Health and Social Care Bill

Viscount Bridgeman Excerpts

Tuesday 11th October 2011 Lords Chamber

[Viscount Bridgeman]

My Lords, I declare an interest as a former chairman of the Hospital of St John and St Elizabeth, in St John’s Wood. That hospital is unusual in that it is an independent hospital that has within its charity, and on the same premises, St John’s Hospice which is wholly National Health Service, contracted to seven primary care trusts north of the Thames. Anyone who works in that environment has the experience of the excellent relations between the private and the public sectors. We receive considerable help and have very good relationships with the adjacent teaching hospitals of St. Mary’s Hospital, the Royal Free Hospital and UCH. Fortunately, the conflict between private and public sectors is no longer a burning issue and it certainly does not form a major part of the current Bill, so in the short time available, I intend to speak to other aspects.

The Minister has articulated, with admirable clarity, the basic reasons why major reform of the National Health Service is now needed. He rightly went back to the origins in 1946. The understandable expectation of Ministers at that time was that the health of the nation would be brought up to an acceptable level and that in these broad, sunlit uplands, the role of the National Health Service would be one essentially of care and maintenance.

However, as my noble friend has said, there have been three developments, which were understandably, in the uncertain times just after the war, not then fully appreciated: namely, the rising expectation of patients, the fact that life expectancy has now increased so markedly—a tribute to the huge success of the NHS—and last, but unfortunately not least, the massive progress of new technology and its exponentially rising costs. We have been given a homely example by my noble friend Lord Eccles, who is not in his place, of the progress in the dental drill. Add to this the present economic situation and it is clear, for that reason alone, that doing nothing is not an option, a sentiment echoed by several noble Lords from all sides of the House.

In his impressive speech, my noble friend also paid tribute to the origins of the reforms initiated by the previous Administration, although the noble Baroness, Lady Thornton, appeared slightly reluctant to accept quite as much of the credit as my noble friend was offering.

At this late hour, I want to touch on only one aspect of the Bill’s proposals: the creation of the CCGs. A point made by a GP for whom I have a very high regard is that there are more bad GPs and more bad GP practices than is generally supposed. Some GPs are on their own out of choice; others are on their own because they cannot get on with their partners in the practice—which in itself begs a question. So often, these sole or very small practices are underresourced both in personnel and funding. This is where the CCGs will be in a position to provide the resources which enable the weaker-performing practices in a group to be brought up to an acceptable standard. I remind your Lordships that it will be obligatory under the Bill for every general practice in England to join a CCG.

The PCTs, which the CCGs will replace, have been far too small in many cases and have spent far too much time competing with each other. The CCGs will be larger and better resourced. Not only will they be charged with commissioning services not provided directly by GPs but they will also have access to clinical networks advising on single areas of care such as cancer—that possibly addresses a point raised by the noble Lord, Lord MacKenzie, who, too, is not in place; perhaps my noble friend the Minister can confirm it—and to the new clinical senates in each area of the country which will provide multiprofessional advice on local commissioning plans. There is also HealthWatch, a powerful new watchdog set up to fight for patients’ rights and referred to by the noble Lord, Lord Whitty. I also welcome the inclusion of a nurse—usually, I imagine, from a practice—and a consultant specialist on CCG boards, a recommendation of the independent review forum. All these bodies will be hosted by the NHS Commissioning Board.

I have listed these groups in some detail because I suggest to your Lordships that, with all these interlocking bodies, the possibility of cherry picking or of cosy deals where there is a potential conflict of interest will hopefully be eliminated when it comes to commissioning, for this has been a concern running through so much of the correspondence that many of us will have received.

I am sure that I speak for many when I say how I have once again been reminded in this huge amount of correspondence just how much the NHS is loved and respected, and just how much gratitude it inspires. It is only natural for many people who owe it so much to feel that any substantial change must be for the worse. The public as a whole are unaware of how much the service must change. I hope that my noble friend the Minister, who has done such an admirable job in setting out his stall today, will with some urgency address the need to communicate continuously with the public to get over the message of what the Bill sets out to achieve. And achieve I am sure it will in marking a seminal stage in the further development and improvement of what has been referred to more than once today as our greatest national treasure.

Perhaps I may refer to the amendment proposed by the noble Lord, Lord Owen. Today’s debate has once again seen your Lordships' House at its best. It has been conducted conscientiously, courteously and constructively, which I am confident will be carried through to Committee. I hope that those noble Lords who are uncertain as to whether they should support the amendment of the noble Lord, Lord Owen, will feel reassured that the Bill will receive proper scrutiny—which includes addressing the constitutional issues—wholly on the Floor of this House and will therefore not support his amendment. I myself will not be supporting it.