Health and Care Bill

Lord Hunt of Wirral Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is my pleasure to support all the amendments in this group, so ably introduced by the noble Baroness, Lady Thornton. I thank her for tabling this amendment and Amendment 28, to which I was pleased to attach my name.

I agree with pretty well everything that has been said but want particularly to highlight the contribution of the noble Baroness, Lady Hollins. As she was talking, I was thinking about testimony that I heard earlier this week at the All-Party Parliamentary Group for Art, Craft and Design in Education. A teacher was saying that if their educational provision caters to the most vulnerable and disadvantaged pupil in their school, that means that it is catering the best for everyone. It might be thought that having a representative for the interests of those with autism and learning difficulties will affect the care that they receive but it would actually greatly improve the care that everyone would receive. That is not often adequately understood.

As the noble Baroness, Lady Thornton, said in her introduction, there are really two sub-groups here. Going from consideration of Amendment 18 to Amendment 30, we are essentially talking about, as the noble Baroness, Lady Bakewell, was saying, the need to avoid corporate capture of our NHS, although the corporate sector has already won many battles and taken over a great deal of the NHS. If the need for profit is the way in which things are being run, care must suffer. Care is the second priority and that is an unavoidable fact. When one considers privatisation—I have later amendments that will address the care sector in particular—we see where this has been allowed to extend to extremes, whereby the private equity sector has taken over our care system at enormous cost to the quality of care for public and private pockets. The system is in a state of near-continual collapse. We have to make sure that ICBs do not go down the route that our care sector has already gone down.

I am thinking about this matter for Report. There is also a further issue whereby although these amendments address people’s current employment and roles, we also need to think about the revolving door situation, about which, I see from social media, the public are increasingly concerned. We see people flipping between the private and public sectors and taking the interests, direction of travel and thinking of one to the other—and not for positive purposes.

I am aware of the hour but I am looking at the second sub-group of amendments, Amendments 37 to 41, and at who should be there. The issue relates to my comments on the previous group. We cannot just say, in terms of managing the NHS, “Just leave it to the doctors and the experts. They know about care.” Of course they do in terms of running services but in making choices and allocations and in ensuring that the ICB meets the needs of its community, it is the community that knows what the needs are and should tell the medical people what needs to be delivered, and the shape of that delivery. The technical details will come down to the medical people.

It is therefore crucial that we do not see the ICBs as technocratic places for people with MBAs and doctors but that we should include trade unionists, patients and carers. Carers are particularly important because our current system does so poorly in meeting their needs and supporting them. We need bodies that truly serve to represent the community.

[Lord Hunt of Wirral (Con)]

My Lords, in declaring my interests as set out in the register, I want to press my noble friend the Minister on conflicts of interest.

Paragraph 8 of Schedule 2 to the Bill provides that local NHS trusts and GPs are to appoint members of the integrated care board. Organisations that provide the bulk of NHS services will therefore be co-opted into the work of commissioning. It is currently the work of commissioners to hold providers to account, objectively determining whether they are best placed to provide a service and assessing their performance. The new integrated care boards must continue to perform that role.

Clause 14 introduces into the 2006 Act new Section 14Z30, subsection (4) of which provides, rightly:

“Each integrated care board must make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes.”


Reference has already been made to amendments that seek to exclude individuals involved with independent healthcare provision from joining the ICBs. Does my noble friend the Minister agree that the membership of provider appointees on integrated care boards may at least risk creating a perception of a conflict of interest between the roles of those individuals on the board and any roles they may hold with provider organisations? How can the benefit of provider input into the work of an ICB be reconciled with the task of objectively assessing both the suitability and performance of providers? I believe that greater clarity from the very outset on the extent of the role that provider appointees will be expected to play will surely assist ICBs in developing robust governance arrangements, which would then enjoy public confidence.

