Health and Social Care Bill

Baroness Donaghy Excerpts

Wednesday 12th October 2011 Lords Chamber

[Baroness Donaghy]

My Lords, we all have direct experience of the health service, some good and some not so good. Like most noble Lords I support change. I would like to go on to a hospital ward and find someone in charge. I hope that no one else will have to go through the obscene ping-pong of an elderly dependent relative going backwards and forwards between care home and hospital, not knowing what is best for them, but having them regarded either as a bed-blocker or a health risk.

Of course we need improvements, but it is vital that our own personal prejudices do not get in the way of the overall picture. To pretend that this Bill will solve any or all of these issues is to present a false prospectus. Despite raising these matters, we still do not know how failing organisations will be dealt with, how we will prevent GPs from abusing financial incentives, or how local authorities will be able to afford to set up elaborate new structures. We still cannot work out how the word “streamlining” can be used in the context of more committees, more overlap and more cost. Asking us to agree to this Bill is not just asking us to walk into the unknown, which is fair enough—innovation is good—it is asking us to dismantle our home beforehand.

If this were 1997, things were so bad there would have been popular support for any change, even a rotten one like this, but we are not in 1997. Things are different now. Enormous resources, self-respect, massive innovation and professional incentivisation have changed the agenda. We are now trying to protect what has been achieved. I was once involved in appointing new consultants. It was one of the most exhilarating of experiences. The new generation is chock-full of talent, is aware of the importance of outcomes and does not think that money grows on trees. We are so fortunate in our health service staff, and we should be praising them and taking them with us. As a former chair of ACAS, I know that consent is what leads to better productivity. I say to my noble friend Lady Wall that of course health service staff want certainty. They have wanted it for 63 years, and they are not going to get it. Do not be tempted by the seductive words that any decision is better than none. I have a friend who has worked in the health service all her life and is now on her 24th reorganisation. I am not saying that uncertainty is good or desirable in itself but, as the NHS constitution says, the NHS belongs to the people. As long as that is the case, politicians will always tinker. The alternative is that they might not belong to the health service any more and might be on worse conditions and have inferior pensions.

Yesterday the noble Baroness, Lady Bottomley, spoke of the burdens of ministerial office in the Department of Health, and I have no doubt that all Ministers work way beyond their best capacity. However, I believe that she obfuscated the true meaning of ministerial responsibility by emphasising day-to-day business and micromanagement, and her Tesco analogy really let the cat out of the bag: there is a national Commissioning Board if ever there was one. Some towns have so many Tescos that they are campaigning against them. Its success was built at the expense of the small provider—the local shop—and suppliers so desperate for contracts that they would enter into deals of slave-like proportions. Yes, quality was improved, but it was achieved by pushing down the exploitation to the lowest level.

Let us be clear: we are all in favour of better integration of services, but I think there are yawning gaps in the Bill about how social care will be treated. This subject is not new. In 1968, there was the Seebohm committee report, the health Green Paper and the Royal Commission on Local Government in England—the Maud report. In the debate on the Seebohm report in this House, Lord Amulree said:

“There is a need for a link between the residential homes … and the hospitals … This is something which does go wrong at the present time”.—[Official Report, 29/1/69; col. 1180.]

Amen to that 43 years later. That comment was made when most residential homes were run by local authorities. If it was difficult then, how much more of a challenge will it be under the current set-up? I believe that care homes are a scandal waiting to happen.

What of the Government? The Prime Minister is to be admired for two reasons. First, he has the luck to have one of the most talented Ministers in this House to present this Bill. The noble Earl can truly make this “Titanic” look like Roman Abramovich’s yacht. Secondly, I admire the Prime Minister for his loyalty to his friends and, in particular, his friend Andrew Lansley. I share the same birthday as the Prime Minister, although, unfortunately, not his age, so perhaps we share that value, but the Secretary of State’s stubbornness is now a liability, and the Prime Minister should consider whether personal friendship is more important than running the country.

What is this Bill really about? It is about two things, and they are simple and stark, so they have to be wrapped up in lots of packaging. First, it is passing the ration book to GPs so that they get the blame. Secondly, it is laying the groundwork for the privatisation and dismantling of the National Health Service.

I shall finish with a quotation from Benjamin Disraeli. It is not:

“England does not love coalitions”,—[Official Report, Commons, 16/12/1852; col. 1666.]

or even his comment on the Liberal Government of the day:

“You behold a range of exhausted volcanoes”.

It is this from February 1851:

“I read this morning an awful, though anonymous, manifesto in the great organ of public opinion, which always makes me tremble: Olympian bolts; and yet I could not help fancying amid their rumbling terrors that I heard the plaintive treble of the Treasury bench”.—[Official Report, Commons, 13/2/1851; col. 602.]

In a previous speech, I compared the health service with Little Red Riding Hood, with the noble Earl as an unlikely wolf sitting in bed with a frilly nightcap and speaking with a soft voice. When you consider how to vote, beware not only the big, bad wolf but, under the bed, the plaintive treble of the Treasury Bench.