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Baroness Noakes: I thank the Minister for that response. Indeed, I thank the noble Baronesses, Lady Northover, Lady Finlay and Lady Masham, for their contributions to the debate. I was encouraged at the end of the Minister's comments that this was being kept under review by the Government. It might seem churlish of me to say that what I heard before that perhaps was not so encouraging as it seemed to resist the notion of an independent inspectorate reporting in the successful mode that the noble Lord described earlier today in relation to its other responsibilities. We were trying to take that success and the ability to penetrate to other real issues and to spread that across.
It is not right to pursue the matter today. We shall think further on it in the light of what the Minister said about the Government's future action. I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakes moved Amendment No. 100:
- After Clause 14, insert the following new clause—
The noble Baroness said: The amendment would insert a new clause after Clause 14 and would place a duty on the Secretary of State to ensure that people receiving services in the National Health Service are given a choice as to time, manner and location of those services.
I shall quote from a recent speech, which states:
Only a few days ago, the Department of Health issued a document entitled, Extending Choice for Patients, which deals only with the rather modest extension of choice to long waiters for heart surgery; but it is a move in the right direction and we welcome it.
Several noble Lords remarked on Second Reading and elsewhere that the Government's policies have moved on in several respects since they introduced the Bill. We think that it is unsatisfactory that when the Bill has completed its passage the National Health Service will still not have a definitive statutory framework representing current government policy. It is not satisfactory for the Government to announce a series of changes that are not reflected in the Bill.
I am sure that the Minister is aware that we have reservations about many of the Government's policies towards the National Health Service, but we think that this issue of patient choice is one thing that the Secretary of State has started to get right. We agree with it and we want to support him in his new conversion to our ideas by seeing a positive duty to achieve patient choice in the National Health Service legislation.
The Secretary of State said that patient choice would be achieved within four years and I do not believe that that is inconsistent with the wording of the new clause, which refers to,
Lord Hunt of Kings Heath: I warm to the habit of the noble Baroness, Lady Noakes, of referring to speeches made by my right honourable friend. I am glad that she finds them so interesting.
The question of patient choice is extremely important. Any vision of a modern National Health Service would need to involve patient choice. The noble Baroness, Lady Northover, referred earlier to information that helps patients to make informed choices. We all agree with that, but I do not think that it would be appropriate to put the matter on a statutory basis. It is much more a question of policy to be decided by the Secretary of State. We have signalled that greater choice is very much a part of what we seek to do.
By 2005 all patients will be able to choose the date, time and place of their treatment. One of the must-do targets set out in the National Health Service plan is that by the end of 2005, all patients will be able to seek treatment at a time that suits them. That is a clear and public commitment. Through the additional resources that we are making available to the National Health Service for the next year, we are demonstrating our commitment by piloting patient choice from July. At that time, patients with coronary heart disease will be able to benefit from patient choice. When a patient has been on an in-patient waiting list for coronary heart disease treatment for more than six months, he or she will be offered swifter treatment in a different National Health Service hospital, or in the private sector, or in another EU country. We are looking to extend the pilots across other specialisms and in different areas. It
As part of our proposals for patient choice, we have made it clear that patients should be able to choose where they are treated. Patients and their doctors will be able to consider a range of options. That might be at the local NHS hospital or at diagnostic and treatment centres or in the private sector or overseas. We want patients to be able to compare different waiting times in different hospitals and across different specialties. We want GPs and referring consultants to be able to book appointments online.
That surely is, as I have said, the vision of a modern health service. I do not think that it is appropriate to place on the statute book in primary legislation the wording that the noble Baroness has suggested. At the end of the day it falls to government Ministers in their accountability to Parliament to decide on the National Health Service. That is what we have done. I have made it clear that patient choice is a priority. I have no doubt that we shall deliver on that. But it is very much a matter for Ministers to make those decisions and in turn to be accountable to Parliament for so doing.
Baroness Noakes: I thank the Minister for those comments. I am perplexed. I had understood him to be moving in the direction of patient choice—that is what he outlined to us—but he said that somehow having the duty of patient choice was not appropriate. I did not hear why it was not appropriate, other than it was something to do with policy decided by the Secretary of State.
The Government show a great lack of commitment to the principle of patient choice, if that is something that the Secretary of State wishes to keep to himself and to prioritise or de-prioritise from time to time. In the light of those comments, we should rightly be sceptical of the Government's apparent conversion to patient choice. I want to think about the matter further. In the meantime, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Noakes moved Amendment No. 101:
The noble Baroness said: In moving Amendment No. 101, I shall speak also to Amendments Nos. 102 to 104.
