Queen's Speech

Baroness Murphy Excerpts

Thursday 3rd June 2010 Lords Chamber

[Baroness Murphy]

My Lords, I, too, warmly welcome the noble Earl, Lord Howe, to his role on the Front Bench. I am sure that he will forgive me for saying that he has been practising diligently for this role for more than 10 years. We now have a Secretary of State and a Minister leading in the Lords in health who have a solid understanding of health policy. That is a great good fortune for those of us who work in this area. While I suspect that parts of the policy are still a work in progress—social care is probably the fuzziest at present, and I hope that noble Lords were listening to the noble Lord, Lord Sutherland of Houndwood, on this point—I welcome strongly the direction set down in the gracious Speech, and the indication that we shall now speed ahead to reverse the unhelpful dithering and procrastination of the past two years.

I declare an interest as a member of the board of Monitor, the NHS foundation trust regulator, and chairman of St George's Hospital Medical School, University of London—although not for long, as I am retiring this summer from both roles. The future agenda is exciting, both for improvements in healthcare and for the impact that such policies are likely to have on health sciences education. I welcome and will support the intentions of the forthcoming health Bill. The coalition agreement, based on pre-existing Lib Dem policy and the Conservative Party publication NHS Autonomy and Accountability, is entirely welcome.

First, I will highlight the news that research into the dementias has become a government priority. This is music to my ears, as it is my specialty, and makes economic as well as clinical sense. I look forward to seeing how it will be effected in reality, given the inevitable pressures there will be on research council funding.

I welcome strongly the intention to complete the shift to a health system where decisions are made locally by patients and professionals rather than centrally, to complete the separation of commissioning and provision, to get all hospitals to foundation trust status, to improve the information available on the quality of care so that better decisions can be made and to put the setting of incentives in the system on a more professional basis by establishing an independent economic regulator of health care. For a system of tax-funded healthcare to be sustainable in the long run, we need better incentives and more local decision-making and innovation. These changes will be very helpful for that.

There is now incontrovertible evidence that competition between hospitals and between service providers improves both innovation and health outcomes if the system is well regulated to ensure a financial level playing field and the quality of care is subject to rigorous monitoring and improvement. Too often in the past, the internal market was left to its own devices and subject to central interference. It worked to keep down costs but did not necessarily improve quality. The BMA and other professional bodies have been rightly critical of it. However, recent evidence from the Centre for Economic Performance at the LSE and other independent studies by US-based researchers of health outcomes in heart disease treatment in English hospitals have confirmed that a properly regulated market has a positive effect on outcomes, including saving lives—about 400 lives in heart disease treatment. This is especially true when clinicians are in real and powerful leadership roles.

I am sure that we will have many happy hours scrutinising the details as the Bills come before the House. We do not yet know what some of these details will look like. In particular, I do not really understand what the relationship will be between a national commissioning board and local GP commissioners. Finding the best way of organising how we spend £100 billion on healthcare continues to be the most significant unresolved question in the reforms. Commissioning decisions need to be made at a sufficient scale to support the right level of analysis and expertise but also close enough to the clinicians who actually make the spending decisions to influence their behaviour and to reflect local circumstances. How will we prevent groups of GPs from delegating their commissioning to junior administrative staff, as they consistently have done in the past? The benefit of small-group GP fundholding has proven extraordinarily difficult to replicate on a larger scale and I look forward to hearing how that can be done.

How will we get all hospitals to foundation trust status? Only half the acute hospitals and three-quarters of mental health services have so far managed to demonstrate that they are sufficiently financially robust and well governed to stand on their own feet and to operate independently. Strategic health authorities have truly struggled in preparing applicants, so we will need a better approach to help the remaining trusts to get up to the required levels of competence. FT status is not about achieving some label; it is about putting the management and finances of the trusts on a sound footing for the challenges ahead.

Will FTs be subject to Treasury spending controls? If so, this will significantly reduce their freedom from central interference and undermine the intention of the Bill to allow more local decision-making. A way of preventing that would be to adjust the FT regime sufficiently to allow the trusts to be taken off the Government’s balance sheet. We could have, as an alternative to Treasury controls, strong regulation and a clear failure regime to ensure sound finances.

I am challenging the Government to show the kind of bravery that will really move the health service forward. When the Blair Government took office, they had some very good ideas and it is not surprising that the new Government are trying to improve on those good ideas. However, the Blair Government did not implement them quickly enough—it took them five years to get started—and latterly the policy sank into the doldrums, besieged by old party slogans. Although this Government now have the opportunity to act, they must truly get on with it. They cannot improve care directly; only front-line clinical staff can do that, as the noble Lord, Lord Kakkar, said in his maiden speech. However, they can provide the structural context in which improvement of care is likely. I disagree that all structural change is unnecessary or unhelpful. Sometimes structural change is necessary to ensure that something completely different is delivered. In this case, I think that we should continue the structural changes that have been begun but do so more quickly. Therefore, I urge the Government to go as fast as they can; it is our health and our lives that are at stake.