Clause 40 - Quality in health care
Health and Social Care (Community Health and Standards) Bill
3:15 pm
Dr Evan Harris (Oxford West and Abingdon, Liberal Democrat)
The two amendments, effectively, are one. The first would omit the word ''and'' between the
two existing definitions. The second, which is the more substantive, would add ''the promotion of wellbeing'' to the existing definition, which states:
''(a) services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness; and
(b) the promotion and protection of public health.''
My argument is that the promotion of well-being for an individual is more than is already covered in subsection (2)(a) and (b). Paragraph (a) refers to
''the prevention, diagnosis or treatment of illness''
but that does not cover the promotion of well-being. The prevention of illness is part of the promotion of well-being, but not all of it. The World Health Organisation definition of health now extends to the concept of well-being. I would argue that health is not simply the absence of illness, particularly a medical model of illness; well-being and living healthily is more than just avoiding illness. It includes being able to make choices and to live as an autonomous individual. Indeed, there are big questions about how we safeguard the autonomy of individuals; that would not be covered by subsection (2)(a), but might be captured under the concept of the promotion of well-being. It is the job of NHS bodies to do that.
It might be argued that the concept of well-being is covered by the promotion and protection of public health, but I am not sure that that is so. What is meant by the promotion and protection of public health? It is better that I ask that now than in the clause stand part debate. I suspect that the promotion of public health relates to public health initiatives, which are important, but also to protecting public health from individuals, such as those with mental illness. Many of us would argue that the greatest threat to health from people with mental illness—especially those who are untreated—is to their own health rather than that of the public.
I accept that there is concern about the protection of the public, which is what subsection (2)(b) refers to. Public health initiatives on, for example, smoking cessation and the protection of the public and issues relating to the control of infectious diseases are also relevant. I do not disagree with anything in that subsection, but I question whether the wider duties that we want health care bodies to adopt would be better safeguarded if the Under-Secretary considered widening the definition.
I do not plan to spend a great deal of time discussing the concept of well-being. However, I shall give some examples of joint working. It has long been argued that NHS bodies need to work with other organisations in the public, private and voluntary sectors to secure the conditions associated with the prevention of illness and the promotion of well-being; for example, decent housing, a balanced diet, the right of children to a proper education and the right of families to live free from fear, whether it be from crime or impoverishment.
In a modern society, so much illness, and other demands on health care services, is caused by what is loosely described as stress from the factors that I have mentioned. That is one of the reasons why demand for health care is so much greater in areas of deprivation.
Some of the issues that I have raised contribute to a lack of well-being, subjectively and objectively measured.
When we define health care, it is important to stress the significance of looking holistically at it. Perhaps the Under-Secretary will be able to say that some of the new concepts relating to preservation of equity and tackling inequalities in health care are specifically provided for in the Bill. Given the background of the Under-Secretary and his constituency, I should hate a Bill to be passed without us making some attempt to check that the Government are looking for every opportunity to reduce health inequalities in communities that are deprived and do not have the same sense of well-being as other communities. We must take such opportunities to improve legislation.
The Under-Secretary will say that we are talking about an existing definition taken from previous Acts. I ask him to open his mind to the idea of developing new definitions to allow us to keep up with other countries and supranational organisations that have wider definitions. That is not just to deal with low-level issues. I am talking about a major factor in why there are such huge demands on the health service, even in the absence of what can objectively be measured as greater indices of actual disease. One problem with which we are struggling is that as we get better off and, arguably, less ill in terms of preventable illness, it does not seem to be having much impact on the demands for health care. I suspect that that is partly about feelings of stress and lack of well-being.
To conclude, the definition would focus the minds of those bodies that are due to be inspected against that quality standard on their duties to work closely with public authorities and voluntary sector organisations that are concerned with promoting well-being.