Health Bill [Lords]

It gives me great pleasure to follow the only practising doctor in the House of Commons, the hon. Member for Dartford (Dr. Stoate). I have to admit that his speed of delivery sometimes leaves me feeling rather breathless, but I admire his turn of phrase. I welcome the new Secretary of State to his position. I remember arriving in 2001 at exactly the same time, and sitting on the Health Committee for at least two years with him. Since then, his rise has been somewhat more meteoric than my own rather pedestrian progress from this very same Bench all that time. However, I welcome him to his post and echo what the right hon. Member for North-West Hampshire (Sir George Young) said: to have mastered that brief in an extremely short time was pretty impressive. First may I say, as I have said many times, that there have been great improvements in the NHS, particularly on waiting times and on cancer and cardiac services? However, in some respects, all is still not yet well. The results of patient satisfaction surveys, to which reference has been made, are impressive, but they miss out some matters on which the health service is not working quite so well, and I am afraid that I must draw the Secretary of State's attention to one or two of them. We all know about Mid-Staffordshire, the failure of leadership and the failure of some staff to deliver quality or even safe care, but I have a horrible suspicion that that lack of quality, especially relating to dignity, compassion and communication, is more widespread. My hope is that the NHS constitution can address and alter the situation, but I shall give two examples of matters that have come across my desk recently. I referred to the first in a Westminster Hall debate on 14 May, but, as the Minister who heard me then is no longer in the same post, I shall repeat some of the points that I made on that occasion. I read out a letter, in its entirety, from an elderly couple who had lost their only son at 31 years old. I shall not put the House through the whole letter, but I shall read one or two extracts just to demonstrate that things are not all well. Those elderly parents said:""We would arrive to see him, to find him lying in a soaking wet bed, or worse."" They went on:""Our son had an infection under his nails and was unable to pick things up. This the staff knew about, so why were pills left in the little plastic cup…from the morning and lunch time. Maybe it was because he had no water jug or cup so he had nothing to drink."" They continued:""Lots of working people have long stressful days, and I know people who went into nursing as a vocation but sadly those days have gone. When someone is training for this job, I'm sure they must learn what is expected from them, and the meaning of the word nurse means to take care of and hopefully give a person dignity, which sadly our son didn't have at times."" They concluded:""We hope that if either of us should need to go into hospital in the future, that the cleaners do what they're supposed to do and our right to dignity is upheld."" I saw that couple in my advice surgery last Friday. They are still so upset that they cannot face putting in a formal complaint or allowing me to name them. In my view, formal complaints are not much use; they lead just to apologies—not, very often, to any particular change. Even in Stafford, the Healthcare Commission upheld many complaints, but the board either took no notice or was not even aware of them. In a second example, which was also raised in my advice surgery last Friday, a qualified nurse told me about her mother, who is 88 years old. She fell with a suspected hip fracture and was taken to an accident and emergency department at 7 o'clock. The family arrived at 10 o'clock, but she had not been assessed or seen. Eventually, she had X-rays and was admitted for review because no trauma and orthopaedics team was on duty until the next day. The daughter, a nurse, felt that there could not be a fracture, because her mother was pain-free and had good movement. Nevertheless, she had to be admitted so that she could be seen by an expert. She had gone six hours without fluids, there were no beds and she remained on a couch in the accident and emergency department. The next day, surprise, surprise, there was no fracture, but she was confused and immobile. When her daughter asked for a glass to give her water, she was told that the tumblers were only for tea, not for water. But this really capped it, the daughter says:""I was told by the staff nurse that she was dehydrated, confused and with a probable urine infection, but that it was not the nurses' role to make her drink anything."" The last straw came when the patient went to another hospital for rehabilitation; it was discovered that she had been having a large, wrong dose of a sedative in the morning instead of at night. Those are two examples that show that all is not going well. I hope that the constitution can do something about such problems. Not that long ago, when I was walking to the railway station, I saw a member of staff picking up fag ends outside the station. He said that it was easy to change policies, but very difficult to change people. I thought that extraordinarily astute. I turn to some of the rights under the NHS constitution. Under the heading "Respect, consent and confidentiality", it states:""You have the right to be treated