NHS: Future Forum

Baroness Thornton Excerpts

Tuesday 14th June 2011 Lords Chamber

[Baroness Thornton]

My Lords, I thank the Minister for repeating the Statement. I start by paying tribute to him for the way in which he has facilitated the debate about the future of the NHS thus far across the House. The all-Peer seminars benefited hugely from the fact that his office ensured the input from senior department officials. I have to add that his noble friend Lady Northover attended every one of those seminars. They have continued and, I believe, have ensured a greater understanding of the Bill from which it can only benefit. Notwithstanding Nick Clegg waving about his list of changes and claiming all, I think we might find out as we move on how influential the Minister has been in bringing about changes to the Bill. However,

“there is more joy in heaven when one sinner repents”.

About a year ago the Minister gently chided me, when he launched the health White Paper, by saying:

“I hope that when the noble Baroness digests this White Paper, she will come to view it rather more favourably than she has indicated”.—[Official Report, 12/7/10; col. 535.]

On this occasion, lest the noble Earl misunderstands me, I will say that I welcome the findings of the Future Forum, although I think that we would both agree that it cannot possibly have covered all the important issues in the NHS in eight weeks. In the detailed response that accompanies the Statement, the Government have gone further than the Future Forum in their proposed changes to the Bill; they are very significant. I particularly welcome issues such as the commitment to the NHS constitution. However, it begs the question of whether we might need a whole new Bill, or no Bill at all, if we all now agree that evolution is better than revolution.

I will mention the process. In this House we are more familiar with the parliamentary process whereby you consult, legislate and implement—not the other way around, which is what seems to have happened here. However, the Future Forum was a device that I think everyone understood. There was a pressing political need to get the coalition Government—Nick Clegg, David Cameron and in particular Andrew Lansley—off the hook. I will say this only once, despite severe temptation; the uniformly fulsome and enthusiastic welcome from Nick Clegg and David Cameron for the White Paper and the Bill ring rather hollow today. However unworthy the motivation, the end of the pause means one very good outcome for which we should all be grateful—probably none more so than patients and staff—namely, that the Prime Minister, Deputy Prime Minister and Secretary of State will cease their endless visits to hospitals to prove how much they love the NHS.

The chairman of the Future Forum said that opposition to the Bill stemmed from “genuine fear and anxiety”. He went on to say that NHS staff feared for their jobs, and feared that their NHS was about to be broken up and—their word—“privatised”. Thank goodness the Future Forum had the wisdom to listen to what so many people have been saying for a year to the Prime Minister and the Secretary of State: during the consultation period, after the Bill was published, with increasing volume during its passage in the Commons, and despite two very sensible Health Select Committee reports. Does the Minister think that the terrible mess that the Government have found themselves in could have been avoided, and have they learnt their lessons?

Since we are now promised significant changes, will the Minister confirm that there will be a new and proper impact assessment and a new set of Explanatory Notes, and that there will be consultation on the changes proposed through amendments before recommittal? Will there be a formal response to the well argued report of the Health Select Committee and its recommendations, not all of which agree with the Future Forum report? Most importantly in many ways, if there is to be a long period of enactment when the Bill is passed—and, as the Minister explained, no drop -dead moments—a very strong recommendation of the Future Forum report must be acted on; namely, the production of a timetabling and transition plan. This must be in place as soon as possible and must be robust. When does the Minister envisage that it will be published?

As the House would expect, since Part 3 is still in the Bill we will seek reassurances on competition, the composition of consortia, NICE, the minimum references to social care that are there, and, for example, the lack of references to mental health. We will pursue all these issues in due course. Will it be possible for the Minister to use his good offices to ask the Government to make time available for a longer debate in the House about these issues before we receive the Bill? When does the noble Earl think that we might start consideration of the Bill?

While the uncertainty continues, the NHS is going backwards. The Future Forum suggested—and we all know—that there is widespread demoralisation and even fear in the NHS. Good managers are being denigrated and made redundant, front-line staff are facing the sack and major projects and initiatives have been put on hold, as nobody knows what structures will be in place in the next few weeks, let alone the coming months. That is the result of the earlier rush, which can now be remedied by a robust transition plan.

