Health and Social Care Bill

Baroness Smith of Basildon Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Smith of Basildon]

My Lords, clearly, in a debate of this length, there will be some repetition on various issues. There is an old saying “everything has been said but not yet by everyone”. But having listened to most of the speeches in the Chamber or on the monitors today, I know that is not true of this debate. The length and complexity of the Bill makes it a little like an onion—every time you peel another layer, new issues and potential consequences become evident, as we have heard from so many of the expert contributions today. I do not want to raise issues that have been raised already, but what has struck me during this debate is that many noble Lords who are not supporting either of the amendments before us today have still referred to their serious concerns about the Bill and said that your Lordships' House should seek to make significant amendments in Committee. That should warn the Government how deep the concerns are about the Bill.

I can think of few Bills that have caused so much controversy and concern in Parliament and in the country as a whole. I was told before I came back into the Chamber this evening that in just 36 hours, 100,000 people have signed a petition collected by 38 Degrees in support of the amendment of the noble Lords, Lord Owen and Lord Hennessy. That is a hugely significant number.

I am not an expert but I listen to the experts and even after the Government had their extraordinary pause after the Committee stage in the other House and made amendments, they failed to satisfy or give confidence to the very people who have responsibility for implementing the Government's changes. Today, the Royal College of General Practitioners in a poll of around 1,900 of its members announced that only 4 per cent agreed with the reforms and 70 per cent said that they were against the Government's reforms as they stand at present in the Bill. More alarming for the Government, nearly 30 per cent were more opposed to the Bill after the reforms than they were before.

The Royal College of Nursing said that the Bill would have a serious and detrimental impact. The BMA has called on Peers to reject or substantially amend the Bill and 400 public health workers wrote to all Peers last week opposing the Bill as it stands. Some 60 medical professionals, including hospital consultants and the General Secretary of the Royal College of Midwives, say that it needs suspension or significant amendment. The noble Baroness, Lady Hollins, as a past president of the Royal College of Psychiatrists, spoke earlier about its serious concerns.

This is extraordinary. Those speaking about the Bill are professionals—people whom we trust with our care. They have no reason to oppose the Bill other than their professionalism. If the Government cannot give confidence to the professionals, how can we then expect the professionals to give confidence to the public?

I have two main areas of concern. The first is the level and degree of change. This is a huge structural change for which there is no mandate. Also, any change of this significance has to be evidence-based. I have not seen the evidence that tells me that we need legislation to effect this degree of structural change in order to move towards more clinical involvement in commissioning. Even the Secretary of State, Andrew Lansley, said that 90 per cent of the Bill could be achieved without the legislation making such substantial structural change. If we see this also against the backdrop of financial pressures in the health service, stresses in the system and increased waiting times, that adds to the complexity of having to drive and push through change at a difficult time. With such significant change, there has to be support and confidence from those who are expected to implement the new system. There is evidence that the Government do not have that. I have no doubt that even if the Bill becomes law—and I hope we will see significant changes—staff at all levels in the NHS will do their best to make it work. But that is too much for us to ask of them and I do not believe that that is how this House wants to proceed.

My main medical concern is the fragmentation of the system, which will make collaboration and integration of services—between health and social care in particular—more difficult. If your Lordships' House is concerned about a postcode lottery now, imagine how it will be when all GP practices are responsible for commissioning. We have seen the pressures the health service is under. Your Lordships may have read reports of the letter from the Haxby and Wigginton Health Centre in York last week. Having set up its own company, HBG Ltd, to undertake minor private operations, it has now written to patients waiting for such minor surgical procedures with a price list, given that these procedures are no longer available on the NHS. You can have a skin tag removed for £56.30, a sebaceous cyst removed for £214.01 or a benign lesion, including a mole, removed for £243.

Unfortunately, it does not take too much imagination to imagine the impact that that could have on patients if replicated across the country, especially in times of financial constraint. How many other GPs will set up their own minor surgical units to undertake private work or seek out partnerships with private providers?

With all those changes, the Bill is also a genuinely missed opportunity to tackle some of the most difficult and entrenched problems in the health service. With such substantial legislation, we need to ask: what are the greatest problems facing the National Health Service; and does the Bill address them in a way that adequately deals with the problems?

To take one example, most experts are agreed that the spiralling costs of providing quality and appropriate health and social care for an ageing population is one of the greatest challenges. So many older people are admitted to acute care. Whatever the ultimate reason, it is often as a result of inadequate integration between health and social care which could have improved their quality of life and helped them to stay safely in their own homes for longer. That challenge must be met. It is a structural problem, a health problem and a cost problem.

Imagine an 82 year-old, Mrs Brown, who is quite frail but otherwise fairly healthy. She just needs a little extra care, support and attention in her own home. She may have a minor medical problem. It does not require hospitalisation, but it cannot be met by social care alone: it is a medical need. Currently, her medical care is free, and her social care will usually be charged, but it is basic social care in her own home that is most likely to keep her out of an acute hospital. For Mrs Brown's quality of life and to reduce the pressure on acute care in the health service, we all know that it would be so much better to provide for all her needs at home as long as possible.

Despite the best intentions behind the Bill, with the health and well-being boards, the way that it fragments services will make that even harder to deliver, as the noble Baroness, Lady Wheeler, outlined earlier.

A well kept secret, although not among my friends and family, is that I am not a great fan of the Guardian newspaper, especially after it recommended to its readers that they vote Liberal Democrat at the previous election—but every sinner has an opportunity to repent. I commend to your Lordships tomorrow's Guardian editorial. It advises Labour and Cross-Bench Peers to vote against Second Reading but then advises all Members to vote for the Motion proposed by the noble Lords, Lord Owen and Lord Hennessy. I will not indulge your Lordships' House by reading the entire editorial, although I recommend it, but it states, as a message to Liberal Democrats:

“The descendants of a liberal party which helped to found the NHS now must decide whether they are prepared to risk a row to defend it. Capitulation here could carry a higher price than raising student fees”.

I regard that as essential reading for all Liberal Democrats in your Lordships' House and another place.

On the evidence so far, I have grave doubts about the Government's willingness to accept changes that may be brought forward by your Lordships' House by effective scrutiny. For that reason, I feel that I have to vote for the amendment of the noble Lord, Lord Rea, but I shall also vote enthusiastically for the amendment of the noble Lords, Lord Owen and Lord Hennessy, because I have no doubt that the only way that this Bill can be made fit for purpose, or be improved to serve the best interests of the population of this country and the NHS, is by effective, detailed scrutiny. It will be hard work, but the penalty to pay if we do not undertake that scrutiny is that we lose the NHS, which we value so much.