Health and Social Care Bill

My Lords, I shall speak to all the amendments tabled in my name, but before I do so I should like to thank all noble Lords who have joined their names to these amendments—and of course there are amendments tabled in their names as well. Given the size and complexity of the Bill and what it covers, my amendments may well appear to address minor issues, but on reading the Bill in detail—I have read it line by line—it occurred to me that there are some fundamental omissions, even if they concern only a single word. I must ask why, when the Bill is supposed to implement a reorganisation of the health service that will deliver world-class health outcomes, such important issues have been missed out. I shall address each amendment tabled in my name, and take Amendment 15 first. Clause 2 will insert a new clause covering the Secretary of State’s, ““Duty as to improvement in quality of services””. New subsection (2) states: "““In discharging the duty under subsection (1) the Secretary of State must, in particular, act with a view to securing continuous improvement in the outcomes””." It makes no sense to me if the word ““health”” is not inserted before the word ““outcomes””. We are talking about the health outcomes that are achieved from the provision of services. Equally, new subsection (4) states: "““In discharging the duty under subsection (1), the Secretary of State must have regard to the quality standards prepared by NICE””." I wonder why the word ““clinical”” is not before ““quality standards”” so as to emphasise that these have to be clinical quality standards. I am well aware that NICE produces technology assessments that are often referred to as technology standards, and that it writes standards in other areas, but they are all for the purpose of refining clinical care or developing eventual clinical quality standards that deliver clinical care. Perhaps I may say with some humility that I am aware of what clinical quality standards are all about, having for five years had the job of writing them. I am also familiar with some of the clinical quality standards written by organisations that we would regard as being the best in the world, such as the MD Anderson Cancer Center in Houston, Johns Hopkins in Baltimore, Harvard, the Mayo Clinic and others, including some Australian institutions. They all refer to quality standards as being clinical quality standards, because they are what matter in the delivery of care. Apart from that, those are the standards that the Commissioning Board will use to build packages of currency that Monitor will then use to produce tariffs, so if they are not clinical standards, what are they? In my view, it is clinical standards that will deliver the outcomes we seek, so why not call them clinical standards? Amendment 107 refers to Clause 20, which covers the duties and functions of the Commissioning Board. Proposed new Section 13E is entitled, ““Duty as to improvement in quality of services””. Subsection (3), which I seek to amend, states: "““The outcomes relevant for the purposes of subsection (2) include, in particular, outcomes which show—""(a) the effectiveness of the services,""(b) the safety of the services, and""(c) the quality of the experience undergone by patients””." That is the definition of quality standards that we are using, but it does not mention delivering better outcomes for patients. Why are these quality standards that will deliver better outcomes for patients not the standards that we want? If we do, why do we not put them in the Bill? It will alter the culture of people who work in the health service when they read language and words such as ““clinical standards”” and ““health outcomes”” for individuals or in practice. My noble friend Lord Warner tabled a similar amendment to which he will no doubt speak. My Amendment 109 would again introduce ““clinical”” to new Section 13E(4)(b) of the 2006 Act, so that ““quality standards”” would become ““clinical quality standards””. My Amendment 134 again relates to the duties and functions of the Commissioning Board. New Section 13L refers to the, ““Duty in respect of research”” and new Section 13M to, ““Duty as to promoting integration””. We have discussed integration previously, when I referred to an example of care for diabetics. New Section 13M(1) states: "““The Board must exercise its functions with a view to securing that health services are provided in an integrated way””." Why does it state ““an integrated way”” when it means ““a clinically integrated way””, as my amendment proposes? The patient will benefit from a service that is clinically integrated to deliver individual care, which will make a difference to their outcome. Amendment 179 again refers to the functions of the NHS Commissioning Board. New Section 14Q is headed, ““Duty as to improvement in quality of services””. It is very important. Subsection (1) states: "““Each clinical commissioning group must exercise its functions with a view to securing continuous improvement in the quality of services provided to individuals””." Again, it misses out the word ““clinical””. It is the clinical quality of services provided to individuals that will deliver continuous improvement and better outcomes. Subsection (2) also misses out the word ““clinical”” when it refers to outcomes, which my Amendment 181 would remedy. I repeat that the use of these words establishes a culture in practice. I know from long experience that these words are important, and these amendments include them.