Health and Social Care

Baroness Pitkeathley Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, there are very few people who know as much about patient participation as my noble friend Lord Harris, so it is entirely fitting that he should lead this debate. I join others in sending condolences to the noble Lord, Lord Prior, and regret that he is not here—by which I mean no disrespect to the noble Baroness, Lady Chisholm, who I know will have more than an adequate response for this debate.

I have never heard anyone say that patient participation should not be encouraged or that it is in any way undesirable. On the contrary, I have heard the praises of patient participation sung over 40 years or so. Sadly though, its history is not marvellous and we have not made as much progress towards the reality of “nothing about me without me” as the rhetoric might suggest. But being critical of the progress of patient participation as a policy does not mean being critical of individual transactions and relationships between NHS staff and patients. On the contrary, I should point out that my own experience as a patient has always been good. Although I was, at one point in my life, in hospital for six months, I have no complaint to make on that score. In the whole of that time nothing was ever done to me—no procedure was started or undertaken with my consent—without asking my opinion and acting on my opinion when I gave it. Your Lordships might point out that there are not perhaps many Baronesses with an interest in healthcare on NHS public wards, but I always perceived the same care and respect being given to my fellow patients, however frail they were and however poor their English was.

But putting patients first in policy terms is easy to say and hard to do, as the various attempts over the last 20 years have shown. As the King’s Fund has observed, despite pockets of good practice, there has been a lack of systematic progress, and it suggests three reasons for this. The first is a lack of clarity about what involving patients and people in healthcare actually means, so people and staff are confused about what is expected. The second is the power issue. The involvement of patients challenges orthodoxies, vested interests and established ways of doing things. If you share power with patients, which everyone says they want to do, it means that someone—the doctor, the nurse, the administrator—has to give up a bit of their power, and that is hard for them to do. The third reason the King’s Fund opposes this is that it may have been a goal but was never a priority across the healthcare system.

It is important to recognise that patient and public viewpoints and opinions can make a genuine contribution to debate in shaping national policy and enhancing accountability. It can also help you to manage resources better, as what patients actually want may be less than what professionals imagine they want. The previous attempts to set up effective means of harnessing patient and public views have been set out by my noble friend. We all remember CHCs. I do not think PALS has been mentioned thus far. LINks, forums and the Commission for Patient and Public Involvement in Health have all bitten the dust amid a storm of criticism that they were not representative, too bureaucratic, not good value for money and so on. Many would argue that they were never given either adequate time or resources to prove themselves.

I am on record as saying I was not a fan of the Health and Social Care Act 2012, which in my view has had a deleterious effect on health and social care because it put in place a disastrous and unnecessary reorganisation even though a pledge had been given when the Government came to office that no such reorganisation would take place, and which distracted the hardworking staff of the NHS at a critical time. However, in spite of the late changes to the Bill that my noble friend pointed out, the setting up of Healthwatch seemed like a ray of hope, a concerted attempt to bring the voice of the patient and consumer into planning and a means of feeding back the actual patient experience.

The vision for Healthwatch is inspirational. It seeks a society in which people’s health and social care needs are heard, understood and met so that people can shape their own care, influence its delivery and hold services to account. I commend the work of its first chair and CEO, together with its board, in setting up the organisation and beginning to establish public trust. The combination of local organisations, fully linked into local concerns, with a national body to influence public policy could provide the best chance that we have yet seen to establish effective service-user representation. The current state of health and social care can leave no one in your Lordships’ House in any doubt of how much that is needed.

As we have heard, though, there are two big issues facing Healthwatch. First, it is only as strong as the performance of its local organisations. Funding at local and national level is being squeezed, with about half of local bodies reporting reductions, and in the current year the funding is one-third less than the £44 million originally allocated to local Healthwatch organisations for them to carry out their statutory duties. We should remember that their complaints work is just that—a statutory duty. Many local Healthwatch organisations are already reporting that the situation next year will be even more difficult.

It is now widely accepted that a major problem facing health and social care is the need for service redesign—the integration of budgets across health and social care, for example, and more rationalisation of hospital services. Unless we involve patients and families in this debate, we will waste time and money on dealing with the resistances that such changes inevitabily bring about, so it would be a wise investment to support local Healthwatch. That is clearly not happening, as my noble friend has reminded us.

The second major issue facing Healthwatch, as we have heard, is about independence. Healthwatch was conceived as independent at both local and national level. The trust of the public depends on that independence. The closeness to the CQC—its subordination, some would call it—has compromised this, but there is some feeling too that the Government are too sensitive to criticism, and the decision not to renew the contract of the outspoken first chair is perhaps evidence of that. We have heard that this defensiveness is widespread at local level too.

This has been an all-too-frequent result of previous attempts to set up effective patient representation, from CHCs through to the Commission for Patient and Public Involvement in Health and the other organisations we have heard about. What happens is that Governments commit to effective patient representation with a big fanfare. Then, the body starts to act effectively, asking for change and giving patient feedback. Then the Government of the day say, “Hang on a minute, we did not want that kind of feedback”.

If they are really committed to patient and public involvement, governments at local and national level must stop being defensive, be confident about the positive role that the voice of patients can play and use the feedback received to improve services, which is surely the aim not only of patient representatives but of the Government themselves. I hope that the Minister will assure the House that that is indeed the aim of this Government and that they remain committed to a strong, vibrant Healthwatch at both local and national level.

I could not be more delighted by the appointment of Imelda Redmond as the new CEO of Healthwatch nationally, and wish her well. Let us please learn from the history of patient and public involvement, and not make the same mistakes again.