Health and Social Care Bill

Baroness Tonge Excerpts

Tuesday 11th October 2011 Lords Chamber

[Baroness Tonge]

My Lords, whatever the noble Earl, Lord Howe, said earlier, we were promised by both parties before the general election that there would be no top-down reorganisation of the NHS. It did not appear in the coalition agreement either and therefore this Bill should not have appeared at all. The noble Lord, Lord Rea, made the arguments for his amendment superbly in his speech and I do not propose to repeat them, but the Bill has no mandate; it is undemocratic and I hope it will be thrown out.

I did not come in to this House because of great works in the NHS, as many colleagues here did. In fact, I am never quite sure why I did come here. But in the NHS, I was a doctor; my children called me a barefoot doctor, working mainly in women’s health screening and family planning. I managed community health services, district nurses, health visitors, the physios, the speech therapists, the porters, the admin staff—all the professions allied to medicine: the poor bloody infantry of the NHS. They come into very personal contact with the patients and they need to be spoken for.

My job changed with each reorganisation and there were very many of them in the time I served. I was a middle manager, trying to keep the staff happy and patient-focused while we underwent each upheaval. Each one wastes a great deal of time and money and, above all, it takes staff away from patient care. A 4 per cent efficiency saving—very lightly called the Nicholson challenge this time—is enough to cope with and may precipitate a lot of change on the way staff do things anyway. But they cannot cope with the uncertainty of this Bill at the same time. In any case, what is the point? The PCTs could have been ordered to include clinicians on their boards and management teams. Some do anyway. An inspection of the way PCTs conduct their business would be useful: there are some PCTs that are not very efficient and are overstaffed. But there are experienced teams that are coterminous with the local authorities, and that will be lost with this Bill.

The GP commissioning groups will need a bureaucracy; they are not going to do it at night after work. Nothing is stopping them employing private medical companies to advise or even do the commissioning—private medical companies spending NHS money and which may be commissioning from their own providers. I find this a nightmare. How long will the NHS survive this scenario?

Many of my old colleagues—and I was with a lot of them last week, which is why I was not here—think that this is the main purpose of the Bill: to gradually privatise the NHS. This view is shared by the thousands of people inside and outside the NHS who have sent individual letters, anecdotes and briefings to us all. Are they to be totally disregarded? We must also consider the effect of letting GP groups decide on the availability of treatments in their area. This will totally disrupt the doctor-patient relationship.

The Secretary of State for Health says that the NHS is broken. The Minister earlier quoted OECD statistics, but other international bodies do not agree with him. According to the World Health Organisation, we have similar health outcomes to Germany, which on the most recent figures spends 2 per cent more than we do. France has slightly better outcomes, but it spends over 3 per cent more than we do. Everyone knows that the USA has poor health outcomes on a much higher expenditure. The King’s Fund and the RSM, to which I refer noble Lords, have also said very good things about the efficiency of our health service. If it ain’t broke, then don’t fix it.

The noble Lord, Lord Darzi, argued earlier that changes were already occurring—that the PCTs were being broken up. I ask the Minister whether it is legal for that to be happening already. The noble Lord told us about the patient under anaesthetic who would die if the operation was not allowed to proceed. I have a lot of respect for the noble Lord, but just consider: if the patient had not given proper consent and the wrong operation took place on that patient, causing the patient to die slowly and in agony, it would be just like the NHS following this very wrong operation. It is better to stop now and think.

The point which is most frequently made in defence of reorganisation is that health needs are changing. I have a very good joke about this which some of you may have already heard. If so, noble Lords should put their fingers in their ears. For those who have not heard it, it is worth it. When the health service was founded, it cared for us from the cradle to the grave. It then had to cater from the womb to the tomb. Then, as medical science progressed, the health service had to provide from the sperm to the worm. The problem with the health service now is that it has to provide for us from erection to resurrection. That is the problem; noble Lords should think about it.

We need more care in the community than ever before because of our ageing population and we need provision for more and more complicated and wonderful treatments available. The general public understands this, and also understands that resources are finite. Choices are going to have to be made about what we provide on the NHS. As the noble Lord, Lord Owen, has said, rationing already occurs—it has to. We need a national consultation and debate about what the health service should provide and where. The general public should be consulted as well as health professionals. We have not done this.

I urge noble Lords to think out of the box: be brave—show the British people that the House of Lords is really worth a place in our national life. Throw out this Bill entirely by voting for the Motion in the name of the noble Lord, Lord Rea. I say this with great sadness: my party is taking part in what I and my old NHS colleagues feel is the ultimate destruction of the NHS, which has been, and still is, the envy of the world. We should be ashamed of this. I am.