Health and Social Care Bill

Baroness Bakewell Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Bakewell]

My Lords, it is the genius of this country that in recent history it has enacted concepts of major significance in human progress. The Reform Act 1832 transformed our democratic process. The Education Act 1870 inaugurated an era of universal state education. In 1929 the creation of the BBC set the global template for world public service broadcasting. In 1946 the National Health Service was just such a bold and significant leap forward. As we consider how it might be improved, we need to bear in mind what we are changing: one of the finest, most highly regarded and valued institutions of British life, with a global reputation. The enduring essence of the NHS must not be yielded up to the transient imperatives of an external free market.

We must examine this Bill in the light of this conviction. We in the Lords enjoy the privileged opportunity of safeguarding what is so widely cherished. We must be vigilant to deliver improvement without sacrificing the underlying principle, that the NHS belongs to the people and is there to serve their interests.

We must also bear in mind that this Bill is not needed. There is no call for it throughout the country. Levels of satisfaction with the NHS were high and improving. Commissioning improvements were already under way under the last Government. No such proposals as now face us were spelled out in any party manifesto, nor in the coalition agreement. This Bill is in breach of a basic democratic contract.

What is more, many elements of the Bill are already being implemented before the Bill has been enacted. On 19 July Andrew Lansley let slip—it was a good day to bury bad news—that from next April £1 billion worth of NHS services, including wheelchair provision for children and a range of talking therapies, will be opened up to competitive bids from the private sector. The reputable Daily Telegraph blogger, Max Pemberton, who is also a doctor, called it,

“the day they signed the death warrant of the NHS”.

Such changes are already in progress. This, when the Bill is not yet enacted, is surely constitutionally dubious.

The National Health Service is the victim of its own success. It has kept people healthier for longer and, together with science and public hygiene, delivered a population living years longer than in 1948. Meeting the needs of an ageing population is the biggest challenge that lies ahead. The old are not well served by current provision, or by the proposed changes.

We have before us already a comparison between the NHS and private provision in this country: healthcare for the old is provided by the NHS; social care, the care of the frail and failing, provided in their homes or in care homes, is subject to the market. For social care, either the state pays for the private provider or individuals and families do. We have already seen two things happen when private finance buys too far into care. First, the service itself can be deficient and the monitoring is poor. Local authorities putting out tenders for care services too often chose the cheapest on offer, risking low standards provided by a shifting population of carers on the minimum wage and with inadequate training. There is already evidence of this happening. Secondly, the care of the elderly becomes a market commodity. The company that first invests moves on and others move in to asset-strip the enterprise for their own gain; then they too move on.

The story of Southern Cross shocked us all. The 33,000 old people in the care of the former company that ran some 750 care homes have been passed from hand to hand. The homes themselves were owned by the Qatar Investment Authority, which charged exorbitant rents to Southern Cross and salted away its profits in the Isle of Man and the Cayman Islands. Southern Cross could not sustain its business model. A Unison report in June 2011 assessed that the care industry was worth £4 billion to private equity investors, but it is considered by them a high-risk investment, with many investors inclined to resell at the highest price in the shortest time. That is what Blackstone Equity had done with Southern Cross. The care of the frail and the needy is far from their first priority. The old are seen as a resource to be milked for profit.

The old are not well served by this Bill and yet they are overwhelmingly the most frequent users of NHS services. Patients over 65 account for 60 per cent of admissions and 70 per cent of day beds in NHS hospitals. Following the recommendations of the Dilnot inquiry into how to pay for social care, the NHS Commissioning Board should now call for a fundamental review of how the NHS assesses, prioritises and commissions health services to meet the needs of an ageing population, and what place competing private providers will have.

Private providers have long had a place in the NHS and are important to it and its commissioning process, but let us not go down the American route. A Harvard-led study found that 62 per cent of all bankruptcies in the United States in 2007 were due to medical bills, an increase of 50 per cent in six years. Most of those affected were well educated middle-class home owners. Astonishingly, three-quarters of them had had their finances destroyed by medical costs even though they had insurance. The latest figures from the World Health Organisation suggest that the US spends 2.4 times more on health per person than in Britain, yet British men live on average two years longer and British women one year longer than in the States.

The NHS has been doing much that is right for 60 years. Every institution can be improved, monopolies can get complacent, and people want choice. However, that does not mean switching the fundamental principle on which this great institution was built. It belongs to the people of this country and they do not want it run on a competitive model.