Health and Social Care Bill

Baroness O'Loan Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness O'Loan]

My Lords, prior to the drafting of the Bill, we had assurances from government that there would be no top-down reform of the National Health Service, a service which is so highly regarded internationally, as the noble Baronesses, Lady Billingham and Lady Williams, said earlier.

The level of concern about this Bill must surely be virtually unprecedented. Representations have been received on a massive scale from hospital consultants, the College of Occupational Therapists, health service managers and, in one case, 1,000 doctors writing to a daily newspaper. It is important to note the range of people who are expressing concern: the NHS Support Federation, the co-chair of the NHS Consultants' Association and member of BMA Council, Mind, Rethink Mental Illness, the Centre for Mental Health, the Mental Health Foundation, the Royal College of Psychiatrists, councillors, the UK Faculty of Public Health, the Academy of Medical Royal Colleges, Diabetes UK, the Royal College of Nursing, the National Children's Bureau, the BMA, the TUC and so on.

Proposals for change in the NHS are not new. We have had decades of them, and this alone should inform us of the need for sensitivity and strategy in the way in which we approach reform.

The concerns which have been identified are various, but they were well articulated by a senior NHS director of public health, who wrote:

“The Bill will do irreparable harm to the NHS, to individual patients and to society as a whole. It ushers in a significantly heightened degree of commercialisation and marketisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies”.

In the creation of the internal market so many years ago, we saw change of a much lesser kind, and it resulted in the creation of hundreds of new bodies which accelerated the cost of NHS administration over the years. I sat on a health board at that time and recall vividly the perplexity and inefficiencies which resulted. Those changes had to be undone at immense cost. There is significant concern that the current proposals are even more unthought-out in their formation. We cannot afford unplanned and ill-thought-out change at a time of economic turbulence with the ongoing threat of global recession.

The NHS is not broken; it is simply being tasked to carry out more and more work for a rapidly expanding population, which is also living longer in a world in which science is providing the answer to many medical problems which were previously insoluble. All this involves rapidly increasing costs. Nobody denies that more resources have been put into the NHS. What is necessary is that we acknowledge that the NHS is meeting huge levels of demand and that will not change.

The proposal in this Bill is that the Secretary of State will no longer have to account to Parliament for the delivery of a service that is key to the United Kingdom’s economic, financial and social stability. There will be new structures for service delivery, for example, which will permit Monitor to determine that an NHS provider is not meeting the needs of its service users and to use taxpayers’ money to buy those services from the private sector. This is effectively unplanned, unstructured privatisation, with the attendant enormous difficulties of regulation. Regulation is no substitute for good governance structures and planning.

The complexity of national demand—of access to clinical specialities and training and management change required by the Bill—are as yet unquantified. The potential for challenge in the courts in the context of service delivery are enormous. This will involve more loss of resources for the delivery of patient care. I have great concern over the proposal to place primary responsibilities with general practitioners who face monumental challenges simply in staying up to date with developments in clinical practice across the whole spectrum of health issues. To fragment purchasing responsibility in this way can only add to cost and to the possibility of inequalities in the provision of care. Many of the relevant questions in this context have already been asked in the House today. I will not repeat them.

Undoubtedly an organisation of the size, scope and range of responsibilities of the NHS must be in a constant process of change. What is profoundly important is that reform is carried out following proper consultation with a clear mandate with properly costed and analysed resourcing decisions and with the support of service users—or patients if you want to refer to them that way—and of the professional bodies that will have to implement the change. I have not seen the evidence to suggest that that is the case in the Bill. Its current deficiencies have been and will be widely articulated in the Chamber today. In the interests of brevity, I will save any further comment for the later stages of the Bill. I will simply state my support for the proposal of the noble Lords, Lord Hennessey and Lord Owen, for a Select Committee.