NHS: Standards of Care and Commissioning

Baroness Sherlock Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Sherlock]

My Lords, I thank my noble friend Lord Turnberg for securing this debate and I declare a non-pecuniary interest as the next chair of Chapel St, a charitable enterprise which delivers services in partnership with primary healthcare.

I should like to wave another report at the House. This one came out last week. It is from the King’s Fund and is called Improving the Quality of Care in General Practice. In fact, it begins where the noble Viscount, Lord Bridgeman, left off, looking at variations in care. The report was the result of a major inquiry conducted over two years by an independent panel. The panel looked at general practice and found that most care is good, which is a relief, but it also found that there is a widespread variation in performance, as well as gaps in the quality of care delivered by general practice. The report is full of examples, which I commend to the House. It showed variations in the quality of prescribing, in the quality of diagnosis—for example, one-third of patients with stomach or oesophageal cancer who required urgent referral to hospital were given non-urgent referrals—and in the rate of referrals. The report also highlighted variations in the continuity and co-ordination of care. It showed some significant differences.

Almost as telling was the fact that it found a significant problem in accessing public information, particularly comparative data, on performance in general practice. When we consider the avalanche of data available for almost every other part of the health service, that is quite striking, and I should be interested in hearing the Government’s reaction.

I see that the noble Earl, Lord Howe, told the Health Service Journal last week that, in response to the report, the Government’s plans to move 80 per cent of the NHS commissioning budget to GP-led consortia will improve this situation. I am very keen to learn how, and perhaps the Minister will take the opportunity to explain it to the House. He may not want to go into detail today but I wonder whether I can encourage him to assure the House that he will engage with the King’s Fund, as well as with the Royal College of General Practitioners and the BMA. I was delighted to hear that they both welcome the report, so there is a fair wind behind it, but perhaps the Minister will engage with them in looking at how these problems can be tackled. Perhaps, in particular, I could encourage him to do so before this House starts to look in detail at the Health and Social Care Bill that will be coming before us.

For me, this report could be a metaphor for the state of the health service: most general practice is good; the NHS is good; popular satisfaction has never been higher; its efficiency is admired; but there are pockets of significant problems, as described by my noble friend Lord Turnberg. It is clear that performance and outcomes vary too much. We all want to see continuous improvement and we all are open to the idea of changing how healthcare is delivered. However, it is not at all obvious to me how the revolution in the health service, on which the Government are embarking, will necessarily solve these problems. Risks will inevitably be taken by such large-scale reform, so not just this House but the country needs to be persuaded that the changes will produce results that will solve the kind of problems that have been identified. I strongly encourage the Minister to look not just at the specific problems raised but to say why the Government think that their prescription will cure the ills. That is the challenge for all of us.

When I thought about what I would talk about today in my four marvellous minutes, I went back to a list of notes that I had made at the wonderful all-party seminars that many of us have attended with experts in the field, and I found a list of 20 questions to which I did not know the answer. It is not simply a list of questions that I cannot answer, as that would be a rather greater list, but a list of questions to which the experts at these seminars had been unable to find the answers after carefully reading the Bill and all the associated documentation. If that is the case, we have to question the wisdom of proceeding at the current pace. This House has enormous respect for the integrity and experience of the Minister. I wonder whether he could speak to his colleague the Secretary of State and encourage him to reflect on the fact that a wise man does not demolish his house while the architects are still sketching the new one.