Health and Social Care Bill

Lord Haskel Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Haskel]

My Lords, I cannot remember the last time I troubled your Lordships on health. There are so many others far better qualified than me to speak, but there are so many aspects to this Bill—nonclinical aspects—that I felt that I had to speak up.

My first concern is the Government’s absolute failure to convince a reasonable proportion of the public of the need for the