[Baroness Meacher (CB)]

My Lords, I support Amendment 37. In so doing, I add my strong support to the comments of the noble Baronesses, Lady Bakewell and Lady Bennett.

Of course, the ICBs will be central to ensuring adequate funding and support, not only for the powerful acute health trusts and primary care but for the services that are historically underfunded. It is for these services that this amendment is particularly important. Before discussing these specific gaps in the Government’s vision for the new system, I want to stress that I am very concerned that we should not lose vital clinical leadership along with patient representation, which were the hallmarks of the CCG system. Of course, we want worker and carer representation but, in my experience, top medics are actually rather good at deciding how money should be allocated across services.

In my view, the absence of a public health representative from the shortlist of necessary ICB members in the Bill is an extraordinary oversight. This amendment seeks to put that right. ICSs are already in the process of developing their draft constitutions, which, while dependent on the final content of the Bill, provide a clear indication of their intent regarding clinical membership. It is particularly concerning that several ICSs have failed to include any role on their ICB for public health experts in their draft constitutions, with some failing to make any reference to public health at all. As the BMA points out in its briefing, this poses a significant risk to the role and prominence of public health within the work of those ICBs.

In relation to the importance of public health representation on ICBs, noble Lords should be aware of the impact of this on the vexed issue of drug addiction. Police services up and down the country are recognising that criminalisation and imprisonment are entirely counterproductive in this field. These responses only limit the young person’s education and employment options and tie them into a life of drugs and crime, with appalling consequences for them but also for their communities. Police services are increasingly adopting diversion to treatment as a preferable response when an individual is found in possession of drugs, but drug treatment services have been cut over the past 10 years. ICBs will need to tackle this situation as a matter of urgency if the police are to be able to stem the tide of county lines and other highly damaging consequences of our counterproductive and, in my view, idiotic drug policies and failure to treat addiction as a mental health problem, which, of course, it is. These urgent issues will not be confronted unless public health is strongly represented on ICBs and other boards and committees in the new structure.

Another cri de coeur is for mental health, as others have said. Having chaired a mental health trust for many years, I am acutely conscious of the impact of bed shortages on very sick people and their families and of the very high threshold for child mental health services. There is no doubt that if we do not treat children with mental health problems, we will have adults with these kinds of problems throughout their lives. The country cannot afford to continue neglecting this important field. I support the other amendments in this group. The NHS has major long-term workforce shortages and other problems. If they are to be addressed adequately, the staff need representation, along with patients and carers.

I end with a plea to ensure, through membership of ICBs, ICSs and ICPs, that clinical leadership is retained within the NHS. On ICBs, this must include at least two primary care members, at least one clinical representative of secondary care, acute care and mental health and at least one qualified and registered public health consultant. I hope the Minister will tell the Committee whether he agrees with this approach to ICB membership.

Health and Care Bill

Lord Hunt of Wirral Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Hunt of Wirral (Con)]

My Lords, I draw attention to my entry in the register, in particular as a long-standing partner at the international commercial law firm DAC Beachcroft. Unlike the noble Baroness, Lady Jones of Moulsecoomb, I warmly welcome the Bill. In its broad architecture and intent, as the noble Lord, Lord Stevens of Birmingham, pointed out in his superb maiden speech, it goes very much with the grain of what healthcare professionals want, building on existing and emerging best practice—in particular non-statutory integrated care systems. Among the innovations in the Bill, I welcome in particular the proposed new Health Services Safety Investigations Body, extended to encourage learning across the whole sector rather than just in the NHS.

Some argue that it might have been better to delay these reforms until the Covid-19 pandemic was truly a thing of the past. Ultimately it is for the Minister to allay those concerns, not me, but if anything I think the Bill is overdue. The pandemic has put the system under unprecedented strain, and although the NHS and its independent sector colleagues co-operated brilliantly to continue to deliver healthcare, some cracks understandably did begin to show.

