Healthcare

Baroness Northover Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Winston]

My Lords, I congratulate the Government on a wonderful, beautifully written document—the White Paper, Liberating the NHS. Finally, the NHS is to be freed. The document’s honeyed tones and warm aspirations are sweetness and light. Its expressions of good intentions will easily deceive less well informed readers. However, to leave aside the aspirations, to which I shall return, the one thing that the NHS does not need is another reform. That is why in opposition Mr Cameron promised to halt the merry-go-round of organisational change with which the NHS had been previously inflicted. This promise was countersigned by a pledge by Mr Clegg, the Deputy Prime Minister.

I have absolutely no desire to embarrass the noble Earl, Lord Howe, for whom I, like so many of us, have genuinely a huge regard, but we have already learnt how trustworthy this Government as a whole are. So this merely minor change—no merry-go-round—means a reorganisation in which all primary care trusts are to be liquidated, all hospitals will become foundation hospitals, strategic healthcare authorities are to be abolished and the responsibility for public health will become part of the remit of local authorities. This does not seem to be so minor after all—more of an amazing big dipper. In this battle for the NHS, more than three-quarters of the £100 billion NHS budget will be devolved to general practitioners for administration.

Over the past few months, we have heard a great deal about the legacy left by the previous Government. Forgive me if I feel angry at this; it is not often that I do and seldom have I felt as angry. The negative tones have been the cornerstone of an excuse for the severest cuts in public spending in living memory. This Government’s pronouncements, on the whole, are not to be trusted. If their pledges on the NHS reforms are void, so are their promises on the ring-fencing of NHS funding. If we want to consider a legacy, perhaps we might recognise that the Labour Government left the NHS in its healthiest state for decades—a position that this Administration have inherited.

In spite of the Government’s assurances, the NHS is already being cut. Managers have been told to find £20 billion in efficiency savings if widespread closures are to be avoided. To give just one other example, in London the deaneries are threatened. Perhaps the Minister can confirm that, where so much healthcare is needed and where the cream of our young professionals is trained, junior hospital posts are facing a cut of 14 per cent next year. As I understand it, 70 key training posts in general medicine out of a total of 300 are to go—perhaps the Minister can confirm this—and another 70 posts from the other specialities are to be cut by 2014.

If the King’s Fund has calculated correctly, the reorganisation will cost the NHS between £2 billion and £3 billion, which will be taken from patient services. Consider this for a moment: the pressure of population change, the incidence of chronic illness, the rising age of our population, inflation and the rising expectations of patients mean a real cut in resources. The biggest problem will almost certainly be in chronic care. The massive cuts proposed in social care and welfare services will inevitably result in increased pressure on what we can now see is becoming an already underfunded NHS.

What about research? Here is another unbelievable sleight of hand by the Government. Some of the so-called ring-fenced NHS research budget will almost certainly come from the other research councils. I declare an interest as a member of the Engineering and Physical Sciences Research Council. We already fund a huge amount of healthcare research, as does the BBSRC. We will be asked increasingly to contribute substantially, at the risk of other research. We will be heavily pressured on our own so-called ring-fenced budgets. Meanwhile, regarding NHS R&D carried out by the NIHR, if we are talking about assessing outcomes, how is its performance to be evaluated? That will certainly not, it appears, be anything like as rigorous as the superb work of international quality, funded by the research councils, in our top research universities. Here, surely, is a case for government scrutiny.

Front-line care is already threatened. The dulcet tones of the White Paper with its emphasis on patient choice and outcomes are a smokescreen. Of course patients would like choice, whatever that means, but what they really want is competent, efficient medical care. I recently went to a maternity ward in one of the most famous maternity hospitals in the country to visit a relative of mine in her 20s, an NHS patient, who had recently given birth to a premature baby at 35 weeks. Her GP had given her the choice of three different hospitals and she had chosen this hospital. She was four days post-delivery and she had not seen a doctor. Her blood pressure had been 200 millimetres of mercury—a situation in which she might even have had a stroke or a seizure—but she said that she had not been seen by a doctor. She was sitting there trembling with worry. She was scared stiff. What she wanted was a doctor to listen to her and to talk to. Even though it is some time since I left the health service or have done any medical practice, I felt obliged to examine her. I went to see the nursing staff and asked whether I could speak to the house surgeons. None was available, so I asked to speak to the registrar. They did not know the name of the registrar. I had to phone the central switchboard to find out who the on-call registrar for obstetrics and gynaecology was. It was only when I left the hospital that there was suddenly an outpouring of care and three doctors visited my relative in about five minutes.

What about outcomes? Outcomes depend so much on social circumstances. Equity and Excellence: Liberating the NHS mentions cancer, stroke, asthma and so on, but the outcomes of treatment depend on the circumstances of the patient. What we learn more and more, certainly with epigenetics, is that what happens to us in early age also plays a part. What happens in a child aged two or three can have far-reaching effects on whether that child is more prone to diseases such as stroke in 60 years’ time. How do you measure those kinds of outcomes with the possibility that this White Paper offers?

