Health Bill [Lords]

We have had a wide-ranging debate, with contributions from all parts of the House that touched on almost every aspect of the Bill. I do not think that I will be able to cover all those issues in my closing remarks, but I am glad that the main thrust of the Bill is broadly welcomed by all parties. It was almost a year ago that my noble Friend Lord Darzi produced the landmark next stage review of our national health service. That review was our opportunity to examine what we want for the NHS in the years and decades to come. I point out that that review emphasised the strong foundations that Labour's record investment and reform in the NHS has achieved over the past 12 years. The NHS has gone from having a budget of some £35 billion in 1997 to one of almost £103 billion in 2009—a real-terms increase of more than 100 per cent. That is in stark contrast to the decades before. We have gone from waiting times for operations of 18 months in the 1990s to the shortest waiting times ever recorded in the NHS. Some 2 million more operations are performed a year than in 1997. There have been dramatic reductions in the number of people dying from cancer, and virtually nobody now waits more than three months for a heart operation. The hon. Member for Wyre Forest (Dr. Taylor) acknowledged those massive improvements, and he reminded us that we also abolished prescription charges for cancer patients; he wanted us to go further. We are determined to go further. We want to build on that unique success of a Labour Government. For the future of the national health service, we asked patients, the public and staff what they wanted from their health service in years to come. The result of that extensive, bottom-up consultation will be a health service that builds on that success and puts quality at the heart of its future. It will be a national health service where patients' choice and patient experience is key to driving up the quality of services, and where power to shape and improve services is devolved to the lowest possible level. The Bill will provide the legal framework to achieve the ambition of the next stage review. We have debated the NHS constitution. The first ever national health service constitution provides an opportunity to safeguard the future of the NHS, reaffirming its core values and refreshing them for the 21st century. I can tell my hon. Friend the Member for Dartford (Dr. Stoate) that the Bill will ensure that the constitution is reviewed at least every 10 years. The Secretary of State will have the ability to revise it in the meantime, although we anticipate that those revisions will be relatively minor amendments to keep the constitution up to date. I say to the hon. Member for Romsey (Sandra Gidley) that the Bill proposes a new legal duty for all NHS bodies, primary care services, and third-sector and independent providers of NHS services to have regard to the constitution in all their decisions and actions. To my right hon. Friend the Member for Rother Valley (Mr. Barron) I say: yes, the constitution does talk about patients and the public, and their responsibility for their own health and how they behave towards the NHS; that is in clause 2. For the benefit of the hon. Member for South Cambridgeshire (Mr. Lansley), I point out that the constitution includes staff, too. Clause 3 spells out the rights and responsibilities of NHS staff, and commits the NHS to ensuring that staff have clear roles and responsibilities, have personal development and training and line management support, and are engaged in decision making. For the record, the hon. Member for South Cambridgeshire said that there were no new rights in the constitution; he could not be more wrong. There are three new legal rights in that constitution—the right to make choices about NHS care, the right to vaccines, as recommended by the Joint Committee on Vaccination and Immunisation, and the right to rational decisions about the funding of drugs and treatments. The handbook accompanying the constitutions sets out rights relating to whistleblowing—a point made by the hon. Member for Wyre Forest in his contribution. The hon. Member for Romsey and other Liberal Democrat Members spoke about integrating health and social care. The hon. Lady is right. She will be pleased to know that we will shortly publish a care and support Green Paper. The issue has been debated in the other place, and a central part of the Green Paper will deal with integrating better health and social care. The hon. Member for Romsey raised the question of people with visual impairments accessing information from and about the NHS. Yes, the NHS constitution sets out the right not to be discriminated against in the provision of NHS services on the grounds of disability—and yes, disability, which will include visual impairment, is one of the seven equality strands in the Equality Bill. Different parts of Government working together closely on both topics are making sure that the Equality Bill and the NHS constitution go hand in glove. We spoke a great deal about quality accounts. Health care organisations are at the cutting edge of quality, and we recognise that public reporting can be a spur to the improvement of quality in the NHS. The Bill will place a duty on all providers of NHS services to produce a quality account, setting out information for patients, the public and staff on the quality of the services that they provide. That information will be easy for the patient and the public to understand. I want to assure the hon. Member for Ilford, North (Mr. Scott) that we are working closely with clinicians and others to develop the new measures so that robust quality data feed into those quality accounts. Our aspiration is not