Health and Social Care Bill

Lord Monks Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Monks]

My Lords, I rise to make a point about good management, which I hope will be accepted as a truism throughout the House. It is a solid management principle that when you are doing something complicated and difficult, and certainly when you are doing it for the first time, you are likely to make mistakes. Excellence comes through practice, repetition and continuous improvement. It applies to surgeons, and administrators, and it should guide us through the management of the NHS.

The NHS is much improved in many respects in recent years. However, as the noble Lord, Lord Walton, made plain, it has for too long been in a state of constant change—almost death by review. The present systems were only just bedding in when this Bill was swung on the nation without inclusion in the manifestos or explicit mention at the election. Indeed, a major spasm of reorganisation is already under way, despite the fact that the Bill has not cleared this House. We have pre-emptive, premature implementation, and I am sure I am not the only one who rather thinks that this House is being taken for granted. So now it is upheaval time again: enormous costs, new systems, new contracts, new turf battles, new everything. A bonanza for the consultants, the lawyers and the logo-designers; but a nightmare for those who are going to be managing the NHS, wrestling at the same time with financial pressures, staff uncertainties and morale problems. For me, this is British public administration at its worst, lurching from review to review. The Government could have tackled the problems in the NHS in a consensual and incremental way and stopped short of volcanic change. However, pejoratively, they have rejected an approach of this kind as piecemeal and have gone instead for the big bang.

The central ideology of this big bang is that the Secretary of State is shrinking his role while expanding the role of the market. This is a profound challenge to the ethos of the NHS. It was not set up with competition as its guiding star; indeed, I doubt whether it will be any good at competing with private providers. These, I guess, will have a field day—hoovering up the profitable treatments while leaving the chronic, the difficult and the expensive for the NHS, mired as it will be in administrative and cost-cutting mayhem.

I am not surprised that the Conservative Party has embarked on this drive towards private health. It has always contained some powerful forces that do not like the NHS and yearn for the American way. However, I am surprised that the Liberal Democrats—with honourable exceptions—have so far followed the same path. As my noble friend Lady Thornton said at the start of the debate, the Liberal Party played a significant and honourable role in the formation of the welfare state through the efforts of people like Lloyd George, Keynes and Beveridge. I like to think that these titans might be spinning in their graves at their successors’ current pursuit of this Bill. I hope the noble Lords on the Benches opposite—indeed, all the noble Lords on the Benches opposite—will reflect on what they are doing before it is finally too late.