Health and Care Bill — House of Lords, 2022-01-18
Topic: Health
Claire Tyler (Liberal Democrats, Centre to centre-left): My Lords, I support this group of amendments in the name of the noble Lord, Lord Hunt. My name is attached to Amendment 149, but I want to talk more generally about this group. Like the noble Lord, Lord Hunt, I am very supportive of the work of Healthwatch, at both national and local level. It provides very helpful and important insights about what it is like to be at the receiving end of our healthcare system. We sometimes do not hear quite enough about that. The national-local structure is helpful, ensuring that local bottom-up insights are then reflected in national-level reports Like the noble Lord, Lord Hunt, I have found some of the reports produced by Healthwatch recently, and during the pandemic, extremely helpful. I am thinking of its work on mental health—particularly, children’s mental health. It has also done a series of projects on social care that are very relevant to the current situation. One project particularly dear to my heart involved engaging with care home residents and their loved ones, and feeding insights into the development of national visiting guidance—very practical, important work. Another recent report, which I have already quoted in your Lordships’ House, looked at vaccine confidence and, particularly, what might need to be done to help support those communities with a higher degree of vaccine hesitancy; again, Healthwatch does some really important work I turn now to the amendments more specifically. In the recent survey of ICS leaders for Healthwatch England and NHS England, 80% of respondents said that they would support Healthwatch having a formal seat on the ICB if this was set out in legislation or guidance. We have already heard the question: what about the other 20%? Should noble Lords have the time, I recommend a quick look at the Healthwatch document and the survey, mapping the relationship between local Healthwatch and integrated care systems. There is a lot of important information in it. I particularly noted in the survey that 100% of ICS respondents said that they would support a mandated seat for Healthwatch on the integrated care partnership. That was one of the main reasons that I wanted to add my name to Amendment 149 Fundamentally, why I think this so important is that I am not convinced that, in all our important deliberations so far, sufficient weight has been given to what we might call the service user voice or the individual patient voice more generally. These deliberations have, understandably, been very much about structures and how these new integrated care systems will work. I feel that there is scope for the Bill to set out some minimum requirements to ensure that the patient voice is heard at the decision-making table. It is fine to have lots of other sentiments about patient voices but, are they there, and are they heard at that table The principle is really quite simple. Patient choice at an individual level—that is, in relation to the patient’s own healthcare—has changed radically. We have moved from a situation where the doctor knows best and will tell you what is happening to the doctor setting out the options and you making a decision with the doctor—almost a co-produced decision. We need to think more about that approach, at the community level, the local level and then the integrated care system level. This will be particularly important in relation to tackling health inequalities because, frankly, if people are not involved in the decision-making or feel that their voice is not being heard, they often do not trust the outcome A recurrent theme in our discussions so far has been who should be on what body. We have had those big debates about whether there should be public health and mental health representatives and so on, which are very important, and those conversations still have some way to go, and we have just had this very interesting debate about place-based partnerships and "insiders" and "outsiders". Again, that has quite a long way to go, but it would be ridiculous if the patient was seen as the outsider; patients need to be front and centre of all this and the reason we are undertaking a restructuring in the first place My main plea is that in all our discussions we consider the user voice and how it can be heard. I think that Healthwatch is an obvious way of doing it; it has the existing infrastructure. There may well be other ways of doing it, but that was the reason I was keen to support the noble Lord, Lord Hunt.