The amendments are important because they deal with patients' experience of the NHS throughout the times that they have to wait at various points in the system. The amendments focus on the areas of patient experience which the Government believe to be important, because they included them in the NHS Plan.
Amendment No. 101 introduces a new clause which sets up the basic framework of targets for patients. It provides that the Secretary of State has a duty to achieve some basic waiting time targets for patients; namely, not having to wait more than 48 hours to see a GP, 13 weeks for an outpatients appointment, six months for an inpatient or other treatment, more than a hour in accident and emergency before being seen or waiting more than four hours for admittance from accident and emergency.
Those are largely the targets which were spelt out in the NHS Plan. The plan referred to a "war on waiting". These targets in the light of our current experience of the NHS might well seem ambitious. However, if one looks to the experience of other European countries the acceptable times are much shorter than the times that we have included. So these are not perhaps very ambitious targets.
Regardless of whether or not the targets are ambitious, it is far from clear whether those set out in the NHS Plan will be achieved. Last year the Audit Commission reported on accident and emergency performance. It noted that waiting times had got worse since 1996.
Professor John Yates, recently writing in the Health Service Journal, noted that some of the waiting time data are showing some worrying trends. One of his conclusions was that the rate of sustained waiting time reductions needed to deliver the targets has never been achieved in the past, with the implication that the targets are likely to be missed.
Patients need to know that these minimum standards will move from aspiration to reality. That is why the proposed clause lays the responsibility on the shoulders of the Secretary of State. It allows him to introduce additional targets and set shorter targets. It is not the Government's intention, I imagine, that the targets in the plan are desirable end states.
Simply placing a duty on the Secretary of State to achieve a target says nothing about what should happen if he fails. Amendment No. 102 requires the Secretary of State to set up compensation arrangements. Patients want to be treated, not compensated for non-treatment—but some form of compensation, which it is left to the Secretary of State to make by order, should concentrate the minds of service deliverers and make it clear to patients that it is their right to receive treatment within certain minimum periods.
The compensation scheme would take effect in 2004, except for the 13-week and six-month targets, which are given a date in 2003. I am sure that the Minister will say that those deadlines are tough compared with the 2005 of the NHS Plan but I doubt that dates alone will be the sticking point with these amendments.
The Secretary of State cannot be expected personally to achieve patient targets so Amendment No. 103 allows him to delegate the duties and compensation scheme to primary care trusts, NHS trusts or strategic health authorities.
It is no exaggeration to say that patients have been let down by the Government who have promised much but delivered little. The amendments put patients at the heart of the Government's responsibilities to the NHS. I beg to move.
"PATIENT CHOICE
It shall be the duty of the Secretary of State in carrying out his functions under the 1977 Act to ensure that so far as it is reasonable for him to do so, persons who receive services under the 1977 Act are given a choice as to the time, manner and location of those services."
"The balance of power has to shift decisively in favour of the patient ... Patients throughout the National Health Service, helped by their referring GP, will be able to make informed choices about how they are treated, when they are treated and by whom they are treated".
That could easily have been said by my honourable friend Dr Liam Fox, and it could also easily have been an extract from Working with Patients—the White Paper which heralded the National Health Service reforms of more than a decade ago. But no, it is an extract from a speech made by the Secretary of State for Health in January this year.
"so far as it is reasonable for him to do so".
If the Government would prefer a more definite commencement period, I am sure that the new clause could be amended to that effect. I hope that the Government will welcome the amendment. I beg to move.
10.30 p.m.
After Clause 14, insert the following new clause—
"Targets for patients
(1) It shall be the duty of the Secretary of State to achieve the following targets for patients—
(a) no patient should wait more than 48 hours for an appointment to see a general practitioner,
(b) no patient should wait longer than thirteen weeks from the time of referral from a general practitioner for a first appointment to be seen as an out-patient,
(c) no patient should wait longer than six months from the time that he is first seen as an out-patient for the procedure or other treatment decided upon,
(d) no patient should wait longer than one hour after arrival at an accident and emergency unit or similar unit before being seen by a doctor or a qualified nurse practitioner, and
(e) no patient should wait longer than four hours for admittance to a hospital from an accident and emergency or similar unit after a decision has been made that he should be admitted to a hospital.
(2) The Secretary of State may by order define how the targets set out in subsection (1) are to be measured.
(3) The Secretary of State may by order add to the targets set out in subsection (1) or alter those targets so that shorter times are specified.
(4) The Secretary of State may by order set targets for shorter times than set out in subsection (1) for defined categories of patients or services.
(5) An order made under subsections (3) and (4) shall not be made unless a draft of the order has been laid before, and approved by a resolution of, each House of Parliament."
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