I have been in Parliament for 45 years now, and the holy grail for me has always been a so-called seamless robe of health and social care. There are always people in hospital who would be better off elsewhere, always shortfalls in at-home care staff, and always breakdowns in communication between healthcare and the social care system. It is an age-old problem, and one that came into sharp—indeed, horrifying—focus during the first wave of the Covid-19 pandemic.

The biggest concern across both healthcare and social care is still staffing. The ability to meet demand through recruitment and, within social care especially, reducing the current unsustainable level of churn, remains the key to delivering the world-class health and social care of which we are capable. The availability and accessibility of alternative care settings—for example, at-home care—also require dramatic improvement. This will all require more people, more training and more money.

In another place there was an attempt to amend the Bill to make it provide for regular, authoritative workforce projections. Perhaps such an amendment might ultimately find its way into the Bill. I hope so.

Those who experience health inequalities have also been disproportionately affected by the pandemic. Might it be beneficial for the Secretary of State to be able to place specific requirements on the new NHS commissioning bodies to have regard to particular aspects of inequalities?

Of course, the Bill is now buttressed by the proposals in the Government’s White Paper on social care, which I also welcome. I would be delighted to hear from the Minister whether anything from the White Paper might yet find its way into the Bill, here or in another place, because we must move more quickly.

No one, though, wants the NHS to live in a state of permanent revolution, so there must be no change for change’s sake. Now more than ever, change must be purposeful, rational and highly effective, capturing the positives in cross-sector co-operation that we all recognise.

Many of the principles in the Bill have long been adumbrated by the opposition parties themselves, in particular the vital principle of affirming that the Secretary of State must have overall responsibility for the NHS. I therefore very much hope that we can now all work together to achieve a degree of consensus across all parties and beyond. The NHS is far too important to be a party-political football.

I already like the Bill very much indeed, and I fervently hope that we all grow to like it more and more as it progresses through all its stages, in particular in this House.

Social Care

Lord Hunt of Wirral Excerpts

Wednesday 8th July 2020 Lords Chamber

[Lord Bethell]

The right reverend Prelate is entirely right that we will need some kind of formal structure to go about cross-party talks and achieve a solution. That formal structure will need to be agreed in cross-party conversations. Those conversations have been ongoing during the epidemic and are now very much the focus of the Government’s attention.

[Lord Hunt of Wirral (Con) [V]]

My Lords, in the light of the surge in support from neighbours, family and friends for older people who have been shielding at home during the pandemic, would my noble friend agree that it is still the policy of Her Majesty’s Government to encourage people to remain receiving care in their own homes for as long as possible?

[Lord Bethell]

My Lords, the role of carers during the epidemic is one of the great stories of commitment and sacrifice. I pay tribute to all those who have given up their time and taken the risks necessary to perform this important community role. On encouraging people to stay home, there are clear guidelines on who is recommended to stay at home. It depends on clinical need and people’s precise circumstances, according to their GP’s recommendations. I urge all people to follow those guidelines.

Queen’s Speech

Lord Hunt of Wirral Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Hunt of Wirral (Con)]

My Lords, first, I declare my interests, as detailed in the register—in particular, as a partner in the international commercial law firm DAC Beachcroft.

As a one-nation Conservative, I strongly welcome the Government’s renewed commitment to our public services, but those public services must necessarily be built upon the strong foundations that only a flourishing economy can provide. As we gird ourselves for the post-Brexit world, whatever our views might have been before the 2016 referendum, we now have to work together to ensure that our economy is as prepared as possible to flourish in this new world.

My specialist subject is financial services—a sector in which the UK excels. I say to the noble Lord, Lord Fox, who raised the issue at the start of the debate, that I believe that financial services are ready to strengthen their position if only the Government will take a number of key steps. It is a sector in which regulation plays an all-important role. The erstwhile Financial Services Authority was obliged to have regard to

“the desirability of maintaining the competitive position of the United Kingdom”.

