Health and Social Care Bill

Baroness Kingsmill Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Kingsmill]

My Lords, as a former deputy chairman of the Competition Commission, I am of course a strong believer in the positive effects of fair competition in most markets. However, we must remember that competition, red in tooth and claw, may not be the most appropriate thing for the provision of public services because competition unregulated tends to end up with the most aggressive monopolist. We must remember that regulation has its limitations. As a former regulator, I know only too well just how limited regulation is. The trouble with regulation is that you are always regulating for the past crisis, not for the next one. I have just come down from the Economic Affairs Committee where we are interrogating the chief executives of our banks. If ever we saw a failure of regulation and the problems that we have in regulating a marketplace, the banking crisis that has arisen from the behaviour of our banks should give us pause. We all tried to regulate them; we all tried to control their behaviour. We failed.

I am not impressed by the regulatory elements in the Bill and I am not impressed by Monitor. It seems at the present moment to be a somewhat underpowered regulator. For something as sensitive as the NHS, if competition is to be introduced, we need to be very careful about how we regulate it. We need a remit for the public interest over and above anything else. An overweening public interest requirement must be the first issue that any regulator in this marketplace must consider. A mandate to prevent anticompetitive behaviour is simply not enough. There will always be the means by which anticompetitive behaviour arises without being apparent in clear ways.

It is also important to recognise that regulation has its limits, but a level playing field is important in the first place. At present, it does not appear that there is a level playing field with fair competition. Large health providers will be competing with current NHS providers that will not have the same access to funds and bank financing. This means that there will not be a level playing field or fair competition and it will be much too late to regulate for this afterwards.

It also concerns me—again as a former chair of an NHS trust—that a great number of very unpopular services will have no adequate compensation. I was the chair of Optimum Health Services, which was a community trust. It was the sister trust—the very poor sister—of Guy’s and St Thomas’. Our remit was to provide community services in one of the poorest boroughs in London. The sorts of things we were concerned with were chiropody for the elderly and incontinency services. We were forced under the previous round of Conservative changes, with the introduction of the internal market, to figure out ways of reducing the number of incontinency pads provided to our clients from six a day to five a day. That was the kind of decision we were being forced to take. I cannot see very much competition for the provision of services such as those being apparent.

It is all very well for us all to talk about market forces and competition as if somehow that will be the answer to everything. However, I have seen from direct experience that it very rarely is the answer to everything. We do not do a good job of regulating our public services in this country. We have only to look at the railways to see that. We do not do a good job and I cannot see anything in the Bill so far that allays my fears.

I have been in the House only for five years but I have received more letters over this issue than any other one and somehow people seem to have got hold of my personal e-mail as well. I am overwhelmed with e-mails and letters and they all say the same thing. Some of them are emotional pleas along the lines of “Save our NHS” which are perfectly understandable but many of them are from individuals and organisations who are very well informed both about the Bill and the NHS. They have come forward with very powerful arguments as to why this is not appropriate for them. They are strong, well reasoned arguments and I feel we are obliged to take note of them. That is why I support the amendment of the noble Lord, Lord Owen. It would be entirely appropriate for us to have a Select Committee where people could come forward and give proper evidence, have it heard in public and televised if necessary so that a full and clear debate about these issues could be had—not simply rushed through with the inadequate scrutiny we have had both in the other place and here. We are all trying our best but quite frankly we just have not had the time. This is a Bill that could fundamentally change one of the pillars of our society and I do not think we have had enough time to look at it. The very modest and sensible suggestion made by the noble Lord, Lord Owen, is one we should all support.

There are other elements of the Bill that concern me greatly. I have some anxieties about the lack of close attention being paid to the problems of conflict of interest. I am very concerned about the possibility of GPs having a financial interest in the providers they may be commissioning. In Australia and New Zealand—I am a New Zealander—that is not allowed. It is expressly forbidden—you cannot have a financial interest in a body you commission. That is a very important thing that seems to be completely missing in the Bill.

We should also recognise—this is something that those who have worked in the NHS will realise—that it is more change. It takes ages and ages for these sort of changes to filter through and actually take place. It is costly, upsetting, damaging and unless you are absolutely certain that the outcomes are going to be improved it should not be embarked on lightly. I have grave anxieties that we are all going too far, too fast.