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Earl Howe moved Amendment No. 77:

Page 11, line 14, at end insert--
("( ) In monitoring and improving the quality of health care which it provides to individuals, it shall be the duty of each NHS Trust to ensure that it takes account of the need to meet or exceed any relevant national standards.").

The noble Earl said: If there is one issue addressed in the Bill which engages the average member of the public, it is surely the quality of NHS healthcare.

We are debating the Bill at a time when standards of care and the levels of professional skill are high in the public consciousness, for a variety of reasons--not all of them happy. It is therefore absolutely appropriate that a Bill of this importance should contain provisions which acknowledge the public's justifiably high expectations of the health service.

It is slightly disappointing that only one clause is given over to the issue of monitoring standards and improving the quality of care. I am very sorry about that. Although I understand all the arguments about cluttering up the face of the Bill, the contrast between Clause 13 and the detail with which the commission for health improvement is described, for example, could not be more marked.

The so-called "quality agenda" is substantial. One of the main planks of that agenda is the implementation of clinical governance arrangements. As we know from last year's White Paper, those arrangements are multi-faceted and complex. The way in which they are implemented is of absolutely critical importance to their success. Part of that depends upon adequate resources but part also depends on the actual mechanisms by which PCTs and NHS trusts monitor care. There will have to be, for example, a continuous process of audit by which standards of care are measured, and the results of that audit will need to be published. Alongside that process of monitoring, there should be a means of collating outcome data on a national basis so that individual trusts can compare their work with that of others.

We are all well aware that NICE will produce guidelines on clinical care. However, in particular areas of clinical care, guidelines already exist, prepared by the Royal Colleges, specialist societies and other organisations. Those national standards of clinical treatment are formulated by consensus between the relevant stakeholders. Some of those guidelines are pan-European. There are good examples of national standards in relation to the treatment of hypertension and diabetes and with regard to renal services.

I feel strongly that some provision in the Bill ought to acknowledge the need of the NHS to comply with national standards, from whatever source. I shall be most interested to hear the Minister's response. I beg to move.

Baroness Sharp of Guildford: I rise to support the noble Earl, Lord Howe, in this amendment. I take on board the points made in the previous debate on Amendments Nos. 74 and 76, that there is a danger of over-monitoring and of having to produce too many reports on one thing or another. However, it is essential

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that this clause has some teeth. That is why we believe that the three amendments are worth supporting and that is why we support Amendment No. 77 in particular.

Baroness Carnegy of Lour: Perhaps I may support the amendment briefly. It seems so much better to talk about,

    "the need to meet or exceed any relevant national standards",
than to refer to "equality of treatment". There is no such thing as "equality of treatment" because needs are never absolutely equal. However, treatments should measure up to the national standard. This seems an excellent amendment and the Government should certainly consider including such provisions in the Bill.

Baroness Young: In considering what seems a very important amendment, will the Minister compare these provisions with what has happened in the world of education? When league tables and other standard measurements were introduced, there was considerable criticism and it was said that they were not a good idea. In fact, the Government have now accepted them and it has been recognised that, once there is a nationally accepted standard of measurement, standards are levered up. I am in no sense criticising the National Health Service, but it must be the intention of everybody to apply the standards of the best to all. One way of doing that is to have national measurements. That is what lies behind my noble friend's amendment and it deserves serious consideration.

Lord Walton of Detchant: When the Minister replies, will she take note of the fact that, in the medical profession in particular, there has been a tremendous move towards the regular audit of clinical procedures during the past few years, guided by the advice of the medical Royal colleges and facilities? Only two weeks ago, the General Medical Council agreed that in the future all doctors would be subject to a revalidation of their performance and of their clinical skills and competence. Although I have every sympathy with the amendment and, indeed, support its underlying objectives, will the Minister accept that there has already been a tremendous move towards fulfilling those underlying objectives?

Baroness Fookes: I warmly welcome the amendment, especially in relation to national standards. In his amendment, I hope that my noble friend is considering also the prevention of ill health. That is a very important matter to which, in the past, we have given insufficient attention. I should like to see the prevention of illness included in the national standards. It may well be, but I seek the Minister's views on that.

Baroness Hayman: Like the noble Lord, Lord Walton, I agree with Members of the Committee who have spoken about the importance of national standards with regard to our overall aim of increasing the quality of treatment given to patients and the quality of the healthcare that is provided. That was why I said, when speaking to an earlier amendment, that the guidance that

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we shall publish shortly on the implementation of clinical governance will set out the core content of clinical governance reports from all NHS bodies.

I am sure that it is inadvertent that the amendment applies only to NHS trusts. I am sure that we would all want primary care trusts equally to fall within the spirit of the provisions. As well as evidence of user and carer involvement, those reports will have to state the progress made on implementing the national service frameworks and the guidelines from the national institute for clinical excellence. Trusts must take full account of authoritative national standards and guidelines where they exist, and, in particular, what we hope will be the "gold standard" guidelines from the national institute for clinical excellence.

The noble Earl said that some national guidelines already exist and that we do not have to wait for them to be introduced. He is absolutely correct, but those many national guidelines are not necessarily the authoritative national guidelines. Sometimes, there are conflicting national guidelines on the same subject. Simply seeking to include national guidelines on the face of the Bill could cause problems. We must be certain about them. One of the main reasons for establishing the national institute for clinical excellence is that we want to have appropriate national standards.

Equally, it is important to emphasise that decisions about an individual's healthcare must continue to be taken by clinicians and the patient, based on clinical need. However much standards and guidelines are issued, doctors will still be responsible for clinical decision-making, and doctors and patients together will still make the final decisions on individual cases. Ultimately, guidance from NICE will do exactly what that word implies: it will offer advice. It will not be compulsory.

Perhaps I may remind Members of the Committee of our earlier discussion on the care of the elderly. The elderly are recognised as a patient group among whom there is very seldom one single condition about which a national guideline could be issued as the sole guidance on the care of such patients. We are trying to move to a more holistic approach and to look at the needs of the elderly overall. Indeed, the interaction of an individual's other particular health requirements might militate against the idea of strict and rigid adherence to any particular national standard.

As I have said, we accept the thrust of the amendment. We shall issue guidance to ensure that NHS trusts and primary care trusts report on their progress. Pursuit of a consistent standard of high quality treatment and care across the NHS is our aim. I hope, however, that I have been able to explain to the Committee why I do not think it necessary or appropriate to take the path set out in the amendment.

Earl Howe: This has been a useful short debate. I am grateful to the Minister for her helpful comments. Perhaps I should have tabled another amendment containing a subsection defining the phrase "national standards".

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I believe that those Members of the Committee who have spoken have been in general agreement with the thrust of the point that I was trying to make and I am grateful to the Minister for echoing that agreement. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Baroness Thomas of Walliswood moved Amendment No. 78:

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