When the FSA was superseded, however, no such obligation was retained. I therefore echo the excellent 11th report from the 2017-19 Session of our European Union Committee and its recommendation in paragraph 225, which says that

“it may become clear that regulators are unduly constrained by their current objectives. We recommend that the Government consider and consult on the desirability of adding a duty to promote international competitiveness to these objectives.”

That recommendation, preferably shorn of its caveats, could be vital for our future success. It was based upon a wealth of informed submissions—for instance, from the Association of British Insurers, which stated: “We believe both regulators”, meaning the Financial Conduct Authority and the Prudential Regulation Authority,

“should be equipped with a clear remit for UK competitiveness ... once we leave the EU.”

That view is widely expressed, with growing vehemence and intensity, right across the financial services industry. Regulators in our main rival territories, such as Bermuda, Switzerland and Singapore, are already subject to a similar obligation and it does not imply a dilution of standards. On the contrary, our competitive edge relies on a delicate balance between a hard-won reputation for integrity, quality and reliability and our ability to be flexible, to adapt and to innovate. I strongly press my noble friend the Minister to go back to the future by using the forthcoming financial services Bill to impose a similar obligation on the FCA and the PRA to restore that vital balance of objectives.

Something that would definitely serve to improve competitiveness would be a period of regulatory stability and, above all, proportionate regulation. In its last manifesto, the British Insurance Brokers’ Association, where I have just relinquished my role as chair, made that point eloquently and persuasively.

In summary, this legislative programme adumbrates measures that have the potential to heal the ugly rift that has opened up in this country between the haves and have-nots, between north and south, and between remainers and leavers. In my opinion, a party that now represents not only traditional strongholds such as Wells, Wimbledon and Wycombe but also those new bastions of Bassetlaw, Bishop Auckland and Blyth Valley has both a unique opportunity and a unique responsibility to rebuild one nation.

Health Service Safety Investigations Bill [HL]

Lord Hunt of Wirral Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Hunt of Wirral (Con)]

My Lords, I begin by declaring my interests as set out in the register, in particular as a partner at the global commercial law firm DAC Beachcroft. I, too, strongly welcome the Bill in principle. The NHS is already a world leader, and the creation of a new statutory arm’s-length body in this space will ensure that, in the tiny minority of instances where something goes wrong, all possible lessons are learned. The new Health Service Safety Investigations Body will indeed significantly improve the NHS and enhance patient confidence.

All noble Lords will have received a plethora of briefings from various organisations in advance of this debate. In the very substantial briefing from the BMA, two very important points stood out for me, both being vital matters of both principle and detail. The first is that the criteria in Clause 3 must,

“emphasise the importance of learning from incidents and moving away from the ... culture of blame”.

I am delighted to see the noble Baroness, Lady Ashton, in her place, because 13 years ago I persuaded her to include Clause 2 in the Compensation Act 2006, so that we could all say sorry without being held as having confessed that we were to blame. I remember that it sparked a load of letters in the Times saying, “At last, we can say sorry”. I think we have moved away from the principle she set out in that Act, and the BMA reminds us that we have to learn all the time and move away from that culture of blame.

The second point is the suggestion, which seems excellent to me, that with the advent of the new HSSIB, greater clarity must be provided about the pathways down which health professionals, other staff, patients—and I would add their friends and families too—can go when and if they wish to raise concerns. Directly connected with this question is an area of the Bill that has already enjoyed some close scrutiny in this Second Reading debate, and a degree of criticism, namely the question of the so-called safe space. I well understand the questions of moral hazard behind this, but I suspect that the balance in the Bill may require some fine tuning. As the House knows, I am not a fundamentalist by nature, but I am quite the stickler for free expression, transparency and openness. Indeed, I am delighted to see the noble Lord, Lord Faulks, in his place and look forward to hearing his contribution later, because he has now taken over the mantle of chairing the Independent Press Standards Organisation, which I had the honour of starting, as its founder chairman.

