Health and Care Bill

Debate between Baroness Finlay of Llandaff and Baroness Thornton

3rd reading
Wednesday 23rd March 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I hate myself for this, but I forgot two people. Half way through the Bill, we acquired a new advisor, Liz Cronin, who has done an excellent job, and there is Richard Bourne, who has been sat by my side, right through the Lansley Bill and this one. They have my thanks.

[Baroness Finlay of Llandaff (CB)]

From these Benches, I very briefly thank the Minister, the noble Baroness, Lady Penn, the noble Earl, Lord Howe, the whole Bill team and all the officials who have worked with them for the way that they have listened—repeatedly listened—as we made our points over and again and as they sought sometimes to try to understand what we were trying to get across and why. I also thank everyone across the House, on all the Opposition Benches, the Cross Benches and the Government Benches, who have worked with us as Cross-Benchers in a very collaborative way and made their own offices available for background support to all of us.

I echo the words of the noble Baroness, Lady Thornton: this Bill leaves us better. It has been a genuine pleasure to work on it. Some of us have worked on previous Bills, and I have to say that this was a more enjoyable and rewarding experience because the dialogue involved a better interchange at many points.

We have made some points of great significance, one of which was over palliative care, which has been dear to my heart. Palliative care has come of age. I think the House will be pleased to know that, on Friday morning, the annual meeting of the Association for Palliative Medicine has a specific session dedicated to understanding the changes and what it now needs to do in the light of those. The word goes fast from here, and that is very welcome.

I hope that I have not forgotten anybody in my thanks, which are open and sincerely expressed.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Baroness Thornton

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare an interest, because a lot of the outcome measures that are now used are in place at Cardiff University. I will expand a little on and support what my noble friend Lord Patel said about outcome measures, particularly for something such as cancer. That is in part because the disease process itself is marching on all the time. It is different from many other diseases, where there might be a chronic condition and other things happen as a result of it. If you do not intervene rapidly with some cancers, you miss the boat and go from being able to cure it to a situation where you certainly will not be able to.

The other group of outcome measures that I do not think we should forget has just now been developed: family-reported outcome measures. That is the impact on the family. We know about the number of carers that there are. There are child carers and many unpaid carers. Having somebody in the family with a disease process, waiting for something to happen and seeing that disease process getting worse and worse in front of their eyes, has a major impact on the health of others and stacks up problems for the future in the health service.

That is why, when I was on the All-Party Parliamentary Group on Cancer, I strongly supported John Baron in all his efforts to look at the one-year survival times in cancer. Looking at outcomes can be far more informative than looking simply at process targets, which is what we have been looking at too much to date rather than looking at the overall impact of disease.

[Baroness Thornton (Lab)]

My Lords, I will speak to Amendments 7 and 9 in my name. I thank the noble Lord, Lord Lansley, for introducing this debate and I look forward to supporting the noble Baroness, Lady Walmsley. I think we are about to see harmony breaking out between the four walls of the Chamber. The noble Lord, Lord Lansley, and I are I think in accord over these amendments.

Historically, the mandate is part of the attempted change—I think that is probably the right way to put it—to distance the role of government and Ministers from the sound of bedpans dropping, if I might put it like that. Unfortunately, as the noble Lord, Lord Lansley, said, despite the mandate’s intentions, recent Ministers have still tried to micromanage and otherwise interfere with NHS managers. During the passage of the 2012 Bill, the Government had to concede that the Secretary of State remained politically responsible to Parliament for the NHS.

I think it would be fair to say that laying the mandate before Parliament in each year, as was intended, has not brought about energetic debates and wise reflections in either House of Parliament. But the mandate is not without merit. It is good that the NHS knows what is expected of it and should be free from sudden announcements and other surprises. Without something of this nature, it is wholly unclear how accountability works. So we accept that, at least until the next reorganisation happens, there has to be a mandate, and the important thing is to get this right.

For that reason, we support the two amendments from the noble Lord, Lord Lansley. If anybody knows how the mandate ought to be used, it is definitely him. Trying to have clearly stated objectives in the outcomes framework, or some equivalent, and ensuring that the mandate is objective, evidence-based and publicly accountable must be correct.