Health and Social Care Bill

Lord Black of Brentwood Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Black of Brentwood]

My Lords, it has been a genuine privilege today for me to listen to so many speeches from noble Lords with distinguished records of service in the health sector, either as clinicians, former Health Ministers or specialists, and to hear their views. Like my noble friend Lord Rodgers, I am afraid that I am just a layman. I can offer no such professional input to match this canon of wisdom but speak simply as a consumer of the NHS’s services, as indeed were my late parents.

As I prepared my remarks, I thought in particular of the care that the NHS provided for my mother during a range of illnesses as she grew older: osteoporosis, heart failure, osteoarthritis, a transient ischaemic attack or mini stroke, and chronic obstructive pulmonary disease. It was that personal experience of the weight of these conditions that brought home to me in the most vivid fashion the extraordinary financial demands that are placed today on our health services as patients live longer and contract age-related illnesses in a way that would not have been the case only a few years ago, let alone in 1946 when the NHS was formed, and how in turn that places huge human burdens not just on GPs but on emergency departments, geriatric wards, carers and others involved in the vital chain of support for older, frail people and how they all work together.

It is of course a cause first and foremost for celebration that some 65 years or so since the founding of the NHS the advances in care and treatment, and above all in public health, have produced longer and more fulfilling lives for so many people. However, one central truth flows from that—the NHS has to change in order to survive. It is, after all, reaching pensionable age itself, and a new way of life is needed.

I come from the world of the media. In recent years we have seen at first hand how the dramatic changes in technology, lifestyle and demographics have shattered the business model that supported media companies. We have had to enter a period of permanent evolution—changing the way we do business and changing the services we offer our readers and customers—just to survive.

The same is true in the NHS. Demand is growing rapidly. Long-term conditions of the sort I mentioned earlier and that consume about three-quarters of the entire health budget are becoming more common. The renewal and regeneration of our great National Health Service is not just an option; it is essential. My noble friend Lord Mawhinney talked earlier about scaremongering. If there is something that we should be scared about, it is that we fail to change.

Osteoporosis—a subject about which I care deeply—is an excellent example of what I am talking about. As the population becomes older, this terrible illness becomes more prevalent. Between 1999 and 2009 the number of bed days attributed to hip fractures increased by 32 per cent. As our population rises by 17 per cent, it is projected that in England they will increase by a further 100 per cent between now and 2036, by which time treating and caring for hip fractures in the UK could top over £6 billion a year, which is a huge figure when considering the current burdens on the NHS. Broken bones already affect a greater number of older people than both heart attacks or strokes and TIAs. Osteoporosis is a costly disease, not just in straightforward economic terms but in the impact on individual lives, and that pressure will grow.

There could not be a more pertinent example that makes it obvious, even to non-experts such as me, that the NHS will have to change if it is to survive another 15 years, let alone another 65. That is precisely what this Bill is all about. Change means that it has to become more efficient, more focused on the challenges of public health and more accountable, and above all that there has to be a greater voice for patients who, in my view, are acutely aware not just of how much they owe the NHS but how it can be made even better.

I believe that this Bill delivers those ends, and that it does so in a way that should command widespread support. After all, as my noble friend Lady Bottomley reminded us earlier, the extension of choice and the extension of competition are not new principles; those of all parties and of none have long supported them. Involving GPs in clinical care is not new. GPs have been providing increased ranges of services for many years, and this Bill provides a logical and coherent extension of their powers rather than the piecemeal approach we have seen in recent years.

I spoke just now about the issue of osteoporosis, a subject that I raised in my maiden speech in this House and have talked about on a number of occasions since. To give a personal example, that one subject provides a prism through which we can see in a practical way how this Bill can help with one of the most chronic and debilitating conditions that are at the root of the need for reform of the NHS. Let me explain why. Giving responsibility to GPs for commissioning health services is giving responsibility to precisely the people who can spot this condition early and initiate treatment for it. They can play a pivotal role in the prevention, diagnosis, treatment and care of patients who are at risk of broken bones, for osteoporosis can be reduced only by involving professionals from a range of settings in the commissioning process.

Of course, GPs are not alone, and many fractures originate in care homes. Adult social care professionals need to be involved too, and the health and well-being boards, which this Bill will introduce, are a perfect way to bring stakeholders together to oversee local fracture services; and clinical senates will be able to act as vehicles for cross speciality collaboration, strategic advice and innovation to support commissioners in local areas. These are developments of real value to the patients of the future, and they spring directly from this Bill.

I also welcome the proposals to increase the amount of choice and information available to patients. Patients with, or at risk of, broken bones should be able to access information about the quality and outcomes achieved by their local services, and this Bill will deliver that. That is a very welcome step for the hundreds of thousands of people who suffer from osteoporosis.

Of course, issues will need to be raised in the Committee stage of the Bill, which quite rightly should take place on the Floor of the House, where, as the noble Baroness, Lady Murphy, said earlier, we have experts to deal with these issues. I highlight in particular the provision of information about whether local hospitals or GP surgeries have fracture prevention services in place. I believe that steps must be taken within the scope of the Bill to ensure that the ability to choose the location in which care is provided is extended to disadvantaged groups, including the frail and immobile. I also hope that the Government will include indicators that measure admissions for fractures in older people in their initial NHS adult social care and public health outcomes frameworks, but these are issues that can be sorted out.

The key point is that with a long-term condition such as osteoporosis—I have deliberately used this as a personal and practical example—the Bill will, for the first time, put in place a framework that will allow us to improve lives through early diagnosis, greater accountability and the cohesion of care services. That is a precious prize.

Of course, as we have heard, this Bill is controversial. Change always is, but if we really care about something—everyone in this House cares about the NHS—we must have the courage to face up to that. If we fail, we will be letting down not just ourselves but those who will come after us.