Health and Social Care Bill

Baroness Howells of St Davids Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Howells of St Davids]

My Lords, I decided today to bring to the attention of the House excerpts from the correspondence that I received from people who in the early days were invited by the British Government to come to Britain and serve in the National Health Service. They have taken the trouble—although most of them have retired—to write to me and ask if I would bring to the attention of the House the fact that the United Kingdom has been admired for its National Health Service that looks after the health of the nation. Those people remember that every Government thus far has seen it as a privilege to be the custodians of the NHS—and they are very proud of the part they played in that.

Despite what the Minister said in his opening speech, the letters suggest that if this Bill goes through in its present state it will reduce accountability to the Secretary of State and thereby to the taxpayers. The clause in the Bill relating to this has created many problems forthe citizens of the UK, as has been said today. One of the anxieties is: to whom is the NHS accountable, if not through the Secretary of State to the electorate? I hope that the Minister will reply to this because it is a burning question for not just those who wrote to me, but nearly everyone in this Chamber who mentioned accountability.

As the Bill stands, there will be increased bureaucracy and costs, and—dare I say—potential legal challenge through the application of procurement law. Will the new and inexperienced commissioning consortia be the appropriate responsible bodies for dealing with these legal challenges? How will this improve the National Health Service, especially at this time when we have a downturn in the economy, squeezes in all areas of government, reductions in staff numbers and immense pressure on the confidence, well-being and mutual trust of staff and patients? The National Health Service is not about things. It is about people. People are different. There is still uncertainty as to the impact of competition law. It is very likely that competition law will apply to the NHS. Have the implications been properly considered? If not, the NHS will be subject to uncertainty and delay, and it will prompt access to legal action that will take away finances from the treatment of patients.

The NHS has often been described as world class because those who work in it have been considered by others as being the most dedicated public servants in the country. Other countries seek to learn from our comprehensive system of practice and its role as the medical home for patients needing continuity of care and co-ordination. The NHS’s reputation has always had a focus on evidence-based medicine, supported by internationally respected clinical researchers; with the funding from the public purse it continues to impress worldwide. There is a great fear among these people that with later developments in other countries the citizens of the United Kingdom will not be able to depend on the National Health Service, which we always boast is free at the point of need.

There have been criticisms of the NHS by users and managers alike in the past. This Bill is meant to improve and enhance the NHS and to evaluate whether it is fit for purpose in the changing world. The Government have had two goes at this Bill and still the criticism comes aplenty in letters from clinicians, patient groups, individuals and trade unions. One of the letters I read was from a doctor who was trained in this country and worked for the National Health Service until he retired. He said he pleaded for my support to protect the founding principles of our National Health Service. He further suggested that the Bill has the potential to destroy the NHS as a universal service. It is very difficult to disagree with him after the other speakers I have heard today.

The Minister in his presentation said that responsibility was not taken away from the Secretary of State. I am afraid market competition and profit, not patient need, will drive the service if we accept the Bill as it is. Taking dentistry as an example, while we accept that competition can drive innovative services, how can it benefit ill people who are poor, illiterate and without internet access? This service as is proposed will cause more harm to patients than good. Those who live outside the radar of the healthy, the employed andthe respectable will be sorely disadvantaged if this Bill is rushed through. Sick people need their local hospital or clinic to remain open and to provide comprehensive care. By introducing competition law this Bill has the potential to erode collaboration between primary and secondary care providers. It will not enhance it.

The Bill also has the potential to destabilise the training of doctors, nurses and ancillary healthcare workers. The number of illnesses far outweigh the service they can give because of the pressures on them. As has been said, this Bill has no electoral mandate. It further appears to flout open promises made by the Prime Minister not to engage in top-down reform. That is exactly what it is proposing. There is a sea of worry out there with good cause. Long-term illnesses will be driven into a US-style of healthcare which Professor Pollock describes as,

“islands of excellence in a sea of misery”.

A well known political figure recently said the NHS as it stands is one of the most efficient, cheapest and fairest health systems in the world. Most practitioners and service users in the field of health and social care share a singular desire—the best possible future for the NHS—and this is not yet shown in this Bill. I ask on behalf of those who wrote to me that we re-examine the way this Bill will become law.