Health and Social Care Bill

Baroness Armstrong of Hill Top Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Armstrong of Hill Top]

My Lords, I would first like to declare my interests. My husband works as an independent consultant, largely in health, and I am a non-executive director of County Durham and Darlington foundation trust. I always enjoy listening to the noble Baroness, Lady Tonge. When we were together in the other place, I always enjoyed what she had to say, but when I was Chief Whip I was very pleased that she was not one of my charges.

We come to debate this Bill today with many members of the public expressing confusion and anxiety, almost at best, about it. The tragedy is that we did not need to be here. The public got used to NHS reform over the past decade and, indeed, one of the reasons we were elected in 1997 was their concern about the state of the National Health Service. They liked the outcomes of our reforms; they liked shorter waiting times, new hospitals, new GP surgeries and more choice. They felt, and they told pollsters, that it was better than they had known it, and it was more popular with the public than ever. When they were elected, this Government could have decided to get cross-party agreement and build on those reforms. One would have thought that that would be in the spirit of coalition politics, but no. Instead, despite what was in the manifestos and the coalition agreement, we were promised a revolution in the NHS. Then, after the pause, we were told by the Prime Minister, and were presumably meant to be reassured, that actually nothing much would change in the NHS. I think he said that the NHS would remain largely the same.

Today, I am still not sure what the Government believe and what they want. I have sympathy for the Minister who has always been incredibly generous with the House as a whole and with individual Members. He is certainly doing his best, but I am afraid that his Secretary of State has not been giving us clear, consistent messages. The Government had a very clear message on tackling the deficit. Even if I did not agree with all their prescriptions on that, I knew what they were, I know what they are today, and I understand where they are trying to get to. However, the NHS has not been dealt with or talked about in the same clear way. We were told that the NHS was outside the tackling of the deficit and its budget was to be protected. It is being protected, but all of us know that that is not sufficient. If we keep going the way we are, the increase in the budget would have to be phenomenal, and the economy could not bear it. But we have had this confusing message, and that is what the public have heard. They have heard, “Money is being protected, so we do not need all this reform”.

What has actually happened is that the Government have simply failed to explain what they want to do and why, and we have had a major failure in the politics of handling reform. I believe that has taken us back years. When he came in, the Secretary of State immediately halted reconfigurations that were going through the pipeline, particularly in London. Now, I understand that all those decisions have been reversed, and the reconfigurations that were in progress and in programme have continued. Eighteen or 20 months later, what has that cost in money and probably also in lives? This confusion, this inability to be consistent and clear, has led all of us to lack confidence in what the Government are seeking to do. The measures in the Bill will make reconfiguration much more difficult, and we will need to look at, for example, what the King’s Fund is advising on this. I will certainly want to come back to that in Committee because I believe that whatever changes are needed in the health service will have to be approached in a very agile way. I am terrified that the Bill will reduce what agility there is—and there ain’t very much there now.

The reality is that no matter how long the Government manage to protect the budget of the NHS, great changes will still be needed in years to come. Given the trends in the economy, reductions of 3 or 4 per cent a year will not be enough. If there is not enough ability to make major changes, what we will see is simply cut after cut that will end up with a reduction of service year on year. These arguments are difficult, but the public have the right for us to make them, and the tragedy is that the Government have ducked them. As many noble Lords have said, the challenges come not just from the economic crisis, they also come from changes in the population, particularly with regard to the increase in the number of people with long-term conditions, the increasing number of people living longer—which is a good thing, but it will put increasing demands on the health service—and changes within healthcare itself. These push us into changing the way we offer care and support patients. This Bill was an opportunity that, to date, the Government have squandered. I find it difficult to believe that such a strong, clear case could be so messed up by a Government in their first couple of years.

My noble friend Lord Hutton said many of the things that I intended to say, so I have cut most of them out, but I, too, remain unconvinced that the key objectives will be met by the Bill as it stands. One of the objectives is to reduce bureaucracy, but I have said a number of times to the Minister that the number of organisations is increasing and the coterminosity with local authorities is being lost, which will increase bureaucracy, not reduce it. The localisation of decisions is simply not happening in the way that we all know it needs to. The power of the national Commissioning Board is increasing, and the more that is given to it, the more it will control what will go on rather than decisions being made locally. We will have to come back to all these things during the passage of the Bill. We will need to come back to choice and competition. I want to mention one other issue: people who have multiple needs. They may be homeless, mentally ill or addicted. I am unconvinced by any of the arguments that I have heard that the Government are properly addressing them, and I will want to come back to this.

The Financial Times today says of this Bill:

“What has emerged can best be described as a dangerous hotchpotch of measures certain to bring tears to patients and politicians”.

In my angrier moments, I say to myself, “Let them get on with it. They are making a real mess of this. Let them get on with it and let the Government pay the price”. The problem is that it will not be the Government who pay the price. It will be the people of this country, and therefore we in this House have a responsibility to look after them and the NHS, and that is what we will seek to do.