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Health and Education

I welcome the equality Bill, but one has to ask why age has been left out of the list of discrimination that the NHS constitution seeks to tackle. We all know that age discrimination happens in the NHS. There is clear discrimination in mental health services: for example, elderly people who suffer from depression and anxiety do not have access to cognitive behavioural therapy. My hon. Friend the Member for Leeds, North-West (Greg Mulholland) is right that we should deal with discrimination based on age as well as that based on other matters. The amendment encapsulates the priorities that we should address, although I do not believe that the Conservative programme tackles them properly or effectively. They include quality of care and outcomes, on which it is right to focus, as well as accountability. Sadly, the Conservative approach—establishing an independent national quango—would reduce rather than increase accountability, but the amendment is right to refer to it. It also mentions the need to tackle bureaucracy, to ensure value for money, to have a renewed focus on public health—the area that has so often suffered when the finances have got tight—and to tackle health inequalities. Earlier this year, a King's Fund report said:"““If the NHS constitution did not confer any legally enforceable rights or guarantees it would, similar to the Patients' Charter””—" that was the thing that the Conservatives came up with—"““before it, be seen as a political device that simply raises expectations, which then cannot be met. Indeed it would hardly be worthy of being called a constitution.””" That identifies the real risk of this document, which is that it will raise expectations. People will assume that will deliver something to them that is not being delivered, but ultimately it will amount to motherhood and apple pie, and there will be no extra delivery. Will there be any legally enforceable rights or entitlements within this constitution? It seems that there will not be; the sanctions for breaching the NHS constitution do not appear anywhere. Trusts will have to ““have regard to”” things—that wonderful legal phraseology means, of course, absolutely nothing, because one can be acting entirely within the legal framework if one has regard to something and then entirely ignores it. [Interruption.] I shall ignore the abuse from the hon. Member for Wolverhampton, South-West (Rob Marris), which is so uncharacteristic. The proposals contain a reference to the responsibilities of patients, but what does it amount to? There is no substance to it. What about the issue of missed appointments? Missed appointments cause the NHS enormous additional costs, and many are avoidable. We can do a lot to reduce the number of missed appointments, by using technology and sending text messages, emails and so on—but should we not be considering the idea of charging people, where appropriate? We should recognise that some people's condition means that they may be unreliable—[Interruption.] Well, there was a great intake of breath from the hon. Member for Bury, North (Mr. Chaytor), but if we are talking about responsibilities, where are they set out? They appear to be entirely nebulous. If we are not talking about responsibilities in any meaningful sense, we should not even use the word.