Health and Social Care Bill

Baroness Murphy Excerpts

Monday 14th November 2011 Lords Chamber

[Baroness Murphy]

My Lords, I must confess that when I first read about clinical senates, I thought, “This is a great solution”. But what is the question? The problem came home to me very much when visiting the New York mental health commissioning services and seeing the great difference in their approach. Mental health is commissioned by the public purse for a largely public service everywhere in the world, so it is a good way of looking at how people commission differently in different places. The big difference between New York’s system of commissioning mental health services and ours was that they had clinical specialists involved on a day-to-day basis who could never be second-guessed by the provider system. That is because they were recognised experts who usually had run a service themselves and were very respected nationally or locally. They were incorporated into the commissioning group. The same was true of public surgical services, public health services, and so on. That was very impressive.

Therefore, when I heard about clinical senates, I thought that this could be the way to provide that kind of serious expertise from a region to clinical commissioning groups. However, it does not seem to be developing quite that way. The noble Lord, Lord Hunt of Kings Heath, is very optimistic, with a slightly grandiose idea of what these clinical senates might do. I would love to share his optimism but I remember those dreadful regional medical advisory groups. I know that the noble Baroness, Lady Emerton, will remember them, because we dealt with the same clinical regional advisory group for the south-east Thames. They were dire; they were the lowest common denominator of time-serving BMA—No, I am going to be very careful now. I do not want to be too rude, but on the whole, they were not the edifying cutting edge of specialties.

[Lord Patel]

Psychiatry.

[Baroness Murphy]

Even the psychiatrists were not. I can remember this group of people being pretty darn useless. You would send up a proposal; they would look at it; they did not like it because it was not in their best interests as a specialty and they would send it back again. I can see that my colleague, the noble Baroness, Lady Emerton, agrees with my every word.

I am a little concerned about what these people are going to do. Will they provide cutting-edge, evidence-based expertise of the best kind to local commissioners? Will they be a talking shop? Will they be a regional medical advisory group?

[Lord Warner]

My Lords, I rise to reassure the noble Baroness, Lady Murphy, and restore her confidence in the Labour Benches on the subject of senates. If the Conservative side can have the Mawhinney-Howe dialogue, why should we not have the Hunt-Warner dialogue on senates?

I can well understand why people would like to be a senator. It sounds very grand. It would be good to put on your CV that you are a member of the senate of wherever—even if it is Birmingham. To some extent, I can understand why the Future Forum thought it would be a good idea to have senates. I can imagine it received a lot of representations from specialists in various parts of the country that perhaps these GP commissioners, as they were then known, were getting a little uppity and needed to be curbed a little and put in their place. Why, then, not give a little more space to the people who really know about these things—the specialists—and bring them together in senates? Yet, since 2006, thanks to the helpful report by Sir David Carter on specialist commissioning, we have gone a long way in putting in place a sensible way for dealing with regional specialties and, on top of that for very rarefied stuff, a national commissioning capability. That has not been around for long. It would not be a bad idea to try to keep some of that learning experience together as we move into this brave new world.

I do not have any problem with networks. Networks have been a proven success. They have done a lot of good and there is a lot to be said for trying to reinforce them, even to put some wording about them in the Bill. But I struggle with senates. We need a really good explanation of what they are out to do. The noble Baroness, Lady Murphy, put her finger right on the button: it is a very good solution but what is it a solution to? I hope we can have some enlightenment on that from the Minister.