just to achieve minimum standards in the NHS, but to strive for excellence and the highest quality of care for all. Quality accounts will make services more accountable to patients, carers, managers and clinicians, and will allow clinical teams to benchmark their performance, and commissioners and providers to agree on priorities for improvement. I say to the hon. Member for South Cambridgeshire that this is one of the issues that will come up for debate in Committee. There is an extensive and inclusive process under way to design the content of quality accounts. All foundation trusts nationally and a variety of other organisations, including the East of England strategic health authority region, are involved. A full consultation will follow. It is right, as I hope the hon. Gentleman would agree, that quality accounts should include a core of nationally consistent information that reflects national priorities. Our ambition is that they go further and reflect local priorities to improve accountability to local people. We debated direct payments this afternoon. During the consultation for the next stage review, people said clearly and consistently that they wanted greater control of and influence over their health and health care. The Bill will enable primary care trusts to pilot the use of direct payments for health care as part of our wider programme for personal health budgets. If successful, those direct payments may be rolled out nationally through secondary legislation, subject to the approval of Parliament. My right hon. Friends the Members for Rother Valley and for Makerfield (Mr. McCartney) stressed the importance of that. We must get it right, which is why we are piloting personal health budgets, with 70 pilots now approved across every strategic health authority area, covering a range of services and conditions, including long-term conditions, mental health—a point raised by the hon. Member for Romsey—end-of-life care, and services for those with learning disabilities. The right hon. Member for North-West Hampshire (Sir George Young) made a thoughtful contribution about how personal health budgets and direct payments will work in practice and the longer-term impact on the national health service. They will include advocacy and support, as he suggested. The pilots were intended to tease out and explore all those issues before we move to secondary legislation. We will, of course, put in place independent evaluation and we will publish the findings. The evaluation will take place alongside the pilots, and we will roll out direct payments for health care only after a review of information gathered from the pilots. The hon. Member for Eddisbury (Mr. O'Brien) mentioned innovation. We want to actively challenge people to develop new solutions to some challenging health problems, particularly in areas where innovation appears to be lacking, and we want to reward the best innovation when we find it. My hon. Friend the Member for Dartford (Dr. Stoate) helpfully identified the value of innovation, particularly in information and communication technology. The new innovation prizes are for innovations that directly benefit patients and the public, and the Bill will provide greater flexibility to reward those who are innovative and help to foster a culture of enterprise and innovation. I agree with my right hon. Friend the Member for Rother Valley that the prizes need to go further than grants for research, so we will engage staff from all parts of the NHS in that process. We propose to make available a prize fund of £5 million a year for three years, and it will be available to individuals and organisations, because both have valid contributions to make and flexibility is vital. The hon. Member for Eddisbury mentioned trust special administrators. The majority of hospitals and trusts are performing well and providing high-quality services, but, in the rare cases where a challenged trust fails to turn itself around, it is important to set out clear processes to resolve that failure. The post of trust special administrator, which the Bill creates, will ensure that the organisation continues to provide safe and effective services for patients throughout the regime, and the administrator will then produce a report and consult on proposals for the future of services. The Government are committed to the fundamental principle that all NHS providers must focus primarily on the provision of care to NHS patients. That is the governing principle behind the private patient income cap, which limits the income that foundation trusts can lawfully earn from private health care. The principle is non-negotiable, but the Government do not want to stand in the way of establishing a fairer system for foundation trusts. There were various contributions on that issue and, in the other place, we gave a commitment about our intention to begin a review, following the outcome of the ongoing judicial review of the existing legislation. The question is: how do we create the right balance between protecting NHS services to NHS patients and allowing foundation trusts the flexibility that they need to operate effectively and in the best interests of patients? It is vital to ensure that any new legislation is workable and has broad support from the NHS and all key stakeholder organisations. We can see that the issue is complex, because we had that debate this afternoon. We should not rush through a quick fix; we need to get it right. I am pleased to say that all parts of the House broadly welcomed the pharmacy provisions in the Bill and the measures, which the hon. Member for Ludlow (Mr. Dunne) mentioned, meaning that an individual service-user and anybody acting on their behalf will be able to raise—[Interruption.]