, Lord Peston and Lord Owen, expressed—which would lead me, if I believed that they were true, to refuse to support the Bill—have raised fears and concerns among a significant number of members of the public. If we can reassure them by a preamble or statement of principle at a proper time, we should do it.

My noble and learned friend Lord Mackay of Clashfern did us a service by going back to the founding statement in the 1946 Act. I say to the Labour Front Bench that it may need a bit of tweaking—I have not studied it in the way that my noble and learned friend has—but going back to the statement of principles on which the NHS was founded would give people that reassurance. For me as a Conservative, and no doubt for the Liberal Democrats as well, it would do a real service by assuring people that we are not about destroying the NHS but about making it better and more fully equipped to fulfil its initial objectives. I hope that my noble friend will look at what my noble and learned friend suggested.

Health: Charities

Lord Phillips of Sudbury Excerpts

Wednesday 12th October 2011 Lords Chamber

[Lord Phillips of Sudbury]

My noble friend the Minister will be well aware that there is a chapter in the health Bill on public involvement. Will he accept that there is a general perception that at present there is extraordinarily little attempt made by the health bureaucracies to engage particularly small local charities, which often have more to give in terms of public involvement than the very large ones?

[Earl Howe]

It varies. I am well aware of some PCTs that are engaging very creditably with voluntary organisations, but I am sure my noble friend can give examples of where that is not happening. I can only say to him that the policy of any qualified provider should mean that local voluntary organisations that can provide services to the quality and terms that the NHS requires should be in with an equal chance of providing services. We will ensure that proper guidance is issued to make sure that happens.