Health Bill [HL]

My Lords, I have great admiration for the hard work that the noble Lord, Lord Darzi, has undertaken with his review and reports, resulting in this Bill. I welcome the constitution and its accompanying handbook, and the fact that the Bill ensures that every organisation and staff member working with or on behalf of the NHS will have to adhere to them. Will the National Health Service’s contractual arrangements with the private sector also have to adhere to them? I hope so. It seems wise that the constitution will not be reviewed more than once every 10 years. There have been so many changes to the National Health Service that people working within it so often say, ““Not change again!””. I am pleased that the constitution puts responsibility on patients too. When patients miss appointments without a good reason and do not call to cancel, it is deplorable. There has been considerable interest in the Bill from many organisations. As a long-term supporter of the National Health Service, I have some questions for the Minister which I hope he will be able to answer. I consider two of the most important aspects of healthcare to be good quality of care and safety. I am sure the Minister will agree with me on these points. I am exceedingly pleased that they are in the constitution and the handbook. However, what will happen if staff do not adhere to good quality of care at ground level with the patients? Let me give your Lordships three examples. Since Christmas, three patients were to be transferred from Scarborough hospital to Bridlington hospital. One of the patients was over 90 years old and the others were also elderly. The transfers were to take place at 10 am. In the end they were transferred at midnight. They found Bridlington hospital cold. The food was cold, the patients got confused and the staff were found to be chatting round the nursing station and not caring for the patients. Recently, another elderly patient of 93 had a fall and was taken for an X-ray to Scarborough hospital. It was found she was only bruised and shaken. At 3 am she was told to go home. There was no transport so an elderly nephew had to fetch her and drive her home at 3 am. On a third occasion an elderly man had a fall and it was found he had serious cancer of the bladder and had to have an emergency operation. As there was no available bed on a ward, he had to stay in a holding ward in A&E. I am told there are real problems in Scarborough and Bridlington hospitals and, when I heard of these incidents which have occurred since the Healthcare Commission’s worrying report, I thought I would ask your Lordships if you thought this was treating the elderly with dignity and good-quality care. I thought it worth mentioning in the hope that there will be some improvements. These were only three cases told to me personally. How many more have there been, I wonder? I quote from the Handbook to the NHS Constitution, on page 14: "““You have the right to expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary””." The NHS provides access to ““specialised services””. I declare an interest—of course, unpaid—as president of the Spinal Injuries Association. A short time ago I met the doctor in charge of the intensive care unit at the Royal London Hospital. He told me he had five tetraplegic patients who were on respirators and waiting to be transferred to a spinal unit where they have specially trained staff but there were no beds. His beds were being blocked. This is a very serious matter and everyone concerned is most frustrated. Some of the spinal beds in the specialist units are also being blocked as some of the patients do not have suitable housing and their home circumstances mean they cannot be discharged. The spinal consultants and the Spinal Injuries Association agree it is essential to enable optimum access. A national bed bureau should be set up, both for first-time admissions and urgent readmissions, like pressure sores. One can have as many constitutions written down as the Government like but if the NHS cannot deliver, which is the case with spinal injuries at the moment, the constitution will be worthless. I hope the Minister will look into this urgently. I agree so much with the statement in the handbook: "““Quality of care is personal to each individual patient—you have the right to high-quality care that is safe, effective and right for you””." It would be impossible for me not to mention the importance of page 28 of the handbook, which says: "““Requirements are also made clear in the duty to provide and maintain a clean and appropriate environment for healthcare, as set out in the Code of Practice for the Prevention and Control of Healthcare Associated Infections””." The Healthcare Commission should be congratulated on what it has done, but it is an ongoing challenge as staff can so easily get lax. I hope, therefore, that the Care Quality Commission will have this as its top priority. I am pleased that the constitution encompasses the recommendations of Professor Mike Richards’s review, Improving Access to Medicines for NHS Patients, which ensures that NHS care is not withdrawn from patients who choose to purchase private drugs. This was so cruel; you will do anything to relieve suffering and prolong life when that is wanted. It may be because I am a canny Scot that I have some reservations about direct payments for the health services. The Department of Health’s own 2006 White Paper Our Health, Our Care, Our Say unequivocally ruled out direct payments. I believe in the founding principle of the NHS that care should be free at the point of need. It has been the envy of many countries. Could direct payments become something like managed care in the USA? Could it lead to means-testing? Could there be greater barriers to services for those who most need them? What happens if the money runs out? What happens if the patient spends it on non-healthcare? What happens if the patient has a long stay in hospital and does not use it? What happens if other family members make use of it and make the patient hand it over? Would it not become a bureaucratic nightmare? What safeguards will there be? How will the pilots be chosen? I hope the Minister will be able to answer some of these questions, as many noble Lords have asked the same. I would be grateful if the Minister would explain how the innovation prizes will work. How will they directly benefit patients and the public? Will they be like merit awards or will they be like targets? I have always known how dangerous smoking is and it has been a great relief to now have so many places smoke-free. With this Bill before us, I have been surprised how much material your Lordships have been sent from all sides of the smoking or non-smoking lobby. I welcome the Government’s initiative to try to prevent young children smoking. It is worth repeating that each year in England deaths attributable to smoking total more than suicide, road traffic and other accidents, diabetes, drink and alcohol-related deaths put together. I would like to query one of the ideas, which is to remove the brand names from the packets. Will this not make it easier for the evil market of counterfeit cigarettes, which seem to be a growing problem? Some young people seem to like to challenge anything which seems to harm them and it is awful to see such young children smoking. I welcome the fact that people who pay for their social care will have the right to complain to the ombudsman. They can be just as much as risk as anyone else. I look forward to the Minister’s reply.