Health and Social Care Bill

Baroness Gibson of Market Rasen Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Gibson of Market Rasen]

My Lords, in the 11 years since I joined your Lordships' House, I have never received as much correspondence on one piece of legislation as this Bill has generated. I have had hundreds of letters, e-mails and telephone calls about the Bill from individuals and organisations. Some have asked, indeed begged, me to oppose the Bill as a whole, others have picked out large chunks or particular clauses of the Bill, and only one e-mail has asked me to support the Bill in its entirety. If I had ever had any doubts about the love of the British people for the NHS before, I would have none now. The NHS is not only dear to our hearts but a fundamental part of our nation. I do not have the expertise about the NHS which many others in the debate have, but I respect and admire it and those who work in it. I have only a few matters to comment upon, about which I have some knowledge.

I will begin by declaring my interest as the honorary president of the Dispensing Doctors’ Association. Its members live and work in rural areas of our country and are a vital part of the NHS. For a great part of my life, I have had the services of dispensing doctors. I still have very fond memories of my first doctor, Dr Shegog, in his surgery in Market Rasen with its spluttering gas fire in the waiting room, handing out what, in those days, always seemed to be foul-tasting medicines, which seemed to do the trick. We are talking about a comprehensive health service, and it must include the health service in rural areas. The legislation before us has to be rural-proofed, and we must consider how it will affect rural doctors and their patients.

The Dispensing Doctors’ Association values the principles of clinical leadership and choice, on which the reforms are based. The DDA absolutely agrees with the principle of “No decision about me without me” and the need for true patient choice. Rural patients depend on the services provided by dispensing doctors, and the DDA believes that several of the Bill’s principles tie in directly with the needs of these patients. It considers it essential that the final legislation supports and promotes joined-up services and therefore better patient outcomes for rural patients. However, the DDA was not consulted directly during discussions on the Bill, and therefore much of it appears to be pharmacy-based rather than dispensing doctor-based.

In the rural health system, the DDA knows that dispensing patients want a choice in where they collect their medicines. For many, travelling to a pharmacy is not always the most convenient option and requires a separate trip in addition to the original GP appointment. Patients in rural areas overwhelmingly support collecting medicines from their dispensing doctor. In 2008, more than 60,000 patients wrote to the Department of Health in support of dispensing practices. Regulations need to be addressed to ensure that all rural patients have access to choice. If “No decision about me without me” is to become a reality, all rural patients should be able to choose where and from whom they obtain their medicines—a dispensing doctor or a pharmacy.

There is a clear need for integrated service provisions for rural patients and for clear guidance from the Government on how these can be promoted. A joined-up approach for dispensing doctors and pharmacies is crucial to ensure that patients receive care in the most convenient location for them, and this should be assessed locally as part of the local authority remit. Failure to address this will lead to an increase in health inequalities. I hope that the Minister can reassure me on these points in relation to rural health service practices.

Turning to industrial relations—a key element in the success or otherwise of the proposals in the Bill—UNISON, a major union in the NHS that represent thousands of its vital workers, believes that the Bill is,

“a major threat to the future of our National Health Service”,

because of the dangers it introduces of fragmentation, instability and inequity. These fears stem from UNISON’s membership, and those members should and must be listened to and considered as we debate the Bill. If those who work in the NHS do not believe in its aims and aspirations, it will not work.

What are their major fears about the Bill? Under the planned reorganisation, NHS staff face nearly 13,000 redundancies, according to the Government’s own statistics, and of course the numbers will treble when the workers’ families are taken into account. The Government do not acknowledge the need for the retention of national workforce structures for terms and conditions, pay and bargaining. This is foolhardy in the extreme. Workforce turmoil helps no one, while a contented workforce brings benefits to all. “Dedicated” is a word that is often used in relation to the NHS and its workers, and indeed they are dedicated. However, we cannot expect this dedication to continue if they feel undervalued and undermined.

A further and real fear surrounds the removal of the cap on private patient involvement. When the cap was established, its aim was to stop hospitals pushing NHS patients to the back of the queues, which are already lengthening. If we are not careful, “Can pay, will pay” may well become a future catchphrase about the NHS, to the detriment of NHS patients—a danger that is acknowledged in the recently revised impact assessment.

There are fears, too, about the NHS being based on competition, not co-operation, because of the market system established in Part 3 of the Bill. I know that other noble Lords have spoken about this area. Surely the Government should be promoting co-operation and collaboration rather than competition. Is there to be a rationing of care because of this competition, and what does the term “any qualified provider” really mean? Additionally, the larger role envisaged for the private sector brings a chill to many a heart. Have we learnt nothing from the awful events at Winterbourne View and Southern Cross?

Of all the other briefings that I have received, I believe that the one from the Coalition of UK Medical Specialty Societies is of prime importance. The coalition is a group of professional bodies representing clinicians and other health professionals working within the NHS who would like to see,

“healthcare reforms that ensure the best care for their patients”.

Key points made in this briefing are that: for the overwhelming majority of the coalition’s patients, having access to high-quality and suitable care is paramount; patients’ choice must be real and informed—patients should know the details of the experience and qualifications of those who treat them; choice must be for the patients rather than the provider; competition could result in the fragmentation of patient care, and many different providers could make it harder to deliver integrated care and prevent health professionals working together in multi-disciplinary teams; and continuity of care must remain a high priority among all providers.

I end by agreeing with the Minister, the noble Earl, Lord Howe, on one thing: the NHS must remain patient centred above all else.