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My Lords, like other noble Lords, I first congratulate the noble Lord, Lord Turnberg, on having secured this important debate and the noble Baroness, Lady Jolly, on a marvellous maiden speech, which was very moving. I also declare my own interest as a clinical academic practising surgeon and my role in the NHS Staff College at University College London Partners.
The question posed by the noble Lord in this debate is an important one. He asks what steps are currently being taken to ensure that front-line and specialist services are not undermined as we move towards the changes proposed in the forthcoming health Bill. Healthcare systems around the world, particularly mature healthcare systems, are all focusing on the need to improve quality and value, so that the very best clinical outcomes can be achieved for our patients and that these can be achieved in the most effective and cost-efficient fashion so that the valuable resources that the state provides for healthcare are used for the maximum benefit of all in society.
In that regard, there are four important actions that might be considered in the interim between now and when any changes that are finally agreed when the health Bill passes through this Parliament come into force. The first is in the area of the education of general practitioners and other clinicians in primary care who will have to play a greater role in commissioning. At the moment, there is no specific training for the skills that will be required to ensure that, at the very least, they can supervise and provide the appropriate governance for any commissioning taking place in the environments where they have responsibility in primary care. I ask the noble Earl what arrangements are being made currently to ensure that programmes of continuing professional development start to come into place to provide the skills to those working in general practice to prepare them for the new responsibilities that they will inevitably have if practice-based commissioning goes forward.
The second is an area that the noble Lord, Lord Turnberg, has alluded to-the whole question of integrated care pathways. These are important. In ensuring that we maximise quality and value in healthcare systems, it is well recognised that a focus on integrated care pathways, particularly for chronic diseases, will be essential. To ensure that we can provide the opportunity for informed commissioning of these services, we need to be certain that metrics that can be used to determine whether the clinical outcomes are successful and are providing best value are developed, assessed and then are available for those who will take commissioning decisions in the future. What arrangements are being made currently to start developing models of integrated care, particularly for chronic diseases? What work is being done to determine the appropriate outcome measures and metrics that might be used to drive commissioning decisions in the future?
The third area is one of specialist services and in particular the important question that has been raised about the tariffs and the current difference in costs for the provision of specialist services. With the move for responsibility for specialist commissioning to the NHS Commissioning Board, is work currently being undertaken to provide clear definitions of what specialist services will be in the future? For those delivered at regional or supra regional level, what will be expected of these specialist services? Is work being undertaken to determine what costs and tariff base will be required in the future to ensure that these specialist services are not undermined in the changed commissioning arrangements? In particular, will the institutions that provide these specialist services remain sustainable in the altered commissioning environment?
Finally, I turn to the issue of clinical leadership, one that I have spoken about previously in your Lordships' House. There is no doubt that that this is a major programme of change. It is often said that it is only those who deliver the service who can change the service. Our healthcare professionals, be they doctors, nurses or other healthcare professionals, will not be managed into this change: they will need to be led into it. Winston Churchill said some 60 years ago in a famous speech:
"Give them the tools and they will finish the job".
I strongly believe that if we give our healthcare professionals effective clinical leadership, they will indeed deliver for us the change agenda of improving quality and value as well as these changes and those that the previous Government quite rightly focused on, so that we can continue to enjoy a National Health Service of which we are all proud, which delivers the very best healthcare for the people of our country.