Health and Social Care Bill

Lord Mackay of Clashfern Excerpts

Wednesday 2nd November 2011 Lords Chamber

Finally, I add one more thing, for which I hope I will be forgiven. I know that those who have been in the House for a long time are fully aware of this, but it may be helpful for those relatively new Peers who are not fully aware of it. If an issue is brought up in Committee and then voted on and voted down, it cannot come back again on Report or at any other stage of the proceedings on the Bill. That would be disastrous. It would mean that if any vote were carried, we could not then go back to trying to get broader and stronger agreement on Report. It would simply mean that the whole issue disappeared. This is far too important an issue to be allowed to disappear. Therefore, I plead with those who I fully understand passionately support my amendment or that of the noble and learned Lord, Lord Mackay of Clashfern, to allow their passions to be put to one side, temporarily at least, while we contemplate the absolute necessity of debating this more fully, trying to draw a consensus from it and accepting that we can go back to these matters on Report, when a vote would be appropriate, right and timely.

[Lord Mackay of Clashfern]

My Lords, in response to the obvious concern over the Secretary of State’s responsibilities, as narrated in the Bill, I attempted to find, from a completely impartial point of view, a solution that would commend itself to everyone. In due course, I came up with an amendment, which your Lordships have seen. My first action was to send a copy of it to the noble Lord, Lord Owen, and others, including the noble Baroness, Lady Thornton. I hope that demonstrated that there was nothing partisan or anything of that sort about it. In trying to put the amendment together, I looked very closely at what the Constitution Committee had said. I think the noble Baroness, Lady Jay, and I demonstrated last time that we had considered these matters in some detail.

I also considered all that had been said about concerns on this matter in the Second Reading speeches, of which there were quite a few. I have endeavoured to meet these concerns in the amendment. As I say, I hoped that the House would find it acceptable but a number of questions have been raised and, as the noble Baroness said, lawyers are apt to disagree on these matters. On the other hand, lawyers are usually reasonably able to reach agreement when they set their minds to it. Therefore, I have no intention of moving my amendment today so there can be no question of its acceptance or otherwise today. An amendment to it has been proposed by my noble friend Lord Greaves. He told me that his idea was to find out what the meaning of “ultimate” was. Maybe I should briefly deal with that now. “Ultimare” is the Latin verb from which it comes, which means to come to the end—not always a comfortable position. The definition in the Oxford English Dictionary is:

“Lying beyond all others; forming the final aim or object”.

That is the sort of idea that I had—that it is the final responsibility of the Secretary of State; in other words, in ordinary language, “The buck stops here”. That was my object in using that phraseology.

During my researches in the Oxford English Dictionary I noticed that Dr Johnson said in 1758 that to be idle is the ultimate purpose of the busy. As I say, I have no intention of moving my amendment today. I hope that we can reach agreement on this matter in informal discussions outside the Chamber. A large number of important practical issues remain to be considered in subsequent Committee days. This sort of question, which is primarily rather theoretical but very important from the point of view of people’s attitude to the National Health Service, should be determined. However, it would be more conveniently determined in discussions between ourselves outside the Chamber. Certainly, I would be willing to participate in those discussions if the amendments before us today are not proceeded with.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, before we move further forward with our debate, I hope that noble Lords will find it helpful if I make a very brief intervention. I am aware that a number of noble Lords wish to speak and I have no wish to prevent that. The Committee must, of course, proceed as it sees fit. However, I felt it might be useful to those intending to speak if I indicated now rather than later what the Government’s preferred course is in relation to this group of amendments. Some noble Lords will be aware that the Government regard the amendment tabled in the name of my noble and learned friend Lord Mackay and the noble Lord, Lord Kakkar, as having particular merit in the context of this debate. Notwithstanding that, and having spoken to a number of noble Lords during the past few days, including my noble and learned friend, it is my view that the best course for this Committee would be for none of the amendments in this group to be moved today, and instead for us to use the time between now and Report to reflect further on these matters in a spirit of co-operation. I shall, of course, say more when I wind up the debate but it may assist the Committee to know that that is the position that I shall be taking.

--- Later in debate ---

[Baroness Masham of Ilton]

My Lords, I first want to ask a quick question to my noble friend Lady Hollins or the Minister. Would the words physical and mental include those people who have a drug and/or an alcohol problem? Would addiction come under “mental”? I do not want those people to fall through the net, as was said by the previous speaker.

[Lord Mackay of Clashfern]

I just wanted to say a word or two about the drafting involved in this. The noble Lord, Lord Williamson, pointed out that the opening clause, which is the foundation of the health service, states:

“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness”.

That is precisely the phrase that is the subject of the amendment, but it comes earlier in the Bill. I cannot believe that when the people who put the health service together in 1946 used that phrase, they did not have in mind that physical and mental health involved the idea that if there was illness, it could be either physical or mental. If we are to change an exactly similar phrase later in the Bill, consideration needs to be given as to whether we should do it at the beginning which is, after all, in many ways the most important place.

I have every sympathy with all that has been said, and I am sure that it is right that we take serious account of it. We must remember the point made by the noble Baroness, Lady Murphy, about the need for integration of treatment for mental illness along with physical illness. Anything that separates them might not be conducive to progress. I have every sympathy with the proposal.

[Baroness Thornton]

My Lords, I congratulate the noble Baroness, Lady Hollins, on bringing forward the amendments and all those who have spoken in what I think has been an extremely useful debate. All those months ago, we had all-Peers meetings about this and many other issues. I am sure that the quality and comprehensive nature of the amendments owes something not only to talent and expertise but also to the fact that the experts in the House have been working with many organisations over a long period. I congratulate everyone on the quality of the debate and the amendments.

The amendments approach the Bill holistically—I do not really like that word. They concern the Secretary of State's responsibilities, the duties of the Commissioning Board and the duties of the clinical commissioning group—the triggers, the levers that may make this a reality. Because of that, I am very attracted to them. It is also important that they express the expectation of parity of esteem between mental and physical health services. As has been said, my Government and this Government have certainly made progress on this issue. I look forward to hearing the Minister’s comments, and I hope that he will find some way to recognise the support for the amendments across the House.