Health and Social Care Bill

Baroness Royall of Blaisdon Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Royall of Blaisdon]

My Lords, what a pleasure to follow the noble Lord Walton of Detchant, with his wise words, his healthy scepticism, his wealth of experience and his staggering link with history. It is a real pleasure to be here with somebody who was here at the birth of the NHS. I find it difficult to match his mental dexterity in my 57th year, I have to say.

It may seem odd that I am speaking from the Back Benches when we have such a stellar cast on our Front Bench, but like everybody else in this Chamber, I feel passionately about the NHS and care deeply about it. For me, this is not about politics; it is about passion and principles. My resolve to speak about this Bill has been strengthened by the hundreds of letters, briefings and e-mails that we have all received from so many people up and down this country. We have a remarkable health service; we should celebrate its success. It is absolutely not broken and it is the envy of the world. That is not to say that it cannot be better; of course it can be better. But it is a fine service.

Before I begin, I must comment on the flurry of letters that have been written by the noble Earl and the Secretary of State. In the case of my noble friend Lady Jay and the noble Lord, Lord Owen, they were received far later than they should have been received, and I understand that one noble Lord among us did not receive his letter until the press had received it. I would say in passing that if that had happened under my Government we would have been slaughtered in this House by all sides, and rightly so.

I am in favour of reform, as is my party, as we clearly demonstrated when we were in government. I well understand the budgetary demands and technological advances, the increased need for health and social care and citizens’ aspirations for a better health service. All these things mean that the health service cannot stand still, but it cannot be right that, while the NHS and its brilliant, dedicated staff are grappling with the huge changes that result from the Nicholson challenges, the Government are imposing a massive, destabilising, top-down reorganisation for which they have no mandate. For any reform to succeed, it has to be owned by those who work in the service, and it is clear that there are very few people working in the health service who support the profound changes being introduced by this Bill. My first question to the Minister, for whom I have the highest personal and professional regard, is to ask where the evidence is that the spending of billions of pounds on this reorganisation will work and why the Government have to do it now. Clearly the Government are following a political timetable, and I believe that this Bill is ideologically driven. It was certainly interesting to listen to the noble Baroness, Lady Jolly, when she admitted that the proposals had driven a coach and horses through the coalition agreement. Services are being cut, waiting lists are going up, nurses and doctors are tearing their hair out all over the country because they are having to make cuts and cut certain services, and they know that they cannot make any further cuts without affecting patient care. The noble Lord, Lord Clement-Jones, said that it looked as if the cuts were being made rather than resources being redeployed, and I believe that to be the case. So why are the Government now inflicting this Bill upon the health service?

My major concern, however, is about the principles which underpin this Bill, especially that relating to competition. As my noble friend Lord Darzi pointed out, free market idolatry is dangerous, and this Bill as it stands makes a free competitive market the linchpin of our NHS. That cannot be right, and it offends against the founding principles of the NHS, which have been much quoted today. Like so many noble Lords, while I am happy to be a consumer in relation to electricity and telecoms, I want to be a patient when I am ill. When my loved ones are ill I want them to receive quality care. Choice is empowering, but when my loved ones need emergency treatment, I want the ambulance to take them to the appropriate centre of excellence, where there is no question of financial transactions. Any step along the road to an American free market in health and social care is a dangerous step, a step too far, and this Bill is, I believe, a step too far.

This morning the right reverend Prelate the Bishop of Bristol mentioned his concern that some health organisations, in order to succeed in the tendering processes, might use unqualified staff, which would be cheaper. That is a real fear, and that is just one reason why I wholeheartedly agree with the noble Baroness, Lady Masham of Ilton, that Clauses 225 and 226 on regulatory bodies must be mandatory.

I want a National Health Service in which all citizens, no matter where they live, no matter what their age or income, have access to quality care, free at the point of delivery. As my noble friend Lord Darzi said, quality must be our collective purpose and common endeavour. But it must be quality for all. There are many elements in this Bill which I fear will lead to a fragmented competitive market rather than a comprehensive public service which reduces health inequalities. Despite the duty of the Secretary of State to have regard to reducing inequalities, I believe that that is too weak. Things like the removal of the patient cap will move the NHS towards a two-tier healthcare system in which private patients could jump the queue. That would exacerbate the health inequalities in our country and I also fear a post code lottery.

We were told today by the IFS that 400,000 children will fall into poverty by 2015. That will entrench the health inequalities in our society. Surely now is the time to do everything possible to ensure that in health and social care, at the very least, we are doing everything possible to minimise health inequalities.

One of the small parts of the Bill on which I will be working relates to the abolition of public bodies. The Government have of course abolished various public bodies to which the citizens of this country are very much committed, such as the Youth Justice Board and the coronial office. They have a very strong policy on public bodies and on getting rid of quangos. In spite of that, with this Bill, they are creating the biggest quango in the world and they are creating hundreds of public bodies. I would just quote a couple of comments from the noble Lord, Lord Taylor of Holbeach, in the Public Bodies Bill debate. He said:

“The landscape for public bodies needs radical reform to increase transparency and accountability”.—[Official Report, 14/10/10; col. 622.]

He also said:

“The quango state has in the past suited both government and politicians. It has never suited the British public, who expect clarity and, as taxpayers, insist, rightly, that Ministers ensure that every pound the Government spend is spent efficiently and effectively”.—[Official Report, 9/11/10; col. 64.]

I do wonder what is happening with this Bill and the various quangos that are being created.

I also wish to raise conflict of interest among GPs. I do not know whether noble Lords are aware, but quite recently it was reported that GPs at a health centre in York had written to patients saying that the NHS will no longer fund minor operations and instead they offered to carry out the procedures for a fee. This is an unprecedented step in the health service. They advised patients that for a number of minor surgical procedures, such as ingrowing toenails, mole removal and chopping out of warts and cysts, they would have to go private. This GP practice is also part of HBG Ltd, which is wholly owned by the practice. So the people who are offering private healthcare are the GPs in question. That cannot be right, and I ask the Minister to look into similar cases and for his assurance that this will not be allowed in future.

The noble Lord, Lord Willis, made a superb speech about research and development. I very much hope that the Government will take on board absolutely everything he said as I believe it is very necessary for a modern health service.

My final point is about prostate cancer, which is very dear to my heart. The Prostate Cancer Charity provided me with an excellent briefing, which I seem to have lost, in which it mentioned various things. The noble Baroness, Lady Williams, mentioned it this morning and some dreadful things that are happening in America. The Prostate Cancer Charity is concerned about the cost of reforms, the savings that are required and the fact that these might threaten clinical nurse specialist posts. I am very worried about things such as late diagnosis and will seek reassurance from the Minister that the Bill is not going to affect referral and diagnosis of conditions such as prostate cancer. My husband died because of his late referral in respect of prostate cancer and I would not want that to happen to any other man or loved one in this country. I should also add that it is common knowledge that, once he had been diagnosed, my husband received the best possible care in this country.

The NHS was established by a Labour Government in place of fear. The Conservatives voted against it at that time. This Bill has established a new climate of fear among staff and patients as it seeks to transform our National Health Service, which provides quality care, into a free market. I will be supporting my noble friend Lord Rea, but should his amendment fall, I will certainly support the amendment of the noble Lord, Lord Owen, which will not delay but will enhance the scrutiny of this very, very important Bill.