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Debate on the Address

My Lords, I, too, congratulate the noble Lord, Lord Darzi, on his opening of the debate on such a wide number of issues with such clarity. It is with pleasure that I support the concept of providing a healthcare system organised around the needs of patients, as proposed in the forthcoming Session in the gracious Speech. I also welcome the approach taken by the noble Lord in the London review, the interim report and the continuing work for the total NHS. It is important in creating organisational change to meet the needs of patients and that patients are involved in planning in a very real way, not just a token involvement but in a participative way. I recently witnessed that by attending the opening of the Royal Alexander Children's Hospital in Brighton, the planning of which I was privileged to start several years ago. Children and young people were involved in the planning and formed a young people's board. They took a central part in the planning and delivery of the operational policies. That was not just a token involvement but a real participation, together with representatives of parents and staff. The board met in the presence of the chief executive, but a young person took the chair—each taking it in turn. There were proper agendas, minutes and briefing papers. For example, they designed the cubicle curtains, interactive sculptures and a new time capsule. They also created a new Alex website with a gallery on the web, where young people could show the artwork that they had produced while they were patients. They also developed a play philosophy in partnership with the Alexander staff, which has now been adopted, alongside some of the patient care pathways. Several awards for that innovative approach have been given and the media attention has raised the profile of the trust. That shows a genuine commitment to involve children and young people in their new hospital. The provision of patient-focused care is possible for every specialty from obstetrics through all the acute and chronic diseases, including end-of-life care, mental health, and learning disabilities, but it requires special skills for engaging patients in a real way, rather than through a token consultation. I declare an interest: as part of my role as a regional nursing officer, I managed the change of the closure of two large institutions, each having more than 1,000 patients with learning disabilities, and transferring them to community care, each having an individual programme following assessment. The whole exercise took 10 years and much patience, involving patients and their relatives, training staff and involving the local authorities, especially the directors of social services, in transferring the services to the community. It was costly, but that service is now proving to be well managed by social care with health services giving support to meet healthcare needs. The noble Lord, Lord Darzi, is spending much time listening to staff and local people in his continuing review of the NHS, and I hope that the innovative ways of involving patients in the design of the new healthcare system will take a hold and that various models of good practice will be delivered so that the quality of care can be raised cost-effectively and efficiently. The management of such changes calls for a change in culture. For some healthcare professionals, the involvement of patients poses a threat. There is no need for this if there is someone to champion change. "““It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm””," wrote Florence Nightingale in 1883. It may seem even stranger that Her Majesty's Government propose to introduce in the new Session legislation to create a stronger health and social care regulator with a remit to ensure a clean and safer service and a high quality of care, but the need has sadly been made evident by the two recent Healthcare Commission reports into hospital acquired infection. Again, I declare an interest as a resident living nine miles from Tunbridge Wells and seven miles from Maidstone, and I am very aware of the great distress caused to patients, to relatives and indeed to staff and the community as a whole. Having studied the reports very carefully, I see that there is indeed a need for accountability and authority to be strengthened from the point of delivery of care to the board, with 80 per cent of care being delivered by nurses. The urgent need is to ensure that the ward sister or unit manager has the authority and accountability to deliver safe care, supported by clinical teachers from the universities to assist in ensuring that theory correlates with practice. The Nursing and Midwifery Council requires 50 per cent of training programmes to be spent in the clinical area. However, with the pressures caused by an overheated system, with bed occupancy often in excess of 95 per cent or more, students very often lack supervision. This requires a review of workforce planning, taking account of patient pathways and the numbers required to be trained and to deliver care, by the Strategic Health Authority in liaison with the universities. The retraining of sisters at ward level is essential if infection is to be prevented and the environment managed, as is providing clinical teachers, possibly with joint appointments between the universities and the NHS trusts, as has already happened in some cases. None of this can be effective unless there is an officer accountable at board level for the delivery of care, and the board must be as committed to the safe delivery of care as it is to balancing the books. This requires a training programme for all board members and will be successful only if there is a change in culture. It is interesting to note that the only NHS trust to have no MRSA for two years was the Royal Marsden, where controlling infection is a high priority and where at board level there is an officer accountable for nursing, catering and cleaning. I have concentrated on hospitals in the time available to me, but the same principles apply to community care. There must be accountability from the point of delivery of care through to the board, and there is a need to review the workforce planning arrangements between the SHAs, taking account of patient care pathways and the number of training places to be commissioned with the universities both at pre- and post-registrations levels, with the inclusion of more joint appointments of clinical lecturers supervising the delivery of care. It must be a false economy to cut training budgets, which the noble Earl, Lord Howe, mentioned. The absence of accurate workforce plans is an even more false economy, as is cutting advanced practitioners and specialist nurses who provide effective care. I look forward to taking part in various debates on the new Bills.