The creation of the safe space around confidentiality of information shared with the new body is potentially a significant step forward in encouraging candour and enhancing potential learning from clinical incidents. However, I find myself wondering just what level of confidentiality will emerge if this Bill becomes law and just how safe the safe space could, would and should truly be. The excellent report of the Joint Committee on the draft Bill, published on 2 August 2018, covered this authoritatively. In paragraph 7 of its conclusions and recommendations, it made the all-important point that the role of the new body will be to promote,

“learning and improvement arising from objective and comprehensive analysis of the causes of clinical mistakes and incidents, leading to better and safer outcomes for users of the healthcare system. We do not think this … is incompatible with obtaining justice in individual cases, which may and should be pursued by other means”.

My noble friend Lady Eaton was of course a member of that committee, the report of which has served greatly to improve this Bill. I look forward to hearing her speech later in the debate.

The new body will publish findings, including factual findings, on a non- identifiable basis, and will be subject to a public inquiries-type process of the equivalent of Salmon letters to those impacted by the findings. Under the Bill, protected material would be disclosed to the coroner in fatal accidents, and if the coroner were to assess that material as relevant he or she would then have to apply to the High Court for an order enabling use of the protected material in the inquest setting. This is intended to provide a safeguard for the confidentiality of the material gathered, applying the safe space principle.

At a practical level, however, I find it difficult to envisage many situations in which HSSIB-protected materials arising from an investigation into a patient’s death are not going to be regarded as relevant to a coroner’s investigation. The question, therefore, is whether the High Court will indeed cherish and protect the safe space principle and the default confidentiality of that material, or whether the need for an order will gradually migrate into a far softer route of access, diminishing that safe space principle over time. Reading the Bill, I am just not sure, and it seems to me vital that we as legislators should be far clearer about our intentions. I am confident that these arguments will be teased out in some detail, here and elsewhere, as we delve into the details of this Bill during the end of this year and, no doubt, for a large portion of next year as well.

There has been a conscious and welcome equalisation of public and independent regulation in healthcare—several speakers have already dealt with this—ever since the creation of the CQC as a single regulator across all health and social care providers. The powers, investigations, reports and enforcement actions of the CQC are intended to be the same for providers irrespective of commissioning or funding back-drop. This is the same for coroners’ and police investigations, and for professional bodies such as the GMC and the NMC.

In contrast, the creation of this new statutory body is targeted solely at those providing NHS-funded care—the noble Lord, Lord Scriven, went into some detail on this aspect. I agree that this threatens to create an inequality, which to many informed observers seems somewhat arbitrary and contrary to the public interest. Clinicians working in both public and private patient spaces would face, and indeed feel, different levels of scrutiny and engagement with learning. Investigations would exist in some aspects of clinical practice but not in others. I have no doubt that the Minister and her colleagues will be pressed during the later stages of the Bill’s passage on whether we should address risk and learning across the primary healthcare sector, irrespective of provider or funder.

In closing, may I offer one more thought? At a system-wide level, is there any intention to create a read-across between, on the one hand, the new body’s findings around leadership and the consequential management of incidents and learning, and, on the other, the recommendations from the Kark review around the “fit-and-proper-person” test for directors, where management of candour in relation to clinical incidents is relevant? In an interesting parallel, the fitness and propriety approach of the Financial Conduct Authority includes a reference to “openness with self-disclosures”. I believe that we could benefit from close scrutiny of the FCA’s senior managers and certification regime. I note that the CQC would not have access to the new body’s protected material, but on the assumption its investigations would—or at least might—deliver learning around the clinical incident and its management, it is at least arguable that the HSSIB process may, consciously or inadvertently, arrive at findings that flag up specific leadership challenges for organisations concerned. How will that process and the risk associated with it be managed, if this is to be a genuinely blame-free process? This is the devil in the detail, perhaps, but it also seems inextricably connected to the vital principles upon which this admirable Bill is founded.

