Health and Social Care Bill

Baroness Anelay of St Johns Excerpts

Tuesday 13th December 2011 Lords Chamber

[Baroness Murphy]

My Lords—

[Baroness Anelay of St Johns]

My Lords, I appreciate that this procedure is not common, but it is not novel. The noble Baroness, Lady Murphy, is seeking to contribute to the continued debate. May I suggest that Peers who are attempting to leave should do so by the other door, and preferably not by that door—I say to the noble Lord, Lord Borrie—so that she can stand and be heard by the House?

[Baroness Murphy]

Thank you very much indeed. I just want to comment briefly on the amendments on licensing. Some of them are asking quite a lot of the licensing procedure, but there may be other mechanisms that achieve what they want to achieve. I am sympathetic to people’s desire to add these conditions, but I think that it is important to see the licensing arrangements as part of the system, in conjunction with registration with the CQC. It enables Monitor to approve the compliance arrangements to achieve good governance and the information requirements needed to monitor that the organisations are delivering the right standard of care.

The threat of licence revocation enables Monitor to pick up at an early stage the problems of quality and finance which other people have spoken about. Obviously the providers will be very concerned to hold on to their licence, which seems to be a very powerful and potent tying-in of organisations to the ethos and objectives of the NHS. We must be very careful not to regard the licensing process as something within which to impose too many conditions, but as a basic framework that ties the licensees into the system. That is particularly important when organisations start to go wrong. We will discuss later how they are rescued from those predicaments. However, it seems to me that this creates a basic level playing field, and that it would be a mistake to use that process to do much more than tie everyone into the basic system. It sort of replaces the old authorisation process on compliance and quality that was operated by old Monitor, but it is a way of going forward as new organisations come into the NHS as providers of NHS services. I just wanted to add those comments because I think that these amendments might be adding a bit too much to the responsibilities of the licensee.

Health and Social Care Bill

Baroness Anelay of St Johns Excerpts

Monday 7th November 2011 Lords Chamber

[Lord Rix]

My Lords, five of the—

[Baroness Anelay of St Johns]

My Lords, I take this opportunity again to remind colleagues that as they are leaving the Chamber they should, in courtesy, not walk in front of the noble Lord, Lord Rix, as they are doing at the moment, but should leave by the other exit. It is considered discourteous to interrupt a speaker.

[Lord Rix]

Thank you. Five of the six amendments that I have tabled to the Bill have been grouped together. I welcome the opportunity to raise some specific concerns about the Government’s health reforms in relation to learning disability. I should also like to thank the Minister, who recently met the noble Lord, Lord Wigley, the noble Baroness, Lady Hollins, and me, along with representatives from the Royal Mencap Society, of which I am president, to discuss our concerns in more detail.

As I made clear during my contribution at Second Reading, people with learning disabilities already have worse health outcomes than the rest of the general population. Mencap’s 2007 report, Death by Indifference, highlighted the neglect that was faced by six people who were treated in the NHS, leading to their deaths, which were entirely avoidable. Since then, many parents have approached Mencap to recount the indifference, prejudice and ignorance that is displayed towards people with a learning disability when being treated by the NHS. The purpose of the various amendments that I have tabled to the Bill is to address this problem.

First, Amendment 13 would ensure that the Secretary of State for Health has a clear duty to improve the quality of services for people with a disability. This is a prerequisite if the health inequalities to which I have previously referred are to be reduced and entirely removed as soon as possible. We hear a great deal from the Government about the importance of local decision-making, empowering patients and more opportunities for clinicians to make their input. In principle, I do not object to these intentions but they must not be at the cost of removing the accountability of the Secretary of State. By placing a duty on the Secretary of State to improve the quality of services for disabled people, I hope greater priority will be given in government to making this happen and seeing improvements on the ground.

My second amendment, Amendment 81, aims to ensure that health services for those with the most complex needs are commissioned by the NHS Commissioning Board. I am concerned that, since the numbers of those with the most complex needs, particularly those with profound and multiple learning disabilities, are likely to be relatively small, clinical commissioning groups may not commission those services that are deemed to be insignificant. We already know that the commissioning of services for people with complex needs by primary care trusts has been patchy. It is questionable whether commissioning led by clinical commissioning groups alone will lead to any great improvement on this issue. My amendment would ensure that the NHS Commissioning Board has oversight in this area, including the co-ordination and commissioning of services and facilities for this very specialist group of disabled people.

The third amendment tabled in my name, Amendment 117, concerns the importance of collecting data on the experiences and outcomes of all patients in the NHS. Where a patient has a disability, it would also ensure a breakdown of disability by impairment type. This will provide a bank of information that could be disseminated and used to inform future NHS decision-making to ensure that it accurately reflects the expectations of those it seeks to serve. It would also help to ensure that clinical commissioning groups, the NHS Commissioning Board and the Secretary of State are more accountable for their decisions and better placed to improve such decisions. Without the collection of this data, including the impairment type for disability, it will be difficult accurately to assess what is happening to people with a learning disability and other disabled people within NHS treatment.

