Health and Social Care Bill

Viscount Eccles Excerpts

Tuesday 11th October 2011 Lords Chamber

[Viscount Eccles]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Massey. My interests are somewhat different. I declare that for many years I have worked with the Hospital for Tropical Diseases. I first got involved in helping to move the hospital from St Pancras. We created a small fundraising group to raise 50 per cent of the cost of the move. What convinced me that we should support the move was asking the chief nurse what she thought. She said, “I’m fed up with humping bottles of oxygen around the hospital when everybody else seems to get it delivered in a pipe”. That was an example of necessary modernisation and the front line knowing what it needed.

I shall make only one more comment about the Hospital for Tropical Diseases. In its clinical faculty there is an expert on leprosy. Your Lordships might not think that it is necessary for the National Health Service to know a great deal about leprosy. However, there are some lepers in this country. That speciality is very important and, in the context of such a large organisation, it is always possible that it could be forgotten. That should not happen. I should declare that I am chairman of a small charitable trust, the Hospital for Tropical Diseases Foundation. That hospital is 200 years old. Arguably the start of the Health Service goes back about 90 years. In 1918, the Cavendish lectures were delivered and the theme was:

“The best means for preserving health and curing disease should be available for every citizen by right, not by favour”.

The speaker went on to say:

“I venture to think that this will be an article of faith for every political party”.

That was in 1918. It would be wonderful if we could agree that there is no dispute or disagreement about the themes of that speaker 90 years ago. There followed a 25-year gap between that, not unconnected with the financial difficulties of the 1920s, and Beveridge. As your Lordships will remember, Beveridge connected want, disease, ignorance, squalor and idleness directly to health. His report was rapidly accepted by the coalition Government of the day.

In 1944 there was the White Paper—it is remarkable that this was happening in the middle of the Second World War—in which it was generally assumed that there would be around 30 area integrated health authorities. However, that was not the decision of the post-war Government. They opted for something more centralised. We should leave it to history to judge whether it would have been better to follow the prescription of the 1944 White Paper or whether what was decided was better. We should live with the decision and not refight those battles.

The progress in medicine in this country since then has been driven mostly by international western research and development. It is important to remember how open the exchange of information is in the western world on these matters. It has also been driven by brilliant engineering. If we think of what it was like to go to the dentist when we were young and think of it now, the development by engineers of drills over that period has been quite amazing. This progress, from research and development and from engineering, will continue, and everybody expects that it will continue. The question that then arises is how significant are the detailed statutory arrangements that we make in order to back up, control and perhaps regulate this progress. Are these statutory arrangements more than enabling mechanisms, or are they possibly disabling mechanisms? Will not the progress continue, whatever the statutes say? I think that it will.

Whatever any Government thought about statutory arrangements, if they went into an election having made what the public considered to be serious mistakes about the Health Service, they would pay the penalty. I am not sure that we should spend too much time in the face of legitimate democratic expectations worrying about the constitution committees and thoughts on the role of the Secretary of State. I feel sure that these matters can be satisfactorily resolved in Committee and on Report.

Secondly, in some of the representations that we have all received, particularly those from expert bodies, the opportunities for progress, which has already taken place, are seen to outweigh politics, either internal to the NHS or external. However, for others it is not so. Some people seem to oppose change, perhaps any change. My conclusion is that in total the representations tell us that this is a serious Bill that needs serious debate and scrutiny without delay. Many serious matters need debate—for example, reducing inequalities, the balance between general practice and the many other services, the balance of resources between prevention and cure, anti-competitive behaviour, and many other matters. Nevertheless, what the Bill needs now is scrutiny and improvement, and I look forward to Committee.