Accidents: Costs

Lord Hunt of Wirral Excerpts

Monday 31st October 2011 Lords Chamber

[Earl Howe]

My Lords, I pay tribute to the noble Lord’s work as president of RoSPA and, indeed, to the work of RoSPA itself. He may recall that the public health White Paper that we issued some months ago—Healthy Lives, Healthy People—as well as the update that we issued, specifically lists accident prevention as one of the key areas of responsibility. That to my mind is par excellence an area where local authorities will be able to make a difference with their new public health responsibilities under the Health and Social Care Bill. They will be able to work with organisations like RoSPA and professional groups such as health visitors to improve safety in their areas. We look forward to working with them on those programmes, should they choose to prioritise them.

[Lord Hunt of Wirral]

My Lords, while declaring an interest as deputy president of the Royal Society for the Prevention of Accidents, I warmly applaud my noble friend’s commitment to the way in which we have restored at long last accident prevention as one of those key objectives. Will he please do a little more by setting the agenda on the right way forward to stop the sort of problem just referred to by the noble Lord?

[Earl Howe]

There is no question but that accidents in the home and in leisure contexts are a serious issue. It so happens that the UK has a very good record compared with some other European countries, but we can never be complacent on this. Some very tragic accidents occur, particularly to children, that we must bear down upon. Again I pay tribute to the work of RoSPA to prevent accidents with looped blind cords, which can often be a hazard to children. NICE has published accident guidelines relevant to home and leisure situations and also guides focusing on home safety and road design. It is that realm of public health that we hope NICE will focus on more and more as the years go by.

Healthcare

Lord Hunt of Wirral Excerpts

Thursday 28th October 2010 Lords Chamber

Moved By

[Lord Hunt of Wirral]

To call attention to the Government’s policy on patient-led healthcare, the focus on clinical outcomes, and the role of health professionals; and to move for Papers.

[Lord Hunt of Wirral]

My Lords, I beg to move the Motion standing in my name on the Order Paper and to say how delighted I am to initiate this debate today, especially following the Government’s commitment last week to protect health spending. As the Chancellor of the Exchequer said, in presenting the Government's spending review:

“But to govern is to choose, and we have chosen the national health service”.

We would do well to remind ourselves that the Chancellor also said:

“That does not mean that we are letting the Department of Health off the need to drive real reform and savings from waste and inefficiency. Productivity in the health service fell steadily over the past 10 years, and that must not continue”.—[Official Report, Commons, 20/10/10; col. 959.]

Nevertheless, overall NHS spending will increase in real terms over the course of the spending review period, and it is right that we should now have the opportunity of setting out the views of this House on the Government’s healthcare plans. Their proposals to put patients at the heart of the NHS, to bring greater focus on clinical outcomes, and to empower health professionals are set out in detail in the White Paper and in all the consultation papers and announcements that have subsequently been issued.

Every Government must grapple with concerns over medical research and screening, accidents—especially in the home—obesity and smoking, to name some of the more perennial concerns. The impact on children’s health of all those arguments over MMR and the fallout from the last Government’s handling of the swine flu epidemic have also emphasised the central importance of vaccination to government health policy. I very much hope that my noble friend will give further details as to the Government’s approach to this critical area.

Before I go further, I need to declare my interest. For several years, I was ultimately responsible for the National Health Service in Wales, and my ministerial team and I worked closely with John Wyn Owen in developing our clear policy,

“to add years to life and quality life to years”.

I should also remind the House that for 41 years I have been a partner in the national commercial law firm Beachcroft LLP.

Many of the Government’s commitments will require primary legislation, and a Bill is due to be introduced later this year which will attract considerable attention not only from within the NHS but from firms in the private health sector and from professional advisers. As a former science Minister, I was particularly pleased with the generous treatment of the science budget, which will also enable the investment of £220 million in the UK Centre for Medical Research and Innovation at St Pancras, and also to fund the Laboratory of Molecular Biology in Cambridge.