Health and Social Care Bill

Baroness Anelay of St Johns Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Rea]

My Lords, the noble Earl, as always, gave us a carefully crafted and elegant speech, much of which I agreed with. However, I will start by raising one point. In the letter he sent to Peers last week, he repeated verbatim the words in the White Paper that claim that Britain's health record is worse than that of other EU countries, especially France. It appears that he has not read the paper in the British Medical Journal by John Appleby, the chief economist at the King’s Fund, which demonstrates that these claims are false, that Britain's health is improving faster than that of any other country in the EU, and that we will shortly overtake France, whose health expenditure is far greater as a percentage of GDP than ours.

I will explain why I put down my amendment. I did not do this lightly. I realise that it is very unusual for your Lordships' House to oppose a Bill that has passed all its stages in another place. However, the Library tells me that it has happened 13 times since 1970—about once every three years. The Salisbury-Addison convention aims, of course, to ensure the primacy of the House of Commons. The convention that has evolved is that in the House of Lords, a manifesto Bill is accorded a Second Reading and is not subject to wrecking amendments. Over the years, the convention has been discussed at length and in depth. In the case of a coalition Government without a joint manifesto—as we have now—the clearest indicator of the policy to be followed lies in the coalition agreement.

The noble Lord, Lord Strathclyde, said on 20 January in a debate on coalition government secured by the noble Baroness, Lady Symons:

“The Salisbury convention applies to manifesto Bills, but this Government did not contest the election as a single party under a single manifesto. However, the Government … were formed and are sustained on the basis of the confidence of the House of Commons. This confidence has been secured on the basis of a programme set out in the coalition agreement”.—[Official Report, 20/1/11; col. 600.]

That agreement contains the words I included in my amendment. I will repeat them:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

The agreement contains no words suggesting that this enormous Bill was in the pipeline. Nor was it mentioned in either the Conservative or Liberal Democrat manifestos.

An indication of Conservative policy that reached far more people than the number who read the 110-page manifesto was David Cameron's widely reported statement made to the Royal College of Pathologists in November 2009. He said:

“It’s true, with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”.

Instead of having a Bill that was in a manifesto, we have one that was expressly ruled out by the words of David Cameron’s speech, and subsequently by the coalition agreement. So the Salisbury convention, if relevant here, applies in a reverse direction. If we allow the Bill to pass, we will be voting directly against the words of the coalition agreement.

It seems that there was deliberate concealment of what was planned. The Bill—or something like it—must have been in gestation for months if not years before the election. Michael Portillo said, on Andrew Neil’s late-evening politics programme, that it was not put into the Conservative manifesto because it would have lost the election, as the NHS is almost a religion in Britain. That implies that it had to be slipped in by the back door. How patronising that is. It says that we, the Conservatives, know what people need better than they do. In fact, it is possible to trace the development of the ideas behind the Bill in Conservative think tanks dating back more than 20 years.

What is proposed is probably the most far-reaching reorganisation of the NHS ever undertaken. It now has 320 clauses and 22 schedules, in two volumes, with 353 pages. It is longer than the Bill that created the National Health Service in 1946.

The White Paper, Equity and Excellence: Liberating the NHS, which is full of euphemistic phrases that everybody can agree with, did not prepare us for the Bill. Neither the White Paper nor the Bill expressed clearly the underlying intention of the Bill, which many think is to open the door wider—it is already ajar—for the market and the independent sector to play a bigger role in the National Health Service. The process was made possible first by the compulsory tendering of domestic services in the 1980s, followed by the introduction in 1990 of the internal market, which was retained by the Labour Government. They brought in the private sector to provide some clinical services, reduce waiting lists and provide certain other services.

Many have argued, with evidence and from experience, that this could have been done within the National Health Service. Short-term political gain has resulted in us now reaping the whirlwind of greatly increased costs, nowhere more so than in the private finance initiative, referred to by the BMA as “perfidious financial idiocy”. This assessment has now been confirmed by the Public Accounts Committee. Since 1990, the proportion of the National Health Service budget devoted to administrative costs has risen from 5 to 14 per cent, according to the Centre for Health Economics at York University. That is an extra £10 billion a year.

This Bill, despite its stated effects of saving administrative costs, is likely to increase them further. The Government say that the financial difficulties of the NHS are such that the Bill must be enacted quickly. However, there is no evidence that the changes suggested by the Bill will reduce costs—rather the reverse. A recent research review by a team at the London School of Hygiene and Tropical Medicine showed that competition in the health sector, far from improving National Health Service costs and clinical outcomes, had the reverse effect.

