My Lords, I thank the Minister for introducing this Bill. I draw the attention of the House to my interests: I was a non-executive director of a health authority, and am chair of ISCAS, the Independent Sector Complaints Adjudication Service.
I welcome the Bill in so far as it contains changes that the NHS requested, promoting local collaboration and reducing bureaucracy. My only hesitation is how such a fundamental reorganisation will affect the NHS when it is already under such huge pressure from the pandemic.
While the Bill is mostly structural, the real test is whether it will deliver positive change for patients. I note that one of its aims is to deliver a range of targeted measures to support people at all stages of life. In the debate on 14 October, the noble Baroness, Lady Finlay, spoke movingly about hospice and social care. Can my noble friend please tell me whether the integrated care systems will have a duty to commission end-of-life and palliative care services to meet the needs of the population? I think I was told that, at present, 60% of these have to be raised from charity, which is unimaginable for other forms of healthcare. Surely, end of life is a critical and essential time when a patient needs most support.
Continuity of care is also a very important factor, especially in the care of the very young and the very old. In the debate of 14 October, I cited an article in the Times about a Norwegian study published in the British Journal of General Practice, which demonstrated the benefits of having the same GP for years. It showed that those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year, rising to 30%, 28% and 25% after 15 years. It was stated:
“It can be lifesaving to be treated by a doctor who knows you.”
Yet in the UK, GP practices are becoming bigger, and the relationship between doctors and patients less constant. While patients over 75 in the UK are also given a named GP, some doctors interpret this as just having to look at patient records. While I understand that patients who wish to be seen urgently cannot always see their GP that day, how can a doctor deliver appropriate and responsible care of a patient without ever meeting them?
To deliver good healthcare and care needs good staff, and the BMA estimates that the NHS is currently facing a shortfall of 50,000 doctors. Many GP practices seem overstretched. Can we ensure that we train more GPs and change the system so that it is advantageous for them to work in GP practices rather than as locums? I know that many people now feel that they have to fight to get an appointment with a GP, or are simply unable to get one. We need to ensure that carers, both paid and unpaid, get the recognition and status that they deserve. A good carer is invaluable and we have a shortage of them too.
I hope that these changes in the Bill will ensure more focus on prevention rather than cure—reducing smoking and obesity, ensuring a better diet and other initiatives would result in a healthier nation. Health checks and screening are also important, to pick up issues such as cancer earlier, when it is easier to treat. Checks for older people are also vital to pick up issues early so that they can lead fuller lives and thus need less care—which all reduces the burden on the NHS.
Part 4 of the Bill will establish the Health Services Safety Investigations Body in statute. The impact of clinical negligence on a patient and their family can be
devastating. Moreover, the costs have quadrupled in the last 15 years to £2.2 billion in 2020-21, equivalent to 1.5% of the NHS budget and eating into resources that should be available for front-line care. Surely we urgently need to find a better way to deal with these cases rather than resorting to law, which can take years to settle, putting a patient through yet more stress. I gather that nearly a quarter of the costs of clinical negligence go to legal fees.
I congratulate those who campaigned—and welcome the provisions—to make the practice of virginity testing an offence. It is a horribly demeaning process and an abuse against women. However, surely it is inextricably linked with hymenoplasty, and any commitment to ban it will be undermined if we do not ban them both together.
To conclude, in welcoming this Bill I am mindful that how we treat our elderly, infirm and ill of health is a measure of our society. We must not be found wanting.
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