Health Bill [Lords]

It gives me great pleasure to follow the right hon. Member for North-West Hampshire (Sir George Young), who talks with great authority about smoking and comes up with extremely important points. As he rightly noted, he is well ahead of his Front-Bench colleagues on the issue, and all power to him. I am sure he will support the measures, as he has promised to do. One of the advantages of a health Bill from my point of view is that it gives me the opportunity to rehearse a well-worn mantra the House has heard many times—"As a practising GP". I do not say that lightly, because it is a serious point. I am proud to be an NHS general practitioner. I am very proud indeed to be on the front line, implementing some of the policies that I have helped my Government to pass over the past 10 years or more. That is an important point because it genuinely informs my work in the House—on the Health Committee, which my right hon. Friend the Member for Rother Valley (Mr. Barron) chairs so admirably; as chair of many all-party Back-Bench groups that do a lot of work behind the scenes; and in debates in the Chamber. Ultimately, the proof of any Bill is in its implementation. Our debate and rhetoric in the House do not matter; what matters is how a Bill, when it becomes an Act, affects the lives of people out there. When a health Bill has been through all its stages in this and the other place and has become law and is implemented, I am in a position to judge at first hand how it affects the running of the health service and its direct impact on the health of my patients. As we have heard, the Bill sets up an NHS constitution—an idea I thoroughly support—which will make a big improvement in the way that patients engage with the NHS. I hope it will improve the way they use the NHS so that they get much more from the service, which of course they pay for. Another aspect of the Bill is that it implements the parts of the NHS next stage review, so admirably run by Lord Darzi in the other place, that require primary legislation. They include provisions on the constitution, quality accounts and direct payments, as we have heard this evening. Despite great progress, the NHS still faces many pressures when it comes to achieving the goals set out in the NHS next stage review. We are a long way away from where we would like to be on the issue; we still have a considerable distance to travel. The next stage review makes it clear that to move forward, the NHS needs to spend time looking at how it can provide a more integrated service for its patients. For example, the review mentions piloting new "integrated care" organisations that bring together health and social care professionals from a wide range of organisations—community services, hospitals, local authorities and others—depending on local needs. The review also said that stronger support will be given to practice-based commissioning by providing incentives for a wider range of clinicians to get involved. That is an important point. That would enable GPs to work alongside other community clinicians and specialists working in hospitals to develop more integrated care for patients. I strongly support that drive towards more collaboration between health care professionals. I have always believed in the effectiveness of the NHS, but it has been severely hampered over the years by the chronic inability or refusal of primary and secondary care professionals to work genuinely in partnership. In the past, GPs and hospital specialists rarely engaged with each other in any meaningful way, while the relationship between GPs and community pharmacists was virtually non-existent in most parts of the country. Importantly, the new constitution emphasises the fact that the modern NHS is an integrated organisation that requires all its constituent parts to work in concert for the good of its patients, and that is long overdue. Although progress is being made in that area, it is clear that in parts of the NHS we still have a long way to go if we are to get the level of integration that we need. One of the main challenges is information technology, and that, in the main, is what I want to talk about tonight. Connecting for Health, which started its life as the national programme for IT, has been mired in controversy since its very inception. Problems with software packages, and to do with access and security standards, together with a woeful failure on the part of its commissioners to appreciate the complexity and scale of the undertaking, have caused severe delays in the roll-out of the NHS care records service, which, of course, is the centrepiece of the entire programme. Until we resolve that issue, we will never achieve the degree of integration that the next stage review envisages. As someone who does some general practice, I have encountered my fair share of IT problems over the years. The much-vaunted choose-and-book system, which is designed to link 30,000 GPs with almost 300 hospitals across the country, is a case in point. When it works, it is wonderful. It allows me to search the entire NHS database for clinics that provide the service that my patients require. It allows the patient to sit with me and choose which of those clinics they wish to be referred to. They can trade off factors such as parking convenience, the knowledge of a particular consultant, particular specialties within a department, and the ability to visit a hospital near where their family lives. All those wonderful things, which in the past were virtually impossible, are now possible with choose and book. A patient could say, "I'd much rather be seen in Birmingham, doc, because my sister lives there"—not a problem. As long as the option comes up on the choose-and-book website and meets the tariff requirements, I can book an appointment in Birmingham for them. When the system works, it works marvellously well.