Finally, to leave the—

[Baroness Northover]

My Lords, I think that I need to remind noble Lords, as the noble Baroness, Lady Farrington, would always remind us, that this is a time-limited debate. When the clock reaches four, noble Lords’ time is finished.

[Lord Winston]

My noble friend Lady Thornton and I have agreed to split our time, which is why I went on for the extra time. I shall finish with one sentence. If we really want to improve the health service, we should make certain that doctors have enough time to listen to patients and that nurses are not involved with so much paperwork that they cannot speak to patients, we need to improve training by better investment, we need to renegotiate the EU working time directive and we need to make certain that hospital doctors work in teams so that there is proper continuity of patient care.

--- Later in debate ---

[Baroness Hussein-Ece]

My Lords, I, too, will focus on what we mean by patient-led healthcare, which others have mentioned before me. In November 2005 a best-practice document called Now I Feel Tall: What a Patient-Led NHS Feels Like was published. It said:

“I strongly encourage all NHS organisations to take a close look at how they deliver their services and to ask their patients if their emotional needs are being met as well as their physical ones”.

It goes through what patients should look for. This includes,

“getting good treatment in a comfortable, caring and safe environment, delivered in a calm and reassuring way … having information to make choices, to feel confident and feel in control … being talked to and listened to as an equal; and … being treated with honesty, respect and dignity”.

The core and developmental standards for the NHS were set out in seven domains, the fourth of which is patient focus. It says:

“Health care is provided in partnership with patients, their carers and relatives, respecting their diverse needs, preferences and choices, and in partnership with other organisations … whose services impact on patient well-being”.

It therefore requires,

“healthcare organisations to have systems in place to make sure that staff treat patients, their relatives and carers with dignity and respect”.

Healthcare organisations must monitor their performance with regard to treating patients and carers with dignity and respect. The evidence has always been clear that if the NHS listens to what patients are saying, it can result in new ideas, better value for money and better care. How do you measure targets in an area such as patients being treated with dignity and respect, and being listened to, when trusts will point to the often relatively low number of complaints as a measure?

There have been numerous inquiries and other pieces of legislation setting out how to empower both individuals and communities in shaping health and social care services. Since community health councils were abolished in 2003—a great mistake in my view, and I declare an interest as I previously worked as the chief officer of a community health council—we have seen numerous attempts to make the NHS more meaningful and accountable. The establishment of local government overview and scrutiny committees with new duties went a long way to bringing accountability to healthcare services and in my view, as a previous chair of an overview and scrutiny committee, shone a welcome light into areas of healthcare services that had not previously been scrutinised. It brought about the need for greater partnership and collaborative working between local government and health. However, again, it relied on local PCTs and other healthcare trusts welcoming and being open to this scrutiny and accountability.

I welcome the Government’s plans to create local government health and well-being boards, but there have been problems on the ground in the way local government and the NHS have to work to bring about greater public and patient involvement in the NHS. In my own area, the local PCT last year took the decision to close a much loved and important health centre, in the most deprived part of the borough—the Finsbury Health Centre. The health and well-being committee scrutinised this decision in some detail and at considerable length, hearing evidence from patients, the public and clinicians. Eventually, after careful consideration, it presented its findings to the PCT, which fairly quickly rejected them. It found itself at loggerheads with the whole health and well-being committee, the council and the overview and scrutiny committee. It did not allow, for example, the chair of the committee to address or present its findings to the PCT board. As a result, the relationship between elected councillors and an unelected board of rather anonymous people, led by the chief executive, who had no accountability to the public, suffered. So, too, did local community confidence in the PCT.

People increasingly want to be able to exercise choice and control over their care. To do this it is clear that people must have the right to reliable information to help them make choices. Things have improved dramatically in some areas over recent years but what has not improved is the consistency across the NHS. My family’s experience of the NHS has been patchy. Three years ago my father spent seven weeks in hospital, suffering from terminal cancer. I saw at first hand how this 87 year-old man was gradually stripped of his dignity. While some of the nursing staff were enormously professional and provided excellent healthcare, others did not. He was not treated with the respect and dignity he should have expected. He was left in pain, with bed sores, little personal care, and alone on the floor after a fall in his room. This was a proud man, who would not leave the house without a shirt and tie, reduced to tears of humiliation just days before he sadly died. After my father’s death, I decided to complain formally about the senior member of nursing staff who had been so unprofessional to my father and my family. I was perhaps not surprised to learn that there had been a number of complaints about this individual, but none had been taken very far, due to the sheer difficulty, time and bureaucracy involved. This is not an easy time for families and carers.

I welcome the fact that patients will have more choice in terms of their GP. I hope the reforms will underpin not only greater choice but more consistency across healthcare services, so that people like my father have a better experience of the NHS.

[Baroness Northover]

I remind noble Lords that this is a time-limited debate. There is another important debate following ours. We need to give noble Lords in that debate the courtesy of being able to start and finish on time. I remind people that when the clock reaches four minutes, noble Lords have spoken for four minutes. There is also somebody who wants to speak in the gap.