Health and Social Care Bill

Lord Birt Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Birt]

My Lords, there is probably no one in your Lordships’ House who does not have cause to be grateful for what the NHS has done for them or their families. Recently, as my own parents entered the final chapter of their long lives, I witnessed at close hand the expertise, dedication and sheer good cheer of the care that they were fortunate enough to receive.

However, I also saw the many ways in which the NHS could improve. That is no surprise. All organisations can improve. All need to adapt and develop in the light of the continuously shifting circumstances they encounter. Technology will offer radical opportunities for improving effectiveness and efficiency. Science will uncover previously unthought-of ways of addressing old problems. Citizens and consumers will make new and different demands. The private sector offers examples of organisations of every size that have transformed their effectiveness, often at times of great adversity. They have had to develop new capabilities, to create new structures or, to define a new focus or accountability.

The test of all health reform is: will the proposal create better health outcomes? Can the UK match or improve on best international practice? Will the reform enhance patient choice, experience and convenience? Will GP surgeries be encouraged to be open when a population largely in work is most free to visit, furthermore relieving an unnecessary burden on A&E? Will the reform promote efficiency, and thus optimise the health outcomes for any given level of available resource? Will it foster and reward innovation? Will it enable a diversity of providers, competing on quality, on clinical effectiveness, and on patient satisfaction, as well as efficiency of provision? As treatment possibilities change, will the new system be flexible enough to enable the supply of the relevant service to be lodged at the appropriate level, whether local, regional or national? The recent welcome improvement of stroke care in London is a case in point. Will the reform encourage greater collaboration and, where appropriate, integration?

My best understanding of the reforms before us today is that they form a continuum, building on the modernisation process begun under John Major, and—with stutters and starts—continued under Tony Blair. Here I declare an interest as I was the Prime Minister’s strategy adviser at the time. Taken together, these reforms are comprehensive and coherent and should address the challenges I have just outlined. They simplify the architecture of the whole health system and lodge accountability for who is responsible for what at every level. In particular, I welcome that they define the role of the Secretary of State not as Minister for the “Today” programme, but as holding ultimate responsibility for the strategic direction and overall effectiveness of the whole system.

These reforms create an arm’s-length commissioning board with the responsibility and the powers to ensure that commissioning is effective. They maintain a system of advice and supervision to promulgate best practice and to safeguard the quality of health service providers. They bring greater openness and transparency, and they allow greater scrutiny of both the system’s marching orders—the three-year mandate—and of the performance of the system overall. They set up, in Monitor, a regulator which can set tariffs to promote best practice and guard against anti-competitive behaviour of any kind. They introduce a failure regime which will maintain essential services for patients while enabling an orderly transition to a more effective alternative. Most welcome of all, they lodge the prime spending responsibility at the front line with GPs and other clinicians, who are far better placed than bureaucrats to make the very difficult trade-offs, and to optimise patient welfare.

These reforms will not be the last word. The NHS will—must—continue to adapt and to change. No doubt the Bill can be further strengthened in its passage through this House. In the round, these measures seem to be another welcome step on the way to the ever more effective NHS that all here desire and want to see.