Health and Social Care Bill

Lord Fowler Excerpts

Wednesday 12th October 2011 Lords Chamber

[Lord Fowler]

My Lords, as the noble Lord, Lord Beecham, has just said, a constant theme of the debate has been the volume of public and professional objection to parts of the Bill. I do not downplay that, but such protest about change in health policy is hardly unique. The first health debate I took part in was as shadow Health Secretary in 1975, when I came from the peaceful realm of dealing with law and order, crime, police and prisons to the health service, and found the most horrendous row on pay beds taking place. The noble Lord, Lord Owen, will remember that as he was Health Minister at the time.

A few years later I took over as Secretary of State and stayed for six years, which is something of a post-war record. I would like to claim that this was a period of unparalleled peace, but this House has certain standards of honesty and frankness. The lesson I learnt from those years was that any change or reform in the health service almost certainly comes up against the implacable opposition of the BMA and the other health unions—and, very often, of the Opposition. When I introduced general managers, there was a fierce row. When I introduced a manpower policy, there was a fierce row. When I introduced contracting out, it was regarded as the work of the devil; and a proposal to have some very modest partnership between the public and private sector at district level was described by Michael Foot as,

“the most serious attack on the National Health Service since it was originally started”.

The worst attack was when the BMA and the pharmaceutical industry combined to attack my proposals to save on the drugs bill by substituting cheaper, generic drugs for branded sleeping pills and tranquillisers. The BMA said that it was an unacceptable interference in the freedom to prescribe, and the pharmaceutical industry said that I was the worst kind of socialist. Even then, the party opposite voted against me. Perhaps it was the word “socialist” that they did not like. Needless to say, none of the policies has been overturned in the 25 years since. My point is that we should not be amazed at the noise and criticism accompanying any set of changes; that has always been the case. Having said that, I acknowledge that many issues raised in the debate are of genuine concern. Those of us who care about the future of the health service want to see them settled. The question is how that can be done.

What would be entirely unacceptable is for the Bill—by any standards a major government Bill—to be defeated by this House at Second Reading. I was a Member of the other place for 31 years and accountable to the electorate. When I came to your Lordships' House, my position changed. This House has great expertise, as the noble Lord, Lord Winston, has just shown, but it is an unelected House and should not on Second Reading substitute its own view of a major Bill passed by the elected House after an exceptional period of consideration. We were asked yesterday where the mandate was for this legislation. The mandate comes from the elected House—from MPs who are elected and accountable. Frankly I am amazed that the opposition Front Bench supports the amendment of the noble Lord, Lord Rea, because my argument is exactly the kind of argument they used in government on issues that were much less important.

The amendment of the noble Lord, Lord Owen, to which the noble Lord, Lord Hennessy, spoke, is nearer the mark. The question that they raise is not new. In many ways, it is the eternal question of the National Health Service. How, when one has an almost entirely tax-funded service, with an obligation on the Secretary of State to answer to Parliament on how money is being used, does one at the same time achieve maximum devolution for the service to be most effectively managed? I do not deny that there is an important issue here that we should consider. What I doubt is whether we require a special Select Committee to examine the issue. The normal committee processes of the House would be sufficient.

In the time available, I will make three quick points on why I support the Bill. First, any Government have an absolute right and duty to ensure that the enormous resources being devoted to the health service are properly used. We can debate by what percentage health costs go up each year, but we are now spending more than £120 billion a year on the health service. By any standards, that is a vast amount of money. What one wants, particularly in the light of an ageing population and the certainty of new treatments coming on stream, is to see that the service is well managed—and I do mean managed. It serves no purpose to refer to the many excellent managers in the health service as bureaucrats and administrators. We should value their skills in the same way as we value those of the clinicians and doctors.

The second reason I support the Bill is that it explicitly recognises that not everything needs to be run by the health service. Fair competition is not an alien concept but something that applies to every other profession in this country. I do not want to wreck the political careers of the noble Lords, Lord Warner and Lord Darzi, but I agreed absolutely with what they said yesterday about this. Fair competition should ensure the best possible service. Equally, the use of the private sector does not mean that one is privatising the service; that is one of the oldest and dreariest charges. We are committed to a taxpayer-financed service, but making sensible use of the expertise of the private sector is what any modern public service should do.

My third and final reason for supporting the Bill is that it potentially contains—I listened to what the noble Lord, Lord Beecham, said on this—one of the most important steps forward: the creation of Public Health England, with a ring-fenced budget. I have just finished chairing a Select Committee of this House on HIV and AIDS. One of our findings was that at the last count, in 2009-10, the Department of Health spent £762 million on the treatment of HIV—mainly on drugs—and £2.9 million on prevention. The trouble is that people do not march up and down Whitehall or block Westminster Bridge carrying banners saying, “Prevention, prevention”. The public demand treatment. The tragedy is that so much treatment could be avoided, as in the case of one man who wrote to me after our report saying that he was on the verge of suicide when he was diagnosed with HIV, and even today is receiving psychiatric care: a casualty of a failure to prevent an entirely preventable disease.

There has already been a long debate on this Bill. Unless we are careful, we will leave the health service in uncertainty about the future. We will leave it in suspended animation. I do not believe that anyone who is committed to the National Health Service wants to see that. My belief is that this Bill should now be given its Second Reading and that we should proceed to scrutinise it in Committee with the skill and care that this House has always shown.