Healthcare

Lord Alderdice Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Alderdice]

My Lords, I declare an interest as a recently retired consultant psychiatrist who spent his life working in the NHS. I am married to a consultant pathologist in the NHS. My brother is a consultant in the NHS, as is my sister-in-law. My brother-in-law is a general practitioner in the NHS. I therefore speak not from the vantage point of academia or any glamorous speciality in central London but from that of psychiatry and general practice in the regions. From my perspective, the NHS is broken and needs fixing.

What are the problems that affected me during my work? Increasingly over the past 15 or 20 years, decisions were being made by a larger and larger bevy of managers and administrators at every level and increasingly decisions were being made, quite naturally, more for the benefit of the management process than for that of the clinical process. As a clinician, you could go to meetings—if you could get to them and if you were invited, and increasingly you were not—and find yourself being berated because your clinics were getting larger because you were going to the meetings, or you could not go to the meetings and the decisions would therefore be made in your absence and without any attention being paid to them. The increasing focus on managerialism over the period of the previous Government meant that clinicians were increasingly ignored. My generation thought increasingly of retiring from the NHS because they felt frustrated, not by terms and conditions of service, which improved, but by diminishing morale, as what they really wanted was the freedom to make clinical decisions.

Decisions were increasingly centralised. Targets and decisions were made in Whitehall and, with the best will in the world, what looks to be the right thing from a Whitehall perspective does not feel like the right thing when you are operating at another level. It is quite true that devolution has helped. For some time, we have had four national health services in the United Kingdom, which has certainly improved things, but the possibility for that improvement through devolution in Scotland, Wales and Northern Ireland happening in England is minimal because of the sheer size of the country. If the benefits of devolution in Scotland, Northern Ireland and Wales were to be achieved in England, it would require further devolution to local government level. Here, there is evidence of the possibility of benefit.

In Northern Ireland, because of devolution, we had proper, full integration of health and social care, which meant that it was possible for me to co-operate with social workers, that in-patient was not divorced from out-patient, that hospital care and community care were seamless and that the hospital did not soak in all the money and resources from the community whenever there were inevitable pressures. There are benefits to be had, but England needs to learn the benefits that Scotland and Northern Ireland, in particular, and, to some extent, Wales have already achieved.

The most important thing was the recognition of the importance of engaged and informed patients. Why? It does not matter how clever a doctor is, even if he can afford to make the right prescription; if the patient does not comply with the treatment, it does not improve the situation and we know that, when the research is done, patient compliance is massively lower than most doctors think. However, it goes wider than that. In my own work, it is quite clear that the fundamental difference is not the prescription of medication but the change in the culture and lifestyle of the patient. That happens only when you have a fully engaged patient—an active citizen—who is taking responsibility. Those are the principles that I see reflected in the Government’s policy and that is why I am so enthusiastic about it as a doctor.

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[Lord Brooke of Alverthorpe]

I am grateful to the noble Lord, Lord Hunt of Wirral, for promoting the debate and express my gratitude to the several professional organisations that have provided me with briefings. I make a contribution today simply as an NHS patient who has no private medical care or back-up whatever. I am also a former cancer patient; I hope that that continues to be so, but I have been waiting nearly three months for an appointment to deal with a spot on my hip. I finally managed to get one this week at the Chelsea and Westminster Hospital, where, within seven days, staff will do a local operation on it. They hope that it will not be the start of skin cancer.

I was spitting blood the other day when I listened to the Minister defending the Government’s position on cancer timetabling and how treatment was taking place. In my case, it had nothing whatever to do with commissioning or the hospital. The problem arose with what has been happening within my GP practice. I know that people in GP practices in many areas are under a great deal of stress and strain and I greatly sympathise with them, but it is extraordinarily difficult when so many patients cannot get through on the phone to their GPs and so cannot get an early appointment with a GP of their choice. They cannot get a meeting with their GP out of hours—it must be at the convenience of the doctors—and certainly cannot get GPs to come out at the weekend or at night. These are issues that my Government were responsible for; they tried to put them right and did not get them put right, so the new Government should be putting them right and not moving on into other areas.

As far as I can ascertain from how things are moving at the moment, there will be little change on these fronts, or indeed on many other issues that have been raised on the Government’s side of the House when there have been complaints. The White Paper and the programme in front of us will not address those problems. I speak with a degree of anger when I see that we are now moving into an entirely new arena, which was not forecast in the run-up to the general election. There was no debate on it and it was barely mentioned. It was not in the Conservative Party manifesto or the coalition agreement, which just said that nothing was going on. I am sorry that we do not have many Lib Dem contributions today because, in the past when we have had debates on the NHS, we have been chased all over the place by them. Today they are missing and they should be ashamed that they are not standing up and taking a firm stand on these issues.

[Lord Alderdice]

I am grateful to the noble Lord for giving way, but I have to point out to him that he is incorrect on almost everything that he has said in the last few minutes about those speaking from the Lib Dem Benches, as well as about the coalition agreement and the manifestos.

[Lord Brooke of Alverthorpe]

I shall not go into that—I shall move on. If we are faced with this, we need greater openness and transparency and greater access to the economic factors behind it all. If I was in the private sector, all the issues that I have just complained about, with a private GP looking after me, would have been solved. I would have had access to the information and to the costs. We should move to a position where, if people are given choices, they should know what the cost is. Equally, we should be given the opportunity under the changes to know what is being paid into the GP consortia, what profits they will make and what the private sector providers will get out of it. At the moment, this area is all within the public service, but it is likely to be privatised under the coming arrangements. Those are the points that I put to the Minister—there should be greater openness on the economic side of the operation.