Health Bill [HL]

I have put my name to one of these amendments concerning carers. Critical to the success of the NHS Constitution is to recognise how people perceive it, use it and, indeed, how the staff wish to work in it. After 10 years we really should have some sort of an indication about how effective it is. Therefore, I am very pleased that the Government will consult when undertaking this 10-year review. I want to say a few words about consultation. Years ago it was highly valued, but it has always been used as a proxy for giving people some influence over policy in a huge and centralised monopoly-run service. That is one of the ways that we can try to get people to have some influence. Over the years, we have consulted on so much that it is losing some of its force. Indeed, some people today tell me that they have consultation fatigue as they are consulted on nearly everything that comes out. Certainly, it is often thought that it is a piece of bureaucracy that the NHS has to go through. Local organisations perceive that the decisions have already been taken and that this is just some exercise that takes three months and has to be gone through. In the commercial world, as a customer you can usually walk away and find another provider, be it a supermarket or a private healthcare provider if you can afford it. The business soon knows whether its product is valued. It has to balance the books. If it does not, the business simply goes out of business. The user has little influence in the current NHS. Consultation seems to be the only tool to involve people in policy decisions. In time, perhaps direct payments, which we shall discuss later, will make a difference. Until direct payments are established and we see the result of them, we have to fall back on this rather barren process of consultation. I am sure that the noble Lord, Lord Darzi, will say to me, ““Hang on a minute””; when he was drawing up his document High Quality Care for All, he took enormous trouble to consult widely. Moreover, he set up structures across every NHS region in the country to get the views that were incorporated into the overall policy. I read in the Second Reading debate that the noble Baroness, Lady Emerton, said how much pleasure working with some of these groups gave her. I have heard other staff say that they felt it was a valuable exercise. It was a massive exercise. It was very well thought out and structured, and it was expensive in time and money, but it was effective because the noble Lord listened and acted on the views expressed. Of course, the views were not unanimous, but they never are when you go out to consultation. I am saying not that consultation never works but that it does not work very often, and that is particularly true when it comes to fraught issues such as closing local services. I think that the time has come when we have to seek some alternative methods of empowering patients and the public, but at the moment we have to go with what is on offer. Although I have enormous sympathy with a number of the bodies suggested in the amendments, I attach my name particularly to carers, principally because I am working with carers and because I am one myself. Caring for an elderly, dementing close relative is miserable and life-restricting. However, I know that other carers have a much more difficult life than I do and that they address their difficulties very bravely. The noble Baroness, Lady Pitkeathley, mentioned the 6 million or so who literally give their lives for years on end to care for someone else, and often it is not a choice but a duty. They are the heroes of our society and we should give them all the help that we can. Knowing their rights as set out in the constitution will, I think, help. In 10 years’ time the world will be different and their input in revising the constitution will be of considerable value. They have first-hand knowledge of the strengths and weaknesses of the NHS and they should be listened to. In recent years, we have included the word ““public”” when talking about patients—patient and public involvement, or PPI. It may have been the noble Baroness, Lady Pitkeathley, who said that when this is mentioned it is usually followed by the plaintive little cry, ““How about the carers?””. Could we adopt the phrase ““patient, public and carer involvement””, or PPCI, as part of our regular terminology? That seems to me to be very simple. Words are important. They frame a mindset, and PPCI would become as natural to us as PPI. It would ensure that carers were always included, as they are not patients. Some are patients in their own right but, in this context, they are people who care for others and are not mere members of the public. I think they should have a distinct status in our society and in the legislation that we draw up.