Health and Social Care Bill

Lord Darzi of Denham Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Darzi of Denham]

My Lords, we live in a time of rising fear. We fear losing our jobs, we fear riots in the streets and we fear that our economic future and our country's place in the world are no longer secure. A little over 60 years ago, the National Health Service was founded to take away the fear that getting sick meant going broke, and growing old meant becoming poor, with rising healthcare bills.

Today, people need our NHS more than ever. It remains this country's most cherished institution. One might conclude that, since our NHS is so precious, it should be protected from change. That is untrue. The NHS must embrace change. To believe in the NHS is to believe in its reform. Healthcare exists at the edge of science. We are constantly finding new drugs and treatments, and innovations in what we do and how we deliver care. The history of medicine has been the history of progress. People rightly expect the latest treatments in the most modern settings. In modern healthcare, to stand still is to fall back.

I will address the three most important features of the Bill before the House. The first is the meaning of competition. The second is the relationship between quality and clinical commissioning. The third is the leadership and management of the NHS. First, there has been much unreasoned debate on competition and choice. They are two sides of the same coin, arrived at from very different starting points. One starts with the ideology of faith in free markets and the responsiveness of corporations to competition in the thirst for profit. The other starts with faith in people and in their capacity to make good choices for themselves, supported and empowered by professionals.

When I was a Minister we introduced free choice, public or private, for all patients. Competition was a means, not an end in itself. With prices fixed and patients empowered, professionals could compete to provide the highest quality care for patients. The right competition for the right reasons can drive us to achieve more, work harder, strive higher, and stretch our hands and reach for excellence. It can spark creativity and light the fire of innovation.

I will also tell noble Lords what I know to be true. There has always been choice in the NHS—but for the few, not the many. Those in the know have always known where to go and how to get there. The reforms of recent years have been about extending choice to the many, not introducing choice for the first time. I fear that the debate today has lost its mind. I have been shocked by the ability to take a pragmatic concept and apply it to the point of absurdity.

I will make one final point on competition. I am tired of the victim mindset in the NHS. It is absolutely wrong and we need radical cultural change to change it. Let us be clear: we have an enormous depth of clinical talent; we have world-leading research; and we provide excellent quality care. In the past decade, waiting times have dropped from 18 months to just a few weeks. In 2009, 92 per cent of our patients rated their care as good, very good or excellent.

Secondly, we must not lose sight of our purpose: raising the quality of care for patients is what inspired me throughout my career. It is an ambition that I share with colleagues across the NHS. It is our collective purpose and common endeavour. I summed it up in the title of my review of the NHS, High Quality Care for All. Today, the NHS faces the huge challenge of raising the quality and efficiency of its services. Fortunately, in healthcare, quality and efficiency are two sides of the same coin. This twin challenge seems to have been lost in the technocratic debate on commissioning.

If clinical commissioning is about empowering clinicians to reshape and reform services in order to improve the quality of care for patients, it has my wholehearted support. However, I need Ministers to give their reassurance that all clinical professionals—GPs, community services and specialists working together—will undertake commissioning. As a surgeon, I would not know where to begin if I was asked to commission community podiatry services. I expect my GP colleagues would find it equally challenging to commission the highly specialised cancer services that my organisation delivers. In the 21st century, we need more integrated care, not more division. We need a health service that harnesses the talent of all our professionals, with a focus on integration and quality above all else.

Finally, I address the question of leadership and management in the NHS. The question is: how do you get the health service to change? How can reform lead to improvements in patient care? My first point is that we in both Houses must stop our frequent assaults on NHS management. If the newly appointed chief executive of a FTSE 100 company came into office and announced that he was firing half the company's management, shareholders would rightly revolt. Attacking NHS management may be good politics, but it is bad policy—and in the long run it will be self-defeating. Change in the NHS happens when coalitions of patients, clinicians and managers come together to break the status quo and to make the difficult decisions that are required to improve patient care. I say “difficult” because changing services is rarely popular. Given the demonisation of those making the changes, that is not a surprise.

Secondly, nothing in the Bill explains how strategic changes will be made to the NHS. With perhaps 300 consortia, how will the necessary changes be made on a regional level? The programme that I led, Healthcare for London, built an alliance of hundreds of clinicians and managers across the capital to improve care. It led to London becoming the world leader in stroke and cardiac care, and dramatically improved the quality of primary care provision. How will similar improvements happen in future?

We had “too big to fail” in the banking sector. Now, healthcare faces a set of reforms that are striking in their managerial complexity, with many changes begun prior to the Bill. We now have health and well-being boards, clinical commissioning groups, clinical senates, local Healthwatches, the NHS Commissioning Board, a quality regulator and an economic regulator—the list goes on. Is this now “too complex to quit”? At the end of the day, who is responsible for making sure that the NHS saves more lives this year than last? Who is accountable for how its budget is spent? Who will improve quality at system level, rather than in an individual organisation or consulting room? Who will inspire NHS staff to lead the difficult changes? What is coming next?

I am a surgeon, so perhaps I may be allowed a surgical analogy. It is the area I know best. The patient—the NHS—is on the table. It has been put to sleep and we have spent the past 18 months worrying more about new commissioning structures than about raising quality and productivity. The incision has been made, the old structures have been swept away and the new structures are beginning to form. The team could not agree on what operation to do. We have already had time out, and the Future Forum have made some good suggestions after the Government failed to listen to the concerns of patients and staff from the start. The question is: what next?

Is more waiting around what the NHS needs? The answer is no. We need to know where we are going and how and when we will get there. This has been a bumpy journey and it would be cruel to refuse to put the end in sight. That is why I find it difficult at this stage to support the amendment of my noble friend Lord Rea. I stand before noble Lords not as a politician but as a surgeon working in the NHS, with the needs of my patients and colleagues at the front of my mind. Our NHS needs leadership. We must never lose sight of our purpose. We aspire to high-quality care for all. The obligation of the Members of this and the other House is to support the NHS to do the things that are tough because they are right.