Health and Social Care Bill

Lord Hutton of Furness Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Hutton of Furness]

My Lords, I declare an interest in that my wife is director of Nuffield Health, the independent healthcare charity.

I very much agreed with the speech of the Minister when he said that the biggest challenge that the NHS currently faces is how to improve patient care against a background of significant improvements in efficiency. If we agree with that, the question for us all is: how will this Bill, in its current form, help the NHS to meet that challenge? Today I have not heard a sufficiently convincing answer. I say that with very considerable regret.

I agree with the noble Lord, Lord Black, that the NHS will need significant change in the future if it is to meet this enormous challenge, which is both economic and demographic. It will need effective competition if it is to stimulate new thinking and new ideas. It will certainly need greater local freedoms from the centre to support the necessary innovation, and it will certainly need less bureaucracy. Sadly, I am not sure that any of these useful objectives are likely to happen under the Bill in its current form.

My noble friend Lady Warwick of Undercliffe drew our attention to the speech of the Secretary of State for Health when he introduced this Bill in the House of Commons. He rightly and properly said that the Bill was designed,

“to improve the health of the people of this country and the health of the poorest fastest”.—[Official Report, Commons, 31/1/11; col. 605.]

Those are good intentions. The Secretary of State gave voice to a noble purpose. However, what happened next was utterly predictable. The groundwork for these very important reforms was not properly laid by Ministers, and it probably was not helped when the Secretary of State told the House of Commons that he could do these reforms without this legislation at all. The legislation certainly contradicted the coalition agreement, so the arguments for reform barely got off the ground before they were shot down by internal arguments inside the coalition. I am afraid that politics rather than policy prevailed. Today we have again had a demonstration of an iron law of government: good intentions do not always result in good legislation.

In my experience, the Second Reading debate on any Bill is about the general principles. I am afraid that the longer this Bill has progressed, the harder it has become to discern what those principles are. Does the Bill favour or hinder localism? I think that it probably hinders it. The national Commissioning Board is a dramatic centralisation of power. Does the Bill represent an attack on bureaucracy? I think not. There seem to be even more layers of management. Some of the bodies coming into existence are the clinical commissioning groups, the clusters, the clinical senates and the well-being health boards, and sitting on top of all these is this new quango, the national Commissioning Board. I am sure the Minister knows that there is enormous upheaval going on in the NHS at the moment, and enormous uncertainty. Given the scale of the current challenge, I do not think that any of this is helpful.

What about promoting competition? I am in favour of that as long as it is properly managed. There is demonstrable research evidence showing that the introduction of new providers and new ideas in recent times in the NHS has improved the health of the poorest at a faster rate. I saw that in my own constituency and that was my experience over seven years as a Minister in the Department of Health. Competition can make the NHS more equitable. So, on this, I am afraid that I part company with some of my noble friends. I do not believe that competition is necessarily bad for the NHS, and I do not share the prophecy of doom that I have heard today. It is all about setting the proper ground rules. Are they being set properly? As I understand it, the amendments made to Monitor’s duties in the House of Commons were designed largely to camouflage the political wheeler-dealing that went on behind the scenes. Are the changes to Monitor’s duties significant? We have not the faintest idea, and we need to know. It is an extremely unsatisfactory situation.

So, any sense of direction and principle has largely been sacrificed. What the Bill stands for now depends very much on which Minister you talk to. It started out as a revolution, but the R was deleted in Committee in the House of Commons. We have ended up with some very obscure concessions whose significance is far from clear. The NHS needs clarity.

I strongly support, as I always did when I was a Minister, a greater role for clinicians in commissioning healthcare. There can be real advantages for NHS patients if we can get that right. However, I doubt that the proposals in the Bill represent the best and most effective way of doing it.

The White Paper rapidly became a white elephant, and now all we hear is white noise. That is a great shame. It has set back the case for the real reforms that the NHS needs today. It needs more enterprise and the stimulus that new providers can bring, but I am not sure that it will get that. It needs less centralisation; instead, it is getting the biggest quango that we have ever created in parliamentary terms. It needs less bureaucracy; I think that it will get the opposite of that. I do not think that the Bill moves any of the important principles of NHS reform sufficiently forward. Ministers have only themselves to blame for the situation they find themselves in.

However, I shall not be voting for the amendment of my noble friend Lord Rea. I do not believe that it is the duty of this House to form a view about whether a Bill has democratic legitimacy; that is very much the view of the House of Commons. It is they who eventually have that rendezvous with the electorate. They have to account for themselves and how they have run the country, we do not. So the Bill should have a Second Reading. The challenge for us is how we can best improve it. That is why I shall support the amendment of the noble Lords, Lord Owen and Lord Hennessy. It has been a distraction from that argument for some noble Lords to have said today that that amendment would represent some delay to or obfuscation of the Bill, which is not a fair interpretation of it. We can look to improve the Bill. My objective is to improve it, not to delay it. The Government have a mandate and are entitled to their legislation.

The stakes are very high. The case for principled reform remains important. That is not being helped by the way in which this Bill has been presented, amended and brought before us today.