Health and Social Care Bill

Lord Rea Excerpts

Tuesday 25th October 2011 Lords Chamber

[Lord Rea]

My Lords, I have spent most of my professional life working in the National Health Service. I have also worked in and observed other healthcare systems and have come to value the NHS all the more not only for its universality but for the high quality of its coverage. I admire it also for its economy of working. We spend considerably less on health per head of population than most other countries at a similar stage of economic development.

By and large, the NHS has conformed to the principles laid down in the amendment. Of course, it is far from perfect. Its bureaucracy, as the noble Baroness, Lady Williams, said, is sometimes inflexible. For example, the treatment of whistleblowers is often inappropriate. Internal criticism should be heard and acted upon and not suppressed, but this Bill is not necessary in order to correct that. The amendment is an important reminder to government at both national and local level of what the NHS stands for. Any action by government or individual staff should be taken with these principles firmly in mind.

[Baroness Morgan of Drefelin]

My Lords, there is nothing like suggesting to a House of Lords Committee that we move on to encourage one to stand up and contribute.

The noble Baroness, Lady Thornton, mentioned the debate that took place at the start of the Committee stage of the Apprenticeships, Skills, Children and Learning Bill, now an Act, in 2009. I remember sitting behind the Dispatch Box next to my then noble friend Lord Young listening to the noble Lord, Lord Hunt of Wirral, make a very convincing case for the Opposition on the need to set out a clear definition of apprenticeships and the importance of a well thought through, principled preamble. I remember listening to my noble friend take the Committee through a detailed and well argued explanation of how all those issues were carefully covered throughout the very long Bill. However, both Her Majesty's Opposition and the Liberal Democrats were united in saying that they needed to be stated clearly at the start of the Bill. They won the day and there that statement is in the apprenticeships Act.

When I saw the amendment of the noble Baroness, Lady Thornton, it made me think about all the important legislation of the past, and it led me to the Children Act 1989, which I am sure the Government are still very proud of. An important aspect of that Act is the principle of paramountcy, whereby the interests of the child are paramount in any decisions taken about their health and welfare.

Listening to debates on this Bill, I have felt genuine concern about how we resolve issues around conflict of interest. The relationship between a health professional —a doctor, nurse or physiotherapist, but principally a doctor—and their patient is based on an extremely high level of trust and is one of the cornerstones of our NHS, and I was wondering how the importance of that trust and that relationship could be incorporated in some principles. Have the Minister or the noble Baroness, Lady Thornton, thought about whether it would be appropriate to have a principle under which the needs and interests of the patient should be paramount when decisions are made about them? Obviously, there are a lot of ways of thinking about that from a legal perspective, but it is something that we need to be very concerned about. How is the conflict of interest to be carefully managed where a GP refers a patient to a service that they own and profit from? How can patients—whether as individuals or a population—be absolutely sure of the decisions being made about them, at every level throughout the system, including commissioning? It is very important that we think about the principles underpinning the health service. This is a very important debate.