Health and Social Care Bill

Lord Kakkar Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Kakkar]

My Lords, I thank the Minister for his thoughtful introduction of this Bill and in so doing declare my own interest as professor of surgery at University College London and as consultant surgeon to University College London Hospitals NHS Foundation Trust. It is as a practising surgeon that I recognise the need for Governments to attend to the question of the National Health Service through the introduction of Bills that ensure its long-term sustainability.

I also welcome the personal commitment to the National Health Service of the Prime Minister, the Deputy Prime Minister and the Secretary of State for Health. Those commitments, however, and indeed the introduction of this Bill, are themselves not sufficient: as we have heard from the noble Earl, Lord Howe, any Bill addressing the future of healthcare in our country must address the serious challenges that all healthcare systems around the world face.

These challenges represent the demographic change in society, with an ageing population attended by more chronic disease requiring ever greater intervention; the need to improve clinical outcomes to ensure that our patients receive the best healthcare possible and that this is done with due attention to the introduction of innovation, technology and new methods of treatment to achieve those improved outcomes; and, finally, that the provision of healthcare is delivered in the most cost-effective fashion to ensure that the vital funds available for healthcare are used most appropriately, recognising that the our economy faces a very serious challenge and will do so for many years to come and that the funds available for all public services, including healthcare, will therefore be limited.

How are we to chart these dangerous and difficult waters? I believe that our north star should be the patient and our road map the National Health Service Act 1946. That Act has defined the way that healthcare has been delivered in our country for six decades—and rightly so. But the legacy of Bevan’s settlement has some important problems today with regard to the delivery of healthcare, specifically with regard to a particularly centralised approach to decision-making and the failure to engage at the outset primary care practitioners.

This Bill has the opportunity to deal with those two important issues in such a way that the foundations of the NHS, laid in 1946, can be built upon. If those two issues are addressed successfully, then local talent and innovation, driving the development of new therapies and new ways of delivering care, will help improve clinical outcomes. Full engagement of our colleagues in primary care, in the management of the service and its resources, will better help us connect with patients, the focus of our service.

There remains considerable anxiety about this Bill, not only among healthcare professionals, but among the people of our country more generally. As we have heard, this Bill comes for consideration at a time when our nation faces considerable challenges and difficulties. The national state of mind is one of anxiety, but there is also professional anxiety because of the scope and potential complexity of this Bill, which may be attended by unintended consequences that could disrupt the provision of universal healthcare. The profession is also concerned because previous reorganisations and upheavals, although well meaning, have not always delivered the benefits that were intended, and sometimes have had detrimental consequences.

It is the responsibility of your Lordships’ House to move forward with careful consideration of all matters in this complex Bill to allay those anxieties, having undertaken very effective scrutiny and, where necessary, appropriate amendment of the Bill.

I have a number of specific concerns beyond the accountability of the Secretary of State and how competition on the basis of quality will be promoted. I am concerned about how the new clinical commissioning groups are going to discharge their responsibilities in accordance with the Nolan principles of standards in public life. These are new public bodies and they will potentially be in a conflicted situation in their localities. These standards in public life need to be strongly promoted and maintained.

I am concerned also about how we are going to focus on outcomes in primary care and ensure that the delivery of primary care meets the very highest standards within the structures that are proposed. As a surgical academic, I am concerned about the potential impact on teaching, training and research, although I believe that there are opportunities for the Bill to address those issues and ensure that the vibrant academic basis for medicine in our country is strongly promoted.

Finally, I am concerned about how we will deal with failures of entire organisations and failure of services within those organisations before they reach a point where the welfare of patients is put into jeopardy.

Beyond legislation, Her Majesty’s Government need also to outline their strategy for implementation. It is fine that we have a Bill, but the two fundamental issues that need to be addressed will be the question of culture change in the NHS and the development of leadership to ensure that the changes necessary to protect and promote the interests of our patients are properly delivered.

Beyond culture change and leadership, I am also concerned that this Bill is subjected early to appropriate post legislative scrutiny. It is an important Bill with important consequences and I hope that a mechanism will be found to establish a committee that would follow this Bill, through its implementation, to determine that what was anticipated is actually achieved.

Healthcare has always been a highly charged and somewhat political issue. The birth of the National Health Service in 1946 was a highly political issue and every reorganisation since has been attended by controversy. Your Lordships’ House, however, has never felt it necessary to deny a health Bill a Second Reading, although in the health Bill in 2003, there was a vote at Second Reading. Nor has your Lordships’ House felt it necessary to send parts of a Health Bill to a Select Committee. It has always felt itself able, with its vast expertise ranging from previous Secretaries of State for Health, constitutional lawyers, current and former medical and other healthcare practitioners, regulators and those more broadly involved in public life to provide the necessary scrutiny for a health Bill. Indeed, I believe that the people of our country expect us to provide thorough, vigorous but thoughtful scrutiny of this Bill to ensure continued universal healthcare, free at the point of delivery, for all the people of our country.