with dignity and respect, in accordance with your human rights."" Under the heading "Quality of care and environment" are the words:""You have the right to be treated with a professional standard of care, by appropriately qualified and experienced staff, in a properly approved or registered organisation that meets required levels of safety and quality. You have the right to expect NHS organisations to monitor, and make efforts to improve, the quality of healthcare they commission or provide."" How will that be enforced? Somehow, Monitor let Stafford hospital through. I believe that Monitor could play a key role, and I hope that it will not let through other aspiring trusts that get the sort of complaints about basic quality of care that I am receiving. I am bothered about the complaints process. The lack of an automatic independent review is a disaster. As the Secretary of State will be only too well aware, to get an automatic independent review, a person now has to go to the ombudsman, who will be completely swamped. Patients and families will lose the will to persevere that far. It really is awful that a constitution should be needed to enforce such basic things. I am sure that at this time of year several of us go to mayors' Sunday services in our own patches. I was at one in the little town of Bewdley at the weekend. One of the readings was the parable of the good samaritan, whose moral is "You shall love your neighbour as yourself." We have forgotten the morals of such stories; we have forgotten some of the good parts of human nature. That takes me back to one of the things that we heard in New Zealand on our recent trip to look at the quality of care there. It was a question: "Will your hospital pass the granny test?" In other words, it asks whether a person would be happy for their granny to be treated at the hospital. I am desperately concerned that we have lost some of the basic duties of the caring professions. The Royal College of Nursing is to be congratulated on its work on dignity. I would like to refer the Minister to an article in May's Journal of the Royal Society of Medicine headed "Doctors and quality improvement". It is by Hockey and Marshall, and is well worth reading. I have a completely different concern about the NHS constitution. I have learned about the difficulties of whistleblowers in various parts of the country, and unless I have missed it, the protection for whistleblowers is not spelt out in sufficient detail or emphasised enough in the Bill. I turn briefly to the clauses on pharmacy. Unless I have missed something, they do not address most people's major concern, which is prescription charges. I know that people with cancer have recently been exempted from paying them, and that is absolutely marvellous. There is also an inquiry, headed by the president of the Royal College of Physicians, into treatment charges for long-term conditions. I would like the Secretary of State to make absolutely sure that prescription charges are likely to be exempted in the case of HIV/AIDS, as that is now a long-term condition. I was amazed to talk to renal experts in the west midlands who did not realise that transplant patients are not exempted from prescription charges. Such an exemption is essential given that they have to take anti-rejection drugs. A lot has already been said about smoking and the bits in the Bill relating to tobacco. As many Members have observed, as MPs we wear two hats. We are concerned about small businesses and corner shops, but we have a tremendous desire to stop the young taking up the smoking habit. The nanny state argument does not cut much ice with me. In the case of something like smoking in public places, which is so terribly bad for other people, not just the smoker, the nanny state does not come into it. I am afraid that some of these kids, who are starting to smoke at an amazingly young age, need the nannies of the nanny state to try to make them see sense. I have no objection to bans on advertising or on sales from vending machines. As other hon. Members have mentioned, covers are available which at the press of a button will obscure all the shelves with cigarettes on them, while the press of another button will expose everything, so without moving from the counter, the shop assistant can expose the products, get out the right thing, and then shut them up again. Cancer Research UK assures us that those covers cost only about £200. It would be a great help if small businesses could be given some sort of help with finding that £200—if it is true that it is only that much. Why, in some places, and from some clinical staff, have we lost some of the best features of human nature—politeness and consideration for others? About 400 years ago, Montesquieu, a French political philosopher, wrote:""The English are busy; they don't have time to be polite."" In some parts of the health service, people can claim that they do not have time to be polite, but that is absolutely no excuse. Webster's dictionary has got it right: it says that politeness is""marked by or exhibiting an appearance of consideration, tact, deference, courtesy or grace resulting sometimes from sincere consideration of others"." If the NHS constitution had teeth and reminded all staff that common courtesy and politeness are absolutely necessary, it could achieve improvements in parts of the NHS that have not yet been reached.