Healthcare

Lord Hunt of Wirral Excerpts

Thursday 28th October 2010 Lords Chamber

Moved By

[Lord Hunt of Wirral]

To call attention to the Government’s policy on patient-led healthcare, the focus on clinical outcomes, and the role of health professionals; and to move for Papers.

[Lord Hunt of Wirral]

My Lords, I beg to move the Motion standing in my name on the Order Paper and to say how delighted I am to initiate this debate today, especially following the Government’s commitment last week to protect health spending. As the Chancellor of the Exchequer said, in presenting the Government's spending review:

“But to govern is to choose, and we have chosen the national health service”.

We would do well to remind ourselves that the Chancellor also said:

“That does not mean that we are letting the Department of Health off the need to drive real reform and savings from waste and inefficiency. Productivity in the health service fell steadily over the past 10 years, and that must not continue”.—[Official Report, Commons, 20/10/10; col. 959.]

Nevertheless, overall NHS spending will increase in real terms over the course of the spending review period, and it is right that we should now have the opportunity of setting out the views of this House on the Government’s healthcare plans. Their proposals to put patients at the heart of the NHS, to bring greater focus on clinical outcomes, and to empower health professionals are set out in detail in the White Paper and in all the consultation papers and announcements that have subsequently been issued.

Every Government must grapple with concerns over medical research and screening, accidents—especially in the home—obesity and smoking, to name some of the more perennial concerns. The impact on children’s health of all those arguments over MMR and the fallout from the last Government’s handling of the swine flu epidemic have also emphasised the central importance of vaccination to government health policy. I very much hope that my noble friend will give further details as to the Government’s approach to this critical area.

Before I go further, I need to declare my interest. For several years, I was ultimately responsible for the National Health Service in Wales, and my ministerial team and I worked closely with John Wyn Owen in developing our clear policy,

“to add years to life and quality life to years”.

I should also remind the House that for 41 years I have been a partner in the national commercial law firm Beachcroft LLP.

Many of the Government’s commitments will require primary legislation, and a Bill is due to be introduced later this year which will attract considerable attention not only from within the NHS but from firms in the private health sector and from professional advisers. As a former science Minister, I was particularly pleased with the generous treatment of the science budget, which will also enable the investment of £220 million in the UK Centre for Medical Research and Innovation at St Pancras, and also to fund the Laboratory of Molecular Biology in Cambridge.

The programme set out by the Government is undoubtedly an ambitious one, particularly in its vision of patient-led healthcare. Few will dispute the merits of giving patients more choice and control. Much debate has already focused in this respect on the shift of responsibility for commissioning most healthcare services in England from primary care trusts to local consortia of GP practices. This is intended to bring decision-making as close as possible to patients, in what the Government terms,

“no decision about me without me”.

Much has been said, and will continue to be said, in relation to the proposed role of GP consortia, on the challenges that this will present to GP practices and other stakeholders involved in commissioning; and the support which GPs will need to commission services and contract with service providers effectively. However, these discussions should not blind us to the fact that the Government’s commitment to giving patients a choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment alone will entail more sweeping changes to how the NHS operates, much more sweeping than many commentators thought only six months ago.

As president of Case Management Society UK, I would like to stress the contribution that case managers can make to the better allocation of resources, and also to the creation of more joined-up treatment for patients. I therefore hope that we shall see an expanded role for case managers as the NHS evolves. As experts in the process of communication and co-ordination, case managers can help patients who have to make informed decisions about their individual healthcare and also provide an opportunity to shape the future of healthcare services.

“Choose and book” has already greatly enlarged the degree of choice that patients or their GPs can exercise in relation to their treatment. The emphasis on the choice of named consultant-led teams for elective care by April 2011, when clinically appropriate, will be a very positive development, and one supported by the Royal College of Surgeons, which has briefed us for this debate and which is helping to lead the way in developing and using outcomes data. I know that my noble friend and his colleagues are rightly concerned to ensure a genuine level playing field for providers of care. Ultimately, effective and fair competition under a rules-based system will stimulate innovation, bring forward extra capacity and underpin genuine patient choice. Notwithstanding the statements of the Secretary of State’s predecessor in favour of the NHS as preferred provider, many privately owned operators already provide additional capacity through the Extended Choice Network. As a means of using all available beds and resources to assist in the major task of improving the NHS, this framework has been a success for patient, taxpayer and private sector alike. I understand that the coalition Government are planning to build on this framework in rolling out the new “any willing provider” framework.

The creation of a level playing field will require not only a focus on high-profile initiatives such as the right to choose a consultant-led team but a detailed attention to the minutiae of commissioning. The duration and termination provisions of the contracts which are rolled out under the framework, the way in which these contracts are awarded and the number of separate contracts that providers will need to bid for and perform may in practice have as much impact on the creation of a level playing field between providers as some of the more publicly debated issues. Of course, plurality of supply in the NHS will need to go hand in hand with a regime for the so-called failing hospitals. This is an area of great complexity from a policy, financial and legal perspective, but one which I hope that the Government will not shy away from in setting out their reform proposals in more detail. We must ensure that patient choice becomes a reality for all patients.