The programme set out by the Government is undoubtedly an ambitious one, particularly in its vision of patient-led healthcare. Few will dispute the merits of giving patients more choice and control. Much debate has already focused in this respect on the shift of responsibility for commissioning most healthcare services in England from primary care trusts to local consortia of GP practices. This is intended to bring decision-making as close as possible to patients, in what the Government terms,

“no decision about me without me”.

Much has been said, and will continue to be said, in relation to the proposed role of GP consortia, on the challenges that this will present to GP practices and other stakeholders involved in commissioning; and the support which GPs will need to commission services and contract with service providers effectively. However, these discussions should not blind us to the fact that the Government’s commitment to giving patients a choice of any provider, choice of consultant-led team, choice of GP practice and choice of treatment alone will entail more sweeping changes to how the NHS operates, much more sweeping than many commentators thought only six months ago.

As president of Case Management Society UK, I would like to stress the contribution that case managers can make to the better allocation of resources, and also to the creation of more joined-up treatment for patients. I therefore hope that we shall see an expanded role for case managers as the NHS evolves. As experts in the process of communication and co-ordination, case managers can help patients who have to make informed decisions about their individual healthcare and also provide an opportunity to shape the future of healthcare services.

“Choose and book” has already greatly enlarged the degree of choice that patients or their GPs can exercise in relation to their treatment. The emphasis on the choice of named consultant-led teams for elective care by April 2011, when clinically appropriate, will be a very positive development, and one supported by the Royal College of Surgeons, which has briefed us for this debate and which is helping to lead the way in developing and using outcomes data. I know that my noble friend and his colleagues are rightly concerned to ensure a genuine level playing field for providers of care. Ultimately, effective and fair competition under a rules-based system will stimulate innovation, bring forward extra capacity and underpin genuine patient choice. Notwithstanding the statements of the Secretary of State’s predecessor in favour of the NHS as preferred provider, many privately owned operators already provide additional capacity through the Extended Choice Network. As a means of using all available beds and resources to assist in the major task of improving the NHS, this framework has been a success for patient, taxpayer and private sector alike. I understand that the coalition Government are planning to build on this framework in rolling out the new “any willing provider” framework.

The creation of a level playing field will require not only a focus on high-profile initiatives such as the right to choose a consultant-led team but a detailed attention to the minutiae of commissioning. The duration and termination provisions of the contracts which are rolled out under the framework, the way in which these contracts are awarded and the number of separate contracts that providers will need to bid for and perform may in practice have as much impact on the creation of a level playing field between providers as some of the more publicly debated issues. Of course, plurality of supply in the NHS will need to go hand in hand with a regime for the so-called failing hospitals. This is an area of great complexity from a policy, financial and legal perspective, but one which I hope that the Government will not shy away from in setting out their reform proposals in more detail. We must ensure that patient choice becomes a reality for all patients.

Patients will need access to information, and I welcome in this context the Government's proposals to centralise all data returns in the Health and Social Care Information Centre. Informed choice will be about recognising the importance of providing more insightful information to patients, but also that,

“different people and groups in society access information differently and need it presented in different ways. We must ensure the right information is available and presented in a relevant way to those who could otherwise be excluded”.

My noble friend has rightly characterised these plans as requiring an “information revolution”. That brings me to clinical outcomes. Few members of the public or the medical and nursing professions will disagree with the Government’s aims to hold the NHS to account against clinically credible and evidence-based outcome measures and remove process targets with no clinical justification. The public will surely welcome their proposals that payments to providers should reflect outcomes, not just activity, and provide an incentive for better quality. The same is true of the plans to pay drug companies according to the value of new medicines and with a view to ensuring better access for patients.

