Healthcare

Baroness Fookes Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Fookes]

My Lords, unlike many of the contributors to this debate, I speak only as a lay man, but a lay man who is interested in the future of the NHS. I welcome the general thrust as set out in the Government’s White Paper. All I ask is that the revolutionary changes that are being made are made with particular care and sensitivity. I have seen a number of changes from the outside over the years and I know that, whatever happens, for those directly involved it is a period of great upheaval, anxiety, uncertainty and worries about how it will all shake down. I hope that this will be done sensitively, and that after that there will be a period of real stability. Thereafter, if changes need to be made, I hope that they are made on a steady basis so that we have evolution, not revolution.

I particularly welcome the idea of the patient being at the heart of the NHS. When I was young and naive, I would have assumed that that was bound to be the case. Experience has taught me, however, that that is not always the case—one can get very lost in systems, management and all the rest of it—so I am glad to see this brought forward. I have a tiny niggle about the expression “patient-led”. It could be considered ambiguous, and I would rather have the term “patient-centred”. As long as we get the actual work done so that it is patient-centred, though, the current expression is fine.

There are difficulties for patients. I shall use one small illustration from an acquaintance of mine who has a rather rare illness that has a number of appalling side effects, so that effectively she is suffering from a number of illnesses at the same time. That necessitates not one consultant being involved in her care but several. There came a crisis point when there were directly conflicting pieces of advice from two consultants. What were the unfortunate patient and her husband to do? One could argue that it should be the GP bringing all the threads together, but I suggest that, with a rare illness involving consultants, the GP is actually in no position to make judgements or insist on what should be done. I hope that when one is looking at the running of hospitals, there will always be the idea that a very senior consultant, perhaps even nearing retirement, could bring the various consultants together and, together with the patient, make sensible decisions.

I am of course delighted to see the end of targets, which so distorted clinical management and had an appalling effect. I hope that I can have the encouragement of the Minister to say that they will go completely. However, I see a case for them if they are done at very local level by the people intimately involved—say, a GP’s practice or an individual hospital—where they can see what they need to do and can set their own local target. That is the only place where I could see some sort of role for targets, and they could be useful.

When we come to outcomes—in my terrible lay man’s language, that means that you either kill the patient, cure the patient or something in between—I hope that the Government will be careful not to fall into the trap of the targets and have outcome measurements that do not actually fit the bill. It is an extraordinarily difficult thing to do and I hope that great care will be taken. That said, though, I welcome the White Paper and the Government’s intentions.