Health and Social Care Bill

Lord Greaves Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Greaves]

My Lords, I declare an interest as a member of a local authority and, like everybody else, a patient—or perhaps a consumer of NHS services. I worked out that I would certainly have been dead at least three times if it had not been for the NHS at various times in my life. No doubt other noble Lords are in the same state—that is, we are alive and well and thriving, despite that. We have heard a wealth of detailed knowledge and experience, although we are not yet half way through this astonishing debate. I have had at least one e-mail this afternoon from somebody who has been watching and listening to the debate and commenting on it. Perhaps all noble Lords will get that when they get back to their computers. I associate myself particularly with many of the remarks made, particularly those of my noble friends Lady Jolly, Lady Williams of Crosby and Lord Marks of Henley-on-Thames.

I shall make several general remarks that put the Bill into a wider political context. If it gets a Second Reading, as I expect it will, I shall hope to take part in the Committee stage on areas where I perhaps have something to contribute and that relate to local structures, the role of local government, the complexity of the proposed structures and systems and how we can sort them out a little, and the representation of the interests of patients and citizens.

As we know, the debate in the country on the Bill is extremely polarised. People often ask me about my work as a Member of your Lordships’ House and we end up having a fairly complicated discussion about what we do and how we do it; I do not know whether they are impressed. This Bill is different. People simply say, “Will you vote for it or against it?”. There is a lack of understanding of many of the changes that have already been made to the Bill. It would help the process of improving the Bill if many of the campaigners and the Opposition would recognise the genuine progress that was made before it came here. A great deal of that progress resulted from action taken by the Liberal Democrat party conference in Sheffield in the spring, the pause that was a direct result of it and the changes that came from that. Unless we understand what the Bill was like when it started and how it changed in the House of Commons—there were allegedly 1,000 amendments—we will not understand how it comes to be what it is now and what we can do to improve it further.

Some of the changes that have been made include the fact that competition can now be on the basis only of quality and not of price. That is a great improvement on the legacy of the Labour Government. Commissioning groups will be more accountable, involving the health and well-being boards in their decisions. These commissioning consortia will meet in public and publish all their plans in draft form for public consultation. That is a significant improvement in local accountability. We are told that there will be no more cherry picking of easy, profitable services by new private providers. Along with all these things, that is something that we shall want to probe. There is no doubt that, despite the House of Commons having spent a very long time debating the Bill, the changes at the end were all put through in two days. Many of them were not properly debated at that stage. If the Bill gets a Second Reading here, one of the jobs that this House must do is to look at those changes, understand them and see whether they will work or need fettling a little more.

NHS commissioning is to remain a public function in full compliance with the Human Rights Act and Freedom of Information laws. That is very important. Commissioning decisions are not to be outsourced to private companies; they have to be made by the commissioning consortium. That is also very important, and something that a lot of people have been concerned about. Monitor will have a primary duty to promote patients’ interests. There is a big debate still to be had about its role in relation to competition, but it is no longer to promote competition; it is to prevent anti-competitive behaviour. I am sure your Lordships will want to scrutinise what that means. There have been huge improvements. Unless we understand them and the role of the Liberal Democrats in achieving them, we will not get as far as we should.

Is the job done? No, it is not. It is part-done and if the Bill is to remain, there is a great deal more to do. Should we give it a Second Reading and scrutinise it in detail, improve it by debate, negotiation and if necessary Division, in the normal way in which the House of Lords works? If we are going to do that it is vital that it is given enough time. The intention is for it to have 10 days in Committee. There are days and there are days, as we have seen with the Localism Bill. Some days can be half an hour, and others can be a full day. Ten days are not enough, and the Government would not be right to push this through as quickly as possible. If the House is going to do its job properly, it has to be given the time and the resources to do it.

The letter sent by the Minister, the noble Earl, Lord Howe, said that the House must have proper time to examine the Bill. He also said that it should be done expeditiously. The relationships between the two Front Benches in this House have not always been the best during this Session of Parliament, but like other noble Lords I was impressed by the Minister’s presentation and that of the noble Baroness, Lady Thornton, who, if I understood her correctly, promised that the Labour Party would not delay for delay’s sake but would seek to scrutinise the Bill properly. If that happens and there are good relationships around the House, the job can be done well.

What is the case for supporting the amendment from the noble Lord, Lord Rea? It is that if this Bill is passed it will be forced through in the face of massive opposition and concern within the health service. This is the fault of the Government, perhaps of a gung-ho Secretary of State and certainly of the language used. As I think the noble Lord, Lord Warner, said, you listen to different Ministers and still get a different message. Some of the concern is certainly justified, some may be a result of misunderstanding, and some is possibly deliberate misrepresentation. We attack the views of so many professionals at our peril. They cannot all be wrong.

The Bill will be forced through in the face of massive concerns from the public, and those of us on these Benches ought to be aware of the massive concerns among Liberal Democrat voters in particular. Opinion polls are not too reliable on this kind of thing, but it is clear that there is no settled consensus in the country behind these reforms. The Government have lost the argument in the country and in the NHS. The noble Lord, Lord Tugendhat, said that it is a haemorrhage of political capital. I would say that they have lost the plot. It will be very difficult indeed to get the argument in the country back on to a reasonable level and away from, “Are you against wrecking the NHS?”, which is the argument at the moment.

What is the best way of doing this? We can vote for the Bill to have its Second Reading, as I suspect we will, and we can scrutinise it properly, and I will certainly take my full part in that; or we can refuse to give it a Second Reading, tell the Government to go back and sort out the reorganisation of the NHS that is taking place in a semi-botched way as the Bill casts its shadow before it—this can be done without further legislation—and concentrate on sorting out the 4 per cent efficiency cuts. I am minded to support the amendment in the name of the noble Lord, Lord Rea, if it is put to the vote, but I shall continue to listen to the debate before that vote takes place.