Health and Social Care Bill

Debate between Lord Warner and Lord Sentamu

Monday 14th November 2011 Lords Chamber

[Lord Warner]

My Lords, I rise to reassure the noble Baroness, Lady Murphy, and restore her confidence in the Labour Benches on the subject of senates. If the Conservative side can have the Mawhinney-Howe dialogue, why should we not have the Hunt-Warner dialogue on senates?

I can well understand why people would like to be a senator. It sounds very grand. It would be good to put on your CV that you are a member of the senate of wherever—even if it is Birmingham. To some extent, I can understand why the Future Forum thought it would be a good idea to have senates. I can imagine it received a lot of representations from specialists in various parts of the country that perhaps these GP commissioners, as they were then known, were getting a little uppity and needed to be curbed a little and put in their place. Why, then, not give a little more space to the people who really know about these things—the specialists—and bring them together in senates? Yet, since 2006, thanks to the helpful report by Sir David Carter on specialist commissioning, we have gone a long way in putting in place a sensible way for dealing with regional specialties and, on top of that for very rarefied stuff, a national commissioning capability. That has not been around for long. It would not be a bad idea to try to keep some of that learning experience together as we move into this brave new world.

I do not have any problem with networks. Networks have been a proven success. They have done a lot of good and there is a lot to be said for trying to reinforce them, even to put some wording about them in the Bill. But I struggle with senates. We need a really good explanation of what they are out to do. The noble Baroness, Lady Murphy, put her finger right on the button: it is a very good solution but what is it a solution to? I hope we can have some enlightenment on that from the Minister.

[The Archbishop of York]

In my day-to-day life, I have to do what they call “oversight”. The trouble with oversight is that it is always remote. The person who comes on the round is the parish priest or the diocesan bishop. The moment you begin to take oversight seriously from a distance, you are in real trouble. How do you know that the delivery of what you want will work? I am not so certain that I want this Commissioning Board to have oversight of both clinical issues and the senates. That would lie somewhere else, not with the board. It is to the board that Monitor, NICE, clinical senates and networks, and the Care Quality Commission actually report. I can understand the other factors in the Bill but the moment you include the business of,

“overseeing sub-national clinical senates and networks”,

you are in real trouble. What is that, by the way? I remain uncertain. We certainly need a clear spelling out of what senates are for. That is a separate question from whether the board should oversee their work, let alone if we understood it.

I am not one to suggest that this amendment is helpful. What would be most helpful would be to hear from the noble Earl what are the senates, what are these networks, and where you would locate the whole question of accountability and responsibility. I do not think it is the board; otherwise you are giving it a much bigger function when it already has five functions; and there are further provisions in the schedule. If you really want the board to fail, add on more work. So my view is that it should not have oversight of the sub-national groups. However, I am still confused. Will the noble Earl tell us what the senates are for? Networks I can understand; but what are the senates for? If he explains, we may actually see that this amendment is redundant.