The Government’s focus on excellence in the NHS emphasises that there is a lot more work to be done to ensure consistently excellent performance in all areas of care. This is about more than just enshrining duties into law; it is about ensuring that the drivers of excellence in the NHS are identified, implemented and promoted.

One area is, of course, cancer treatment. I know that my noble friend Lady Finlay of Llandaff will on 11 November give us all an opportunity to debate the measures necessary to improve the quality and quantity of life for people with cancer, so I will not say anything further on that—although the Minister may want to say something further.

It would hardly be possible to comment on the setting of new quality standards in the NHS without paying tribute to the excellent work of the National Institute for Health and Clinical Excellence. At a time when the future of certain valuable arm’s-length bodies remains uncertain, the steps which the Government are taking to ensure the independence of NICE and its core functions are encouraging. Of course, the Government have also indicated their intention to empower professionals and providers, give them more autonomy and make them more accountable to patients through choice, and to the public through more formal means of accountability. I read carefully my noble friend’s speech to the King’s Fund. He said, “It boils down to trust”. How right he is.

GP consortia will be accountable to the proposed new NHS commissioning board and it must be the clinicians and their patients in consulting rooms and clinics, not the board, who are the so-called “NHS headquarters”. The independence of this board will deliver on the promise of taking political micromanagement out of the NHS that so many Ministers have made in this House, but few, sadly, have been able to honour.

Nor will this promise be honoured in just the commissioning of care. The same degree of independence will be given to Monitor in its new incarnation as the economic regulator of healthcare providers. Several of my colleagues may well want to refer to that. We of course need greater autonomy at the operational level, and colleagues may recall the strong reservations of my noble friends regarding the constraints imposed on all those powers given to, for instance, foundation trusts. We had doubts about the constraints imposed on the freedoms that were originally promised. As part of the Government’s commitment to,

“create the largest and most vibrant social enterprise sector in the world”,

foundation trusts will at last be given those greater freedoms. My goodness, they are going to need them, and we await those further announcements with great interest.

In conclusion, I recognise that there is a place for effective performance management in the NHS. This has yielded promising gains in productivity in some regions, such as the south-west. Handing more freedom to our successful foundation trusts will be the key to unlocking greater innovation in the NHS. We also welcome the additional responsibilities which are to go to local authorities, and we will be monitoring those very carefully. This will all require investment in infrastructure and a clear focus on the management of NHS assets, informed by the skills of those organisations with particular experience in the field of asset management. The White Paper does not outline in detail what will happen to, for instance, the LIFT schemes to which primary care trusts are party. This is clearly an important area, as well as one that is ripe for fresh thinking. We look forward to hearing from my noble friend on that.

My noble friend’s task in bringing these reforms to fruition will be daunting. These are the most important reforms to the NHS since 1948. It is critical that we get them right and move the debate from one about structures and processes to one about priorities and progress in health improvement for all.

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[Lord Hunt of Wirral]

My Lords, it remains for me to thank everyone who has participated in a debate which I believe shows this Chamber at its very best. Some direct, penetrating and important questions have been raised and we have had the benefit of informed, expert advice from those who really know what is happening on the ground and who are involved professionally. Specific issues have been debated.

We all respect my noble friend Lord Howe as a caring, compassionate Minister. The way in which he has sought to respond to almost to every point that was raised shows him at his best. Some noble Lords who have participated in the debate are still experiencing the aftermath of a rather difficult election year, but if we are to have a five-year Parliament we face the prospect of just one general election in the next 10 years—perhaps two in 15 years. Many speakers have told me privately that they would love to achieve consensus as the NHS is a great institution. The principles on which it was founded are as important now as they were then—namely, that it should be free at the point of use and available to everyone based on need, not ability to pay. Some still maintain that conflict exists, but the White Paper gives us all a chance to unite to try to create a better National Health Service. This debate is an important step in the right direction as we discuss how best to drive up standards, deliver better value for money and create a healthier nation. I beg leave to withdraw the Motion.

Motion withdrawn.