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It is important to realise that quality can be improved only at a local level. I have been here for 12 months on a part-time basis, and I reassure the House that no one in Whitehall alone can decide how to improve quality at a local level, or help to do so. Quality needs engagement of staff at a local level, and that is what the report has done. The spirit of the review over the past 12 months has been all about empowering clinicians locally to design models of care based on patient pathways, starting from birth and finishing off with end of life.
I am sure that, once the noble Earl reads the report, he will appreciate that all sorts of other policy themes will address the many good questions put to me about, for example, more foundation trusts—on which I could not agree more. We will be working with Monitor and others to both reinforce what we have been doing over the past 10 years and to have more providers obtaining foundation status. We are also extending that to the community services. This Government introduced the NHS tariff, and we will be working further on it by introducing a normative tariff, paying for the highest quality of care.
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There is a lot in the document about practice-based commissioning, and how we free up staff at a primary community level using the practice-based commissioning escalator. On the postcode lottery, we are attempting to expedite the approval of NICE drugs, which now takes on average 18 months to two years and will in future take between three and six months. In addition, the noble Earl referred to our more transparent process, in which PCTs could still approve the use of drugs which have not yet received NICE approval.
I turn to maternity services; the noble Baroness, Lady Barker, also raised mental health and long-term conditions. There are 10 regional reports, each of which has a pathway on maternity services, mental health and long-term conditions. I would be delighted to send the noble Baroness copies, because they highlight local aspirations of how these services should be reported. The noble Earl also raised the future of maternity services. The best people to decide the future of maternity services are local clinicians working on the front line, in consultation with the public and patients. In the future, no one in Whitehall should be in any way involved in this decision-making. That has been the Government’s policy over the past couple of years, and it will be our policy in the coming decade.
I have not mentioned my favourite word: polyclinics. “Polyclinic” was a description of primary community services in London. I was fortunate and privileged enough to work with many clinicians in London. When I did that report, I was a clinician working in London; it was a response to the aspirations of Londoners with regard to improving primary and community services. Since joining your Lordships’ House, it has become clear to me that decisions on the implementation of polyclinics are a local issue. Noble Lords are aware that local consultations with Londoners were carried out for six months. We have made no announcements on further investment in primary and community strategy since the interim report published in October, highlighting 115 new health centres, which we have debated in this House on many occasions. We must increase capacity in primary and community services to meet challenges facing the health service now and in the future.
I remind your Lordships that the life expectancy of a person living in Manchester could be 10 years shorter than the life expectancy of someone living in some parts of London. We must invest more in primary and community strategy because primary and community services have the biggest impact on survival rates and the health of the nation. We also want patients to have more choice in them.
Workforce education and training is another significant area that we have debated in this House. I remember our debate on modernising medical careers, and the dilemmas we have had following the introduction of MMC. I reassure the House and the noble Earl that I have been working with not just the profession and its leaders but with John Tooke himself in designing the workforce planning and education. The relevant document was published today and contains a letter from him, which warmly received the contributions that the next stage review has made, including the creation of Medical Education England.
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More importantly, I was asked in the House about the need for greater transparency with regard to funding arrangements. I am delighted to tell the House that we are introducing a tariff system whereby the money will follow a trainee. That is in addition to the other announcements that I made.
The noble Baroness, Lady Barker, asked about innovation. There will be innovation funds at a local level, which is very different from social enterprise. Social enterprise is one way in which staff could be freed up in the future to enhance community services, but we have innovation funds to the tune of £100 million, which clinicians and others will be able to access to make innovation part of everyday working life.
4.45 pm
The Lord Bishop of Chichester: My Lords, as a relative newcomer to the House, I apologise if I have not followed the protocol for intervening in discussion on a Statement. Like many of your Lordships, I was a “baby-boomer” born after the Second World War and have lived through this incredible period of unprecedented and unparalleled healthcare, which is one of the marks of a truly civilised society. Like many people in their sixties, I feel the need for something of a retread. Therefore, I entirely welcome the review and am very grateful for what has been reported to us of it. I have only just received it and have not had a chance to read it in detail. However, I wish to raise two concerns about the Statement and the Minister’s comments.
First, I welcome the Minister’s comments on nutrition, respect and dignity and the references to wider health teams in the context of the promotion of health. The church and members of all faith communities in this country will welcome the reference to wider health teams but will regret the lack of an explicit mention of chaplaincy as part of that. Physical and mental health can be seen only in the context of the wider human and social health of individuals, everything that goes to make up spiritual health. I hope that the next next stage will contain much more explicit recognition of the need to make statutory provision for chaplaincy and not treat it just as a bolt-on or occasional or optional extra.
