---

Queen’s Speech

My Lords, I am delighted to participate in this wide-ranging debate. I intend to focus my contribution on the health element of the debate. I declare an interest as chair of an acute trust, Barnet and Chase Farm Hospitals NHS Trust, which delivers healthcare to people across north London. I do not recognise the health service mentioned by the noble Lord, Lord Freud, in relation to an 18-week target. For weeks my trust has met 18-week targets. We are now setting a 12-week target. That is happening all over the place. The picture that the noble Lord painted is unrecognisable to me as chair of a big trust comprising two district general hospitals. I hope that the noble Lord will take the opportunity to look at what is going on in trusts such as mine. In healthcare today our nation is facing enormous challenges from access and coverage to quality, safety, costs and value. The obligation of everyone engaged in the delivery of healthcare to protect the safety of their patients has been recognised since the time of Hippocrates. Over the past 50 years medicine has improved to the point where many previously life-threatening conditions can be controlled or even cured. This has brought enormous benefit but has also been associated with complacency concerning the primary responsibility of healthcare professionals to ensure patient safety above all else. An acute trust such as Barnet and Chase Farm Hospitals is responsible for providing safe, timely and high-quality care to our patients. To support this we have developed our patient experience strategy, which emphasises that we must put our patients at the heart of everything we do. This is the first thing we discuss at every board meeting to ensure that we always know how we are doing and where we need to focus our attention to achieve the quality of care that our patients are entitled to expect. People’s expectations are changing. They rightly want greater choice and quality and a more personalised service that meets their individual needs. Over the past 12 months, quality of care has been the driving force of change in my organisation. We recognise that patients have a right to the highest quality of care. Quality of care has been a focus for this Government. Initiatives have been launched that focus on the fundamental aspects of care that we know are so important to our patients. For example, we know that our patients prefer to be cared for in single-sex accommodation. To that end, and benefiting from central government funding, we undertook significant building work to transform some of our very outdated facilities to achieve that important element of privacy. We were delighted when the strategic health authority and the Department of Health came to visit our hospitals. They were very impressed with our effective use of funding. Usually one has a sense of trepidation about these visits, in case things are not exactly as they ought to be. This time, it was absolutely superb. Furthermore, we are working with City University and the Royal Free Hospital on a dignity and care project that focuses on the fundamentals of care and quality. For example, we are auditing the interaction between nurses and patients. This, combined with patients’ feedback, is a huge learning tool for our staff. Patients who were cared for in the pilot wards have fed back positively on the quality of care, and we have lessons to learn. There is a key role for patients and carers in the quality initiative. The involvement of patients and the use of case histories and personal stories are powerful tools to assist in the learning process at all levels, from the board to the ward to the department. My trust recognises that the feedback from the national patient survey is valuable; but it is annual and must be supplemented by more immediate feedback. To provide that, we have implemented the patient experience tracker. In addition, patients are encouraged to fill in "message to matron" cards, which are available on all wards and are used prolifically by patients. We have also just held our first "meet the matron" event in a local shopping centre, where passers-by were asked to tell us about their experiences as patients or carers. At first, everyone including the matrons was reticent; but throughout the day the feedback—both good and less good—was tremendously helpful. Patients’ experiences were shared with us and will be key areas for us to learn from. Our Government have rightly set challenging targets to reduce hospital-acquired infections. This approach, in association with unannounced inspection visits, raises and sustains the importance of best infection-control practices that encompass not only clinical practice but also high standards of cleanliness. Unfortunately, my trust was on the receiving end of an improvement notice 18 months ago after just such an inspection; but the difference that it made has been absolutely tremendous. We have seen significant reductions of hospital-acquired infections. Last year we saw a 50 per cent reduction in the number of MRSA infections. This has resulted in safer care for patients. Participating in centrally driven campaigns such as Leading Improvement in Patient Safety allows us to focus on learning from incidents and reducing the risk of them being repeated. It is our goal to develop long-term plans to make sure that first-class services continue to be available and to ensure that they are in the right place at the right time to meet the changing needs and expectations of our patients. We are also working closely with our primary care colleagues to integrate community and hospital-based care in order to provide better, more personalised services closer to home. That is what people and patients want—we have heard that from several noble Lords today. We are developing models of care that facilitate effective management of patients with long-term conditions—for example, diabetes and chronic obstructive pulmonary disease—to meet the needs of our ageing population. In line with the national End of Life Care Strategy that we have also heard about today, we are developing partnership pathways of care that will give patients better end-of-life care and ultimately a good death in the place where they choose to die. Overall, the Government’s drive has been to develop high-quality, safer care around patients’ needs. I hope that my examples have demonstrated how this important, quality-driven approach is being translated into reality in acute care. I look forward to contributing to the discussions on health and other aspects as this debate continues. I want to express the reality of life inside hospitals and make that part of our deliberations.