Health and Social Care Bill

Baroness Cumberlege Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Cumberlege]

My Lords, I declare an interest as executive director of Cumberlege Connections, which is a training organisation. I am also a fellow of three royal colleges and have associations with a number of health charities.

“The GPs of the future …working closely with social services, should have a wonderful chance to organise the complete care of the community”.

Those are not my words but those of a great leader of the medical profession—the remarkable Archie Cochrane, when he gave the Rock Carling lecture at the Nuffield Trust in 1971, 40 years ago. Forty years ago he could see the sense in putting GPs in the driving seat. But I know that there are many GPs who would be back-seat drivers rather than take on the,

“wonderful chance to organise the complete care of the community”.

I can really understand why. It is a great responsibility. It takes courage. It is very demanding and many of them feel that it is not their vocation. They came into medicine to treat, cure and heal. Fair enough. But we are not asking every GP to step up to the plate—only those who want or feel able to.

After the report on medical professionalism commissioned by the Royal College of Physicians was published, I was invited to a number of roadshows across the UK, sponsored by the King’s Fund, to explain the thinking of the working party I had chaired. On one such occasion in Bristol the hall was full and we invited feedback from the audience. A very distinguished and respected hospital consultant said: “I remember the Griffiths reforms in the 1980s. Roy Griffiths recommended the introduction of general management and we the medical profession said, ‘Right, you can have your managers, they can manage, but we will go away and stick to our clinical work’. What fools we were!”.

We are now giving clinicians another chance—not to be day-to-day managers, not to become expert finance directors poring over endless spreadsheets, but to lead, shape and organise the services that they know matter to patients. That makes a lot of sense. We know that 95 per cent of healthcare problems are dealt with by GPs and their practice teams; more than 15 per cent of the entire population see a GP in any two-week period; and 75 per cent of patients want to consult a GP they know and trust. It seems sensible that those who are so trusted by their service users should be designing services and commissioning them. Currently the PCTs do that.

Since the threat of abolition there has been a great wave of nostalgia for the good old PCTs. Never before have they been so loved and wanted. I recently spent two days in Torbay and if only all PCTs were as good as Torbay the case for change would be hard to make. But sadly that is not the situation. Too many PCTs have been criticised for their inefficiency, lack of understanding of clinical issues and inability to commission quality across the board.

Dr Clare Gerada, the chair of the Royal College of GPs, writing in her blog last month, said:

“We should be taking every opportunity to celebrate the health service … That’s not being complacent, and the College has long argued that there is room for reform”.

I so agree. She went on to say:

“One thing I am confident of is that we will not see a full adoption of the market-driven health service provided in the US and for that I think we should be relieved”.

Me, too, my Lords. I do not want the NHS to be driven by a credit card economy—I want it to offer the best.

People move house in order to get the education they think best for their children. Parents know all about “pester power”—from a very young age children are deeply competitive. They want the very best: the best trainers, the best scooter, the best track suit. It is part of human nature—we are competitive animals. For those of us who know the NHS well, we will choose the best: the best hospital, the best GP, the best clinic for ourselves and our families. For me, raising standards means removing the worst and installing the best. If people want to call that competition—fine. I call it something to strive for.

If Assura Medical is judged, after a fair and open process, to run, manage and deliver a better service of higher quality than the NHS, I cannot understand why the noble Baroness, Lady Jay, should be so concerned, particularly when we know that the Brunswick research shows that patients are not especially worried about who provides the service, so long as it is of a very high standard and free at the point of use.

According to the CQC, 96 per cent of NHS patients using independent facilities for elective surgery are satisfied, but only 79 per cent of those using NHS facilities are. Commenting on the seminal four-year study by the University of York into competition in the NHS, Julian Le Grand, professor of social policy at the LSE and policy adviser to the then Prime Minister, Tony Blair, told the Financial Times yesterday:

“This is a very important result. It shows that one of the most frequent criticisms of patient choice and hospital competition in the NHS—that it would disadvantage the less well-off—is quite misplaced”.

The NHS is of itself competitive. When dealing with the pharmaceutical industry, it negotiates for the best deals, moving to generic medicines when it is to its advantage. And yet here we have people within the NHS who are being highly protective when it comes to service provision. They will resist any suggestion that another organisation outside of the NHS should provide a service, even if it is of a higher quality, more efficient, innovative, and giving the taxpayer better value for money. This is simply inconsistent.

The basis of democracy is competition. There is competition for seats in another place, and competition for party leaderships is so fierce that brother competes against brother. The best win, losers are driven out. Why are these principles attacked by the vested interests within the NHS? Is it to hide bad practice from scrutiny? Is it barefaced protection of inefficiency and the worst manifestation of trade unionism? We, the people, demand open government. The NHS should not demand a closed shop—a cosy nest on a rotten bough.

I accept that this Bill is not universally loved, but it does bring the NHS into the real world. There is room for scrutiny and improvement, which as always your Lordships in Committee will undertake with wisdom, skill and, in this case, fortitude. I will be voting against the amendments proposed by the two noble Lords in this debate for the cogent reasons outlined by my noble friend Lord Howe.