Secondly, I appreciate the Minister’s reference to bringing down levels of morbidity and mortality. However, the ability to remove death altogether has escaped this Government, and, I suspect will escape all Governments. Death remains the end of life. I appreciate very much the several occasions on which the noble Lord referred to patient pathways from the beginning to the end of life. However, if I am not mistaken, hitherto the one area in which the National Health Service has not been required to demonstrate achievable outcomes in terms of patient experience is the end of life. It seems to me that the way in which we honour and try to set standards for palliative and terminal care is hugely important, and that that should at least be commensurate with what we do throughout people’s lives. The hospice movement is one of the glories—albeit all too often it is rather marginalised from the National Health Service—of our health provision, and needs our support desperately. I hope that further attention can be given to that matter.
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I have had a chance to look briefly at the report. Paragraph 70 refers to the need for a service that,
That adequately covers both my points.
Lord Darzi of Denham: My Lords, I am grateful to the right reverend Prelate for the points that he raised. As regards long-term conditions, I am grateful for the support for our plans to meet the challenges of the future. As I said, one of the great successes of the NHS is converting acute illnesses into long-term conditions. Therefore, we are living longer and we need to have a strategy to deal not only with the ageing population but patients with long-term conditions. I could not agree more with the comments about chaplaincies. That is the subject of the social care Green Paper. I recognise the major role that chaplaincies play in the provision of health and social care. I repeat that the 10 regions discussed an end-of-life pathway. The thematic conclusion was that care needs to be more integrated in that pathway. It is probably the one pathway that we will all go through, and health and social care need to be co-ordinated around the needs of patients, and more importantly of their families, to ensure that patients die in their home environment with their family and loved ones.
Baroness Finlay of Llandaff: My Lords, I welcome the Minister’s report today and congratulate him on having reinvigorated positive attitudes to and respect for patients throughout the NHS. Will he explain how the new bodies, NHS Medical Education England and the NHS evidence service, both of which I warmly welcome, will ensure that patients understand the importance of research as a way of providing an increased information database so that they can take sound decisions about purchasing drugs and so on in the future, and so that they understand that researchers are benefiting care and patients are not guinea pigs for the NHS? Does the noble Lord intend to do anything to decrease bureaucracy for those undertaking research evaluation projects?
Lord Darzi of Denham: My Lords, I am grateful to the noble Baroness for her question. I am delighted that NHS Medical Education England and the NHS evidence service have been welcomed. We have a lot to say about research in the constitution: what the patients’ responsibilities are in regard to it and how important it is. As I said earlier, we need to exploit some of the innovations that we have seen in the NHS and, more importantly, to see how we can translate our excellence in science and technology in this country to the benefit of patient care.
Lord Patel: My Lords, I too thank the Minister for repeating the Statement. Everyone knows that it is his report, and we do not need to worry about where it was spoken about first. When the papers referred to a tethered goat, his name was not mentioned. However, I assure him that we all know that he is not a goat. I have known him for years, and I know that you cannot tether Ara Darzi.
I welcome the report’s emphasis on quality and standards. However, I have many questions, and an appropriate time should be allocated for a long debate on the report rather than the one hour that we will get
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Lastly, how will the universities be involved in improving the quality of care? I welcome that suggestion.
Lord Darzi of Denham: My Lords, I am grateful to the noble Lord for his points. I shall be brief. First, the National Quality Board will advise NICE on setting standards, which include both minimum standards and clinical standards. We are well aware that NICE works with professional bodies to set clinical standards, but it will have an additional role in kite-marking some of the standards that professional bodies, such as royal colleges, already have.
On the dashboards, we will provide the tools by which we will measure how we empower patients. I referred to measurements by which we will empower patients. Measurements are also extremely important in allowing clinicians like us to improve services. These are dynamic measurements, and we will provide the tools and the clinical team to make this happen.
I believe, for several reasons, one of which being that I work at a university, that the university leadership could be exploited to improve patient care. The universities will have two roles to play. First, they will be part of health innovation and education clusters, providing leadership in education and training. Secondly, they will have a leadership role in innovation in health and social care.
Lord Roberts of Llandudno: My Lords, since the National Health Service was established, there have been changes in the devolved nature of the Administrations. Although these are welcomed, what arrangements are there for this new, next stage of reform for England to be made known to and possibly introduced in Wales? We do not want to miss out. Would Scotland also be included?