Patients will need access to information, and I welcome in this context the Government's proposals to centralise all data returns in the Health and Social Care Information Centre. Informed choice will be about recognising the importance of providing more insightful information to patients, but also that,

“different people and groups in society access information differently and need it presented in different ways. We must ensure the right information is available and presented in a relevant way to those who could otherwise be excluded”.

My noble friend has rightly characterised these plans as requiring an “information revolution”. That brings me to clinical outcomes. Few members of the public or the medical and nursing professions will disagree with the Government’s aims to hold the NHS to account against clinically credible and evidence-based outcome measures and remove process targets with no clinical justification. The public will surely welcome their proposals that payments to providers should reflect outcomes, not just activity, and provide an incentive for better quality. The same is true of the plans to pay drug companies according to the value of new medicines and with a view to ensuring better access for patients.

The Government’s focus on excellence in the NHS emphasises that there is a lot more work to be done to ensure consistently excellent performance in all areas of care. This is about more than just enshrining duties into law; it is about ensuring that the drivers of excellence in the NHS are identified, implemented and promoted.

One area is, of course, cancer treatment. I know that my noble friend Lady Finlay of Llandaff will on 11 November give us all an opportunity to debate the measures necessary to improve the quality and quantity of life for people with cancer, so I will not say anything further on that—although the Minister may want to say something further.

It would hardly be possible to comment on the setting of new quality standards in the NHS without paying tribute to the excellent work of the National Institute for Health and Clinical Excellence. At a time when the future of certain valuable arm’s-length bodies remains uncertain, the steps which the Government are taking to ensure the independence of NICE and its core functions are encouraging. Of course, the Government have also indicated their intention to empower professionals and providers, give them more autonomy and make them more accountable to patients through choice, and to the public through more formal means of accountability. I read carefully my noble friend’s speech to the King’s Fund. He said, “It boils down to trust”. How right he is.

GP consortia will be accountable to the proposed new NHS commissioning board and it must be the clinicians and their patients in consulting rooms and clinics, not the board, who are the so-called “NHS headquarters”. The independence of this board will deliver on the promise of taking political micromanagement out of the NHS that so many Ministers have made in this House, but few, sadly, have been able to honour.

Nor will this promise be honoured in just the commissioning of care. The same degree of independence will be given to Monitor in its new incarnation as the economic regulator of healthcare providers. Several of my colleagues may well want to refer to that. We of course need greater autonomy at the operational level, and colleagues may recall the strong reservations of my noble friends regarding the constraints imposed on all those powers given to, for instance, foundation trusts. We had doubts about the constraints imposed on the freedoms that were originally promised. As part of the Government’s commitment to,

“create the largest and most vibrant social enterprise sector in the world”,

foundation trusts will at last be given those greater freedoms. My goodness, they are going to need them, and we await those further announcements with great interest.

In conclusion, I recognise that there is a place for effective performance management in the NHS. This has yielded promising gains in productivity in some regions, such as the south-west. Handing more freedom to our successful foundation trusts will be the key to unlocking greater innovation in the NHS. We also welcome the additional responsibilities which are to go to local authorities, and we will be monitoring those very carefully. This will all require investment in infrastructure and a clear focus on the management of NHS assets, informed by the skills of those organisations with particular experience in the field of asset management. The White Paper does not outline in detail what will happen to, for instance, the LIFT schemes to which primary care trusts are party. This is clearly an important area, as well as one that is ripe for fresh thinking. We look forward to hearing from my noble friend on that.

My noble friend’s task in bringing these reforms to fruition will be daunting. These are the most important reforms to the NHS since 1948. It is critical that we get them right and move the debate from one about structures and processes to one about priorities and progress in health improvement for all.

--- Later in debate ---

[Lord Hunt of Wirral]

My Lords, it remains for me to thank everyone who has participated in a debate which I believe shows this Chamber at its very best. Some direct, penetrating and important questions have been raised and we have had the benefit of informed, expert advice from those who really know what is happening on the ground and who are involved professionally. Specific issues have been debated.

We all respect my noble friend Lord Howe as a caring, compassionate Minister. The way in which he has sought to respond to almost to every point that was raised shows him at his best. Some noble Lords who have participated in the debate are still experiencing the aftermath of a rather difficult election year, but if we are to have a five-year Parliament we face the prospect of just one general election in the next 10 years—perhaps two in 15 years. Many speakers have told me privately that they would love to achieve consensus as the NHS is a great institution. The principles on which it was founded are as important now as they were then—namely, that it should be free at the point of use and available to everyone based on need, not ability to pay. Some still maintain that conflict exists, but the White Paper gives us all a chance to unite to try to create a better National Health Service. This debate is an important step in the right direction as we discuss how best to drive up standards, deliver better value for money and create a healthier nation. I beg leave to withdraw the Motion.

Motion withdrawn.