Health and Social Care Bill

Baroness Meacher Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Meacher]

My Lords, I shall address only three issues—I am sorry; I am losing my voice. The starting point for any reform has to be to define the problem. The Government have defined excessive bureaucracy as the key. Having, in my view, identified the wrong problem, it is not surprising that the Bill comes up with what I would regard as the wrong solution—wholesale organisational change. The real reasons for the financial pressures on the NHS are twofold in my view: first, the failure of the system under all political parties over the decades to lead to the necessary closure of hospitals in the interests of patients; and, secondly, the failure of commissioners over the years to identify the need for much smaller acute hospitals—a wholesale shift from acute hospital beds to community services.

Will the new structures make it more likely that the essential closures will occur in the future in contrast with the past? The King’s Fund is concerned that there should not be too much centralisation of power. I am sure that that is right for many decisions but, in the case of service closures, surely only the NHS Commissioning Board will have the clout and the independence from local campaigning groups to judge the evidence objectively and to make unpopular decisions, when necessary. Of course, local campaigns are legitimate and important but difficult decisions are quite another matter. The Minister puts his confidence in local authorities, health bodies and consultative groups to undertake a needs analysis and take responsibility for closures. My heart sinks.

The noble Baroness, Lady Williams, has strongly supported the continuation of the Secretary of State’s powers. With respect to most decisions I support the noble Baroness wholeheartedly. However, when closures or reconfigurations have to be made in the interests of patients and the long-term health of the NHS, then in my view if the case has been made out—the evidence is there—and is supported by the NHS Commissioning Board, the Secretary of State should only need to satisfy himself or herself that the proper procedures have been followed. At this stage, I have no confidence at all that the new system will be any better than the old in this all-important respect unless we manage to make a key amendment during the passage of the Bill. I know that there is some discussion and thought about the precise role of the Secretary of State. I think that we have to have evidence-based decision-making, and it is very difficult for politicians, whatever their colour.

I now want to turn to the need for the wholesale closure of acute beds and investment in intensive community services for patients with long-term conditions, terminally ill people and those with dementia. We know that hospitals are the worst possible place for these patients, yet vast numbers enter hospital for a procedure that requires perhaps only four, five or six days in hospital but they never get out. Why? It is because there are no intensive community care services to enable them to do so. What will the Bill contribute to this problem? In my view, nothing.

The transformation happened in mental health about 30 years ago, with the wholesale closure of big asylums and their replacement with small in-patient units and a complex array of community care services. There was shock and panic at the time but it was the right policy. Now, with modern surgical techniques, day surgery and very short hospital stays, the time is right for a similar revolution in acute medicine. Indeed, I remember the noble Baroness, Lady Bottomley, saying exactly that when she was Secretary of State all those years ago. It has not happened.

Today, then, elderly, terminally ill people and those with long-term conditions remain in hospital, deteriorating, becoming more demented, underfed and even starved of water on occasions. Soon, discharge from hospital becomes impossible. The average length of stay of these particular groups before they finally die a miserable death in a hospital bed is about two years. All this could be resolved with good commissioning and leadership from the top.

In East London, our commissioners—no credit to me at all—took this step, de-commissioning just one ward and investing in intensive community care. We call it a virtual ward. The savings are £2 million a year; the ward costs £3 million a year to run; the community costs are under £1 million; and 623 patients have been through the virtual ward in just six months, with an average stay in the virtual ward of 10 to 15 days before returning to normal community care. Early feedback suggests that patients are very happy. No legislation was required to do that and it needs to be replicated across the country, as it can be.

My third point concerns the threat of privatisation of NHS services and even hospitals. The Minister assured me yesterday that the capital assets of a hospital would not be sold to private profit-making companies. This is of immense importance. Once a hospital is sold it will be almost impossible to get it back into public ownership. The irreversibility of some of these developments is one of my big concerns about the Bill.

We know that the profit motive is entirely unsuited to the health service. The Economist calculated that the market-driven US healthcare system in 2009 generated between $250 and $325 billion of charges for unnecessary care. The UK cannot afford such waste. Also, what of the patients put through unpleasant procedures to provide profits for others but no gain and perhaps risk to themselves? That is why I feel so passionately about this issue.

I agree that competition is healthy but can the Minister give an assurance on the Floor of the House that profit-making organisations will not be permitted, as he said yesterday, to take over the capital assets of hospitals. This at least would enable future Governments to reverse the planned privatisation of services. I hope that the Minister may even go further. Trusts and other not-for-profit organisations can provide healthy competition. Can the Minister give the House some assurance that such organisations would be regarded as preferred providers when compared with profit-making companies, bearing in mind the experience in the US, Germany and elsewhere?

This is an unnecessary, costly and—I hate to say—potentially dangerous piece of legislation. I hope that the Minister can allay some of my fears tomorrow.