Healthcare

Baroness Donaghy Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Donaghy]

My Lords, until last year I was a non-executive director at a foundation trust hospital, and I am an independent assessor for clinical excellence awards at both local and national levels. Therefore, to that extent, I declare an interest.

My views are of course influenced by personal experience. I remember what the National Health Service was like before the Labour Government were elected in 1997. It was coming up for air for the second time. It was starved of resources, innovation and decent buildings. However fashionable it may be to condemn target cultures and so-called spending sprees, the Labour Government tried to catch up on a generation of neglect. Waiting lists were the scandal of the day, with demoralised and underpaid staff and a Nissen-hut building culture. Some of us will never forget that and will for ever be proud of what Labour tried to achieve. However, it was always going to take a generation to succeed and unfortunately we did not have that amount of time.

I always assumed, perhaps naively, that a coalition Government were about strategic consensus but I just wonder whether this coalition Government are not about mixed messages. They claim to support localism but set up the biggest quango in the world, doling out £80 billion. It does not get much more centralist than that. The NHS Commissioning Board will also be taking on responsibility for specialist commissioning and at least 10 other important roles. It is going to be accountable to the Secretary of State for financial stability, and, yes, it is going to be independent of the Government? If it looks like a quango and acts like a quango, surely it is a quango. In order to carry out these functions, the commissioning board will require an enormous framework to build intelligence and process information. Will it have regional offices, provided they are not called SHAs? How will this leviathan work?

Then we come to the proposals for Monitor’s new role. I have had direct experience of Monitor. I joined the board of a London hospital which had just been turned down for foundation trust status and we worked hard to achieve it the following year. Monitor’s job was, as the consultative document says, to authorise foundation trusts. If applicants for foundation trust status were not up to the stringent requirements of financial planning, sustainability, governance and leadership, they did not obtain that status. The new role envisaged for Monitor is to develop a general licence for all. Does that mean that it will lower its standards? It will certainly be a completely different body with completely different skill sets, and it will require considerably more staff to undertake the responsibilities envisaged.

Finally, within three years it is proposed to support all NHS trusts in becoming foundation trusts. It will not be an option for organisations to decide to remain as NHS trusts; they must become, or be part of, a foundation trust. Will NHS trusts still have to meet the current tough requirements in order to become FTs or will there be a lower levelling? Will those who have no hope of achieving FT status due to a long-term lack of financial viability be foisted on existing FTs, deficits and all, leading to a lowering of standards? The consultative document claims that the debate on health should no longer be about structures and processes. However, the Government’s proposals are precisely about structures and processes, and promise to be an enormous waste of badly needed resources.