Healthcare

Baroness Gould of Potternewton Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Gould of Potternewton]

My Lords, I will concentrate my remarks on public health, particularly sexual health, on which I have spoken so often in this Chamber. It is clear that the White Paper does not understand current provision for sexual health, to which I shall return in a moment. First, I should declare an interest as chair—I still am for another few weeks—of the Independent Advisory Group on Sexual Health and HIV. I am encouraged that sexual health is still on the agenda, with a new committee being established. I hope that the committee will have the capacity to ensure that sexual health and HIV does not go back to the days of being the Cinderella service that it was under the last Conservative Government.

The introduction of a public health service, incorporating all aspects of sexual health, could provide the opportunity to commission improved and holistic sexual health and HIV services, and to join those up with other allied public health services. But, as my noble friend said, local government will be taking on this responsibility with no experience in the field whatever. There has to be clarity as to who will be responsible for commissioning sexual health and HIV services.

I am not in any way opposing the concept of patient choice and I am pleased that it will cover aspects of long-term care. But there is a uniqueness about sexual health, for health promotion and healthcare have been and should continue to be clearly linked. To maintain that link, overlapping frameworks for health, public health and social care are essential, which has been achieved in the sexual health field by community clinics. Where do community clinics for STIs and contraception fit into the new structure, because there is no mention of them? Has an impact assessment been undertaken to identify their value? They have provided a model of patient choice from a range of providers. That model is now threatened by the shift to GP commissioning. Considering that few GPs want to take on this work, I have to ask whether the community clinics will continue and whether the GP consortium will commission them to do the work.

A matter of great concern is education and training, which will now be the responsibility of providers. An enormous knowledge gap has to be filled by GPs, nurses, and local authority staff. Who will determine the level of training required? Who will pay for it? Who will determine the level of standardisation and accreditation that is required? A lack of experience among GPs and local government means that it is unlikely that they will be able to commission effectively.

Many patients want support and advice to make sense of their options. It is therefore essential that all patients have confidence and trust in the choices being offered, which means a workforce that is properly trained and skilled. With the abolition of the PCTs and SHAs, this will be further exacerbated because many staff are already leaving the service. That loss of trained personnel will seriously affect the whole question of how much training will be needed. Patient choice and quality of service are already being diminished by closures of services in public health and in some hospitals. For instance, one consultation document produced by the Government talks about choice for those who are dying. At the same time, I am aware of at least one special NHS unit to ease dying for the patient and their families that has been closed down. Those people are not being given a choice and their objections are not being listened to. There are cuts in the provision of chlamydia screening, with clinics closing and reductions in contraceptive services. These front-line services are easy options for cuts which will deny the patient not only choice but access to services.

Many issues arising from the White Paper still have to be resolved, but how do we convert rhetoric into reality? At the moment we have fine words but we need much more than that: we need absolute detail.