Secondly, for generations, people with neurological diseases and so on in north and mid-Wales have gone to Liverpool; they have crossed the border. Now there is some introduction of a scheme whereby people from north Wales travel not for an hour to Liverpool but for five hours to Cardiff or Swansea. Also, people from mid-Wales go to the Shrewsbury hospitals. What guidelines will the Minister have for those cross-border issues raised, as well as the devolved issues?
Lord Darzi of Denham: My Lords, I thought that my brief was big, but I never thought that I would be dealing with a devolved Administration. However, I reassure the noble Lord that, since the publication of the report, the department has talked to the devolved Administrations to answer at least some of the questions raised—most importantly those about cross-border
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Baroness Carnegy of Lour: My Lords—
Lord Brooke of Alverthorpe: My Lords, it is this side, I believe.
Baroness Thornton: My Lords, there is time for both.
Baroness Carnegy of Lour: My Lords, in relation to what the Minister just said about talking to the devolved Administrations, is the constitution that we are told about in the report one for the National Health Service of the United Kingdom or one for that in England? It talks about empowering patients. Patients do not need empowering; they need treatment, understanding and respect. What exactly is the constitution and who is it for?
Lord Darzi of Denham: My Lords, the constitution is for the NHS in England, not the NHS elsewhere. However, as I said earlier, we are talking to our colleagues in Wales and Scotland in relation to it. The content of the constitution is out for consultation today, for 14 weeks. I would be grateful if the noble Baroness contributed to that consultation.
Lord Brooke of Alverthorpe: My Lords, I join others in congratulating the Minister on producing a magnificent manifesto, in a sense, for the health service for the next decade.
My first question is on the further information that will be made available for us. I would like to be assured that targets will not disappear completely. As one who uses the National Health Service and does not have private medical insurance so that I can go through the service quickly, I worry greatly that we may slip back to waiting longer for treatment, as we did in the past. It is 10 years since I had cancer, and I knew many people who died then because they did not get treatment as quickly as they should have done. Their cancers moved into different parts of the body; had they had early treatment, they would have avoided those illnesses and subsequent death. I would like some clearer statements from the Government on where we stand on targets because, notwithstanding what is alleged politically about targets, many people feel that they have delivered a great deal and would be reluctant to see them disappear without the knowledge that there will not be any backward movement to longer waiting for different types of treatment.
According to the Daily Telegraph, 1.25 million people have signed up to oppose changes in GP practices. Is the Minister aware from his researches that many people around the country are unhappy with services from their GP practices in a number of respects? He
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Lord Darzi of Denham: My Lords, I want to reassure my noble friend that minimum standards, which we previously described as targets, will remain, including not only the four-hour wait in A&E but the 18 weeks. Interestingly, many of the regional reports have challenged themselves to further reduce these targets below four hours and 18 weeks. Many services across the country provide services within nine weeks, and the south-west region has a two-hour A&E target rather than four. However, the national standard is four. Information on GP practices will be available. All service providers, whether of acute or primary care, will have to publish the quality measures and, more importantly, information on patient experience and outcomes.
I think that information on salaries is already in the public domain. I am sure that my noble friend is aware that my salary is published as are those of many of my GP colleagues.
Lord Stoddart of Swindon: My Lords—
Baroness Thornton: My Lords, there is time for everyone to join in. Perhaps we can take the Cross Benches first.
Baroness Meacher: My Lords, I add my considerable gratitude to the Minister for his report, which has very many strong features. He mentioned the mental health pathways in the regional reports. Is there anything in his national review about the need to give greater priority to the quality of service and level of safety in psychiatric in-patient units? If there is no such emphasis on a priority in this area, we will continue to have wards where patients and staff are living and working at risk.
Lord Darzi of Denham: My Lords, the 10 regional reports address the mental health pathways in 10 different regions. In some, they have addressed the issue and certainly challenged themselves on safety. I really want to stress that it is an enabling report. It is not a report that I have designed in Whitehall; it is one that I have built on in consultation with 2,000 clinicians across the country about the tools they need to make this happen.
Safety is a feature of the report, and we are introducing two schemes. The first is “never events”, which will be introduced next year and within which we believe the NHS will not tolerate certain things. The type of events covered still need to be decided. The second is the national patient safety campaign, which covers areas of catheter infection. At a local level, clinicians have challenged themselves under the mental health pathways in addressing safety issues in high-security mental health environments.
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