Clinicians in the proposed clinical commissioning groups will find that commissioning is a highly complex task. They will need the assistance of experienced administrators, statisticians and public health specialists, as well as competent clerical support. These experts are already being lined up. They are not experienced PCT staff who are available without extra expense, and who are now anxious about their future, as David Nicholson pointed out yesterday. They are mainly from commercial health companies. A freedom of information request revealed a list of 40 organisations, most of them private, which have been invited to bid for contracts to train GP consortia, now clinical commissioning groups. For this role, in London alone, £7 million has been allocated for the initial phase, taken from funds originally allocated for postgraduate education.

It will be argued that changes on the ground are too far down the road to reverse. However, PCTs are still in existence and could be re-established in a leaner and more efficient form, with enhanced clinical membership, perhaps bringing in pathfinder groups. A similar suggestion has just been made by Andy Burnham, our new shadow Health Minister, in a letter to Andrew Lansley. Many of us would like to know the Government’s justification for starting to implement the changes before the Bill has passed through Parliament. An inquiry might find this to be unconstitutional, if not illegal. The noble Baroness, Lady Williams of Crosby, suggested as much in a powerful article in the British Medical Journal this week.

In conclusion, I ask Liberal Democrat and other government Peers who are unhappy with the Bill to seriously consider voting for my amendment, or at least abstaining if a Division is called. The Bill is not in the coalition agreement, and it is always open to coalition parties to disagree on some issues. The coalition will not fall if the Bill is lost. I assure the noble Lord, Lord Owen, and other Peers, that if my amendment is not carried I will certainly vote for his amendment, and I urge all Peers to do so. Of course, I know that I can count on the support of my noble friends.

There are many aspects of the Bill that I have not covered. However, I am sure that others among the many speakers will fill in the gaps. I shall be guided by the course of the debate on whether to divide the House. However, I know that many thousands of people throughout the country—not only health professionals by any means—oppose the Bill and want the House to reject it. The large, peaceful demonstration on Westminster Bridge on Sunday was an example of this. They will be bitterly disappointed with the House if I do not call for a vote, and I will not ignore them.

[Baroness Anelay of St Johns]

My Lords, it may be helpful to the House if at this stage I give some guidance on an advisory speaking time. There are 100 speakers signed up for the whole of the debate, including the Front Bench spokespersons. If Back-Bench contributions were kept hereafter to eight minutes, the House should today be able to rise at about 11.30 pm. For the avoidance of doubt, perhaps I may emphasise that the next speaker is the noble Baroness, Lady Thornton, who is a Front Bench spokesperson for the Opposition. Therefore, my advice is for all speakers subsequent to her.

Winterbourne View

Baroness Anelay of St Johns Excerpts

Wednesday 8th June 2011 Lords Chamber

[Baroness Nicholson of Winterbourne]

My Lords—

[Baroness Anelay of St Johns]

My Lords, we have reached 10 minutes and should progress to the next item of business.

Public Bodies Bill [HL]

Baroness Anelay of St Johns Excerpts

Monday 9th May 2011 Lords Chamber

[Lord Newton of Braintree]

My Lords, I hope that it will be in the spirit of the debate—

[Baroness Anelay of St Johns]

My Lords, before my noble friend makes what I know will be succinct and relevant remarks, as his remarks always are, perhaps I may remind the House of the guidance that Third Reading is not an opportunity for debate and that comments should be extremely brief.

[Lord Newton of Braintree]

I am tempted to sit down in view of that rebuke but I shall not do so. I only wanted to say, in a modest kind of way, that I know I have been a lot of trouble to my noble friends. I know that my noble friend Lord Taylor of Holbeach has been incredibly patient and understanding with me and I say to the Chief Whip that I really did not want to do anything more than be nice to him. Is that allowed? He has done a great job in helping us as a House to do our job, and he has produced the near-miracle—I speak in the presence of a number of ministerial colleagues—of bringing about a Bill that leaves the House shorter than it entered. Can anyone think of a government Bill that went anywhere and ended up shorter when it finished than when it began? That is a near-miracle. My noble friend has brought it limping into port with its superstructure destroyed and most of its cargo dumped, but at least he has got it there. He has contributed to the worst defeat of Henry VIII at the hands of the barons in 500 years, but unfortunately I do not think that it is yet the Waterloo. Henry is regrouping in Whitehall, hoping to find some mercenaries and commoners to come to his aid, and your Lordships may yet have more work to do. Meanwhile, my noble friend and many of his colleagues have done a fantastic job for us with patience, courtesy and understanding, as well as, I think, working behind the scenes to good effect, and I add my thanks to those of others.