It is to the credit of all the organisations—patient groups, carers, long-term conditions, medical and others—that have persisted in making their views known and whose views the Future Forum heard. During this period, my colleagues and I concentrated on asking people to look at and understand the Bill because we were confident that the more people understood this legislation, the less happy they would be about the threat to our NHS and to patients. We will be doing the same with the new Bill. We will look at it carefully in detail, and I will again be asking whether it meets the concerns that they and their organisations have raised. I say that because almost every single suggestion in the Future Forum report was put down as an amendment by my colleagues in the Commons in Standing Committee. I suggest to the Government that they might save a lot of time and trouble if they adopted all the other amendments that we put down that were not in the Future Forum. Honestly, what a way to conduct the reform of our most precious national asset. The lesson I take from the past year is this: it is very important not to suspend our critical faculties, even in the face of what seems a huge and, at the moment, welcome change. I am sure that this House will not do that. We have a very important job to do in making sense of this Bill and in ensuring that whatever the Government say today, their rhetoric is matched by the reality. We need to consider these suggested changes in this light. We have much work to do, and the sooner we start, the better.

[Earl Howe]

My Lords, I am grateful for the constructive and positive tone that the noble Baroness adopted in her response. I am grateful to her for her welcome of the Future Forum report, and I thank her for expressing appreciation for the seminars which my department is continuing to run. I can return the compliment in expressing my gratitude for the seminars that she has organised to inform Peers.

There is no disguising the fact that this is an extremely wide and detailed programme of modernisation. There is a great deal to absorb. It is important for noble Lords to understand as fully as possible what the proposals amount to before the Bill reaches your Lordships' House. She is right: they are significant changes. However, I would disagree with her about there being no need for a Bill. Since these changes are so extensive, it is appropriate that Parliament should have the opportunity of approving what is proposed for the National Health Service which, as the Statement said, is designed to be an enduring structure that successive Governments can back. Certainly, lessons have been learnt. I think that when we consulted on the White Paper last year, it was clear that there was general acceptance of the key principles that we set out in it, but when the Bill, which set out how we proposed to implement those principles, was published, the concerns bubbled to the surface, which was why we thought it right, and I still think it right, to have the listening exercise.

The noble Baroness asked me whether we would publish a new impact assessment and Explanatory Notes. We will be updating the impact assessment and Explanatory Notes to reflect the changes to the Bill. They will be published when the Bill is introduced in this House in accordance with normal protocol. She also asked me about timetabling. We want to ensure that the Bill is given sufficient scrutiny in both Houses. We hope that the stronger consensus for change that has been built as a result of the listening exercise will be reflected when both Houses consider timing issues and that the Bill will come to this House at the earliest appropriate moment. Currently, I cannot tell the noble Baroness when that will be. It is, of course, not for us to dictate to another place how it should manage its business. She also asked about the possibility of time being available for a health-related debate. The Leader of the House is sitting beside me, and I am sure he heard that request and that it will be discussed in the usual channels.

The noble Baroness rightly insisted on a robust transition plan, which I believe we have. She will have noticed from the Statement that we have adjusted quite significantly the pace at which these changes will be rolled out. I believe that those working in the health service will be reassured by that because in some quarters there was anxiety that we were going too fast for some to be sure that they would be ready in time.

The noble Baroness asked a number of questions, many of which will be the subject of a paper we plan to publish during the next week or so. The paper will set out more precisely how we plan to implement the changes proposed by the NHS Future Forum. I am not in a position to provide all the answers today but it is clear that, above all, the NHS needs certainty, which we can now give to those who work in it. However, I can say today that there is hardly anything in our proposals that does not represent a natural evolution from the policies and programmes pursued by the previous Government: that is, the development of the quality agenda initiated by the noble Lord, Lord Darzi; extending patient choice; developing the tariff; clinically led commissioning at primary care level, which is a natural extension of practice-based commissioning; completing the foundation trust programme; the continuation of the co-operation and competition panel established by the previous Government but now within the framework of a bespoke healthcare regulator; strengthening the patient voice by the evolution of links to HealthWatch; and augmenting the role of the CQC. None of that is wholly new: the difference is that for the first time we are setting all these things out in one coherent programme and not, as did the previous Government, in a piecemeal fashion.

I believe, and I hope, that we have the basis for broad consensus. We will see when the Bill reaches this House whether that belief is borne out. Not for a minute would I wish the noble Baroness to suspend her critical faculties, or for any other noble Lord to do that. I look forward to those debates in due course.