Health Bill [HL]

I shall speak to the amendments in this group that are tabled in my name, Amendments 14, 15, 17, 19 and 20. One of the surprising features of an NHS Constitution that is meant to be all about delivering patient-centred services to high standards of quality is that the process involved in the review and revision of the constitution is to be anything but inclusive or transparent. I hope that the Government do not mean this. We see in Clause 3 that provision is made for the Secretary of State to undertake a consultation before revising the constitution. That is fine until we look a little further on and see how limited is the nature of that consultation. Nowhere is there a mention of carers; patients are mentioned but not bodies representing patients or particular groups of patients; and there is no mention of local involvement networks, the bodies created by the Government only last year to act as local patient watchdogs. I would like to see mention made of bodies that represent staff, such as the BMA, the RCN and the other unions—not just, say, a handful of random NHS employees. At the end of the consultation exercise, what does the Secretary of State have to do by way of publishing the results of the consultation? Absolutely nothing. He can review and revise the constitution without having to disclose to anyone what feedback he has received, so that it will be impossible for any of us to know to what extent he has taken account of the comments made to him. It is a closed process, and that surely cannot be right. There are two reasons why that is not satisfactory. The first relates to specialised services, which got a raw deal in the NHS Constitution; they are not even mentioned. There is a paragraph on page 15 of the handbook about the existence of specialised services, but couched in terms that grossly belittle their importance: "““The NHS also provides access to ‘specialised services’ for the small number of people””—" the small number of people— "““who suffer from rare conditions. These specialised services are commissioned either regionally or nationally from a few specialist centres, depending on the rarity of the condition or treatment””." Given that specialised services account for no less than 10 per cent of the NHS budget and many hundreds of thousands of NHS patients, often in the most extreme need, this seems to be—to put it mildly—inadequate recognition. The constitution itself, not just the handbook, should enshrine the importance of regional and supra-regional services alongside local planning and provision. It is, after all, this combination of local, regional and supra-regional that makes the NHS a truly national service. The second reason why this part of the Bill is unsatisfactory is the absence of any acknowledgment of patient and public involvement in decision-making. A number of organisations have pointed that out, including the BMA, RADAR and the RCN. Patient and public involvement is mentioned in the constitution, which is well and good, but there is no provision in this clause for involvement by LINks or bodies like the Patients Association in providing feedback on the drafting of what is intended to be a key point of reference for the delivery of health services. It is difficult to involve everyone in a dialogue, but if the Secretary of State were to have an explicit obligation to publish a report setting out the results of the consultation, it would at least add a welcome measure of transparency and make consultees feel that their representations had been factored in. One group that feels short-changed is the disabled. RADAR has made clear its disappointment that the opportunity was not seized during the drafting of the constitution to highlight the full nature of existing rights under the Disability Discrimination Act in relation to equality of access to health services and to treatment. Neither the constitution nor the handbook refers explicitly to the right to reasonable adjustments for disabled people, which is a key provision of the DDA. All that the documents mention is the right not to be treated less favourably on various grounds, which is not at all the same thing. It would have been very helpful if, at the very least, the handbook could have given clear information about the statutory duties that exist to promote disability, race and gender equality. We know that there are large inequalities in access to primary care on the part of people with mental health problems and people with learning disabilities. A reminder to PCTs about the need to tackle those would not have gone amiss. I shall say a brief word about carers. Carers engage with the NHS in a completely different way from either patients or ordinary members of the public. Very often, it is carers who facilitate access to services on behalf of the patients they look after, and their own lives are almost as much affected by the quality of those services as those who are in receipt of them. As a result, they bring a different perspective on how well or how badly the NHS is meeting patients’ needs. As the Minister will know, that valuable difference is recognised in other contexts, where health bodies are required to consult and involve carers. The NHS operating framework for 2009-10 says that PCTs must devise joint plans with local authorities to provide carers with breaks. The Putting People First concordat between the NHS and local government recognises that family members and carers are to be treated as experts and partners in the delivery of care. There is a strong case for seeking the views of carers whenever the NHS constitution is being reviewed or revised. I should add that I am very much in support of Amendment 31 of the noble Baroness, Lady Tonge, which says that the three-yearly report on the practical effect of the constitution should include a report on how it has affected carers.