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Health and Social Care Bill

I shall speak in particular to Amendment No. 1, to which I have added my name. It is crucial that the objectives should be on the face of the Bill so that everyone knows why the inspectorate is there. There are powers given and the duties and responsibilities which go with them must be clearly laid out. Patients can move between different sectors and may often be in healthcare and social care—and possibly in mental health care—simultaneously. It makes sense to bring the regulators together, but that makes it all the more important that the objectives of the different branches that are now going to be jointly inspected are clear and consistent. As patients move between different sectors, they need to know that all the care they receive, wherever they are, is of a uniformly high standard. In health, they need consistency across the NHS, especially for emergency care provision—not only emergencies occurring outside in the community that cause them to be taken into hospital but also emergencies that arise as a complication of the treatment or investigation that they undergo. It is no good for a patient to be in a unit which is fine at dealing with something until it goes wrong and then have to be taken a long way in a helicopter and put at risk by inordinate delays because there is no adequate infrastructure to deal with complications. The word ““dignity”” is rightly used in the amendment, because there is now good evidence that care given in a way that enhances people’s sense of personal dignity, worth and well-being improves their recovery time. If anyone has any doubt about that, I refer them to the work of Harvey Chochinov, who has published several papers on the subject and done sound research into how care is given. Dignity is not an internal construct; it depends on the way that others interrelate with us, react to us and make us feel of value, and on the way that we are asked our opinion, consulted, and how our needs and fears are listened to and addressed. The word ““improvement”” comes up in two parts of the amendment, which is crucial. It is too gentle a word to describe what really needs to happen. I would like it stated clearly that ““improvement”” must encompass research and development, and the educational infrastructure that provides it. Improvement does not happen unless people continually reflect on practice, learn from it, and put in place education and training to improve standards and audit their care. When we talk about promoting independence, we have in mind particularly those services which sit between health and social care, such as occupational therapy, and which are of key importance. Physiotherapy and occupational therapy are often the services which help patients get home. If they are not in place, patients do not get home. The speed with which improvements in occupational therapy in particular are put in place can make all the difference between someone languishing in hospital and deteriorating and their getting home and beginning to resume independent living, with a raft of infrastructure support then being given. I anticipate the Minister flagging up some difficulties regarding the fourth objective, and I have some sympathy with him. I was unable, however, to come up with better wording. My difficulty is with that word ““choice””. In some aspects of service provision in health, it is extremely difficult, if not nigh-on impossible, to promote the exercise of choice and still provide appropriate clinical care, because there is always an outcry when local services are closed or rationalised. The only way to deliver new technologies cost-effectively and use them appropriately is to develop a critical mass and invest in them. A clear example of that is positron emission tomography, or PET as it is known. To turn on the PET scanner is inordinately expensive. The scans that one gets are brilliant and will influence clinical decision-making hugely, but it is not feasible for people to choose to have a PET scan rather than something else if it is not clinically indicated; nor is it appropriate for people to demand that their local service develops PET scan provision because of the complexities of delivering that technology, including the radiation source, which needs to be near a cyclotron. It is true that patients often ask for scans in the mistaken belief that a scan is some kind of magic investigation that can come up with all the answers, whereas the reality is that scans, whether they are CT scans, MRI or even, occasionally, PET scans, are undertaken to confirm a clinical suspicion of a diagnosis. A negative scan does not mean that disease is not present; it simply means that the amount of disease was not big enough to show up or cast a shadow on a scan. So there are some difficulties around the word ““choice””, but there is an important role for advocacy for patients. Choice is much stronger in social care, where people have a much better knowledge and awareness of what they need to continue living independently. However, even in the health service people need choices over what to where, what to eat, whether they want to be in with other people or whether they desperately want to be in a single room on their own. It is surprising how many patients feel more comfortable surrounded by other patients in a four-bedded bay because of the security of having others around rather than the loneliness of being in a side room. There are other choices that even in healthcare must be made available, such as the timing of medication. It is tragic to hear of Parkinson’s disease patients who are not given choice over the timing of their medication and whose condition deteriorates hugely during a hospital admission because they do not get their medication on time. In proposed paragraph (d) of the new clause, I wonder whether we need to look at the wording to make sure that people get the best quality care within the resources available and that there is a just allocation of resources to meet need rather than simply to respond to demand. With that caveat, I give my wholehearted support to having the objectives in the Bill. I could live with the wording as it is in the amendment rather than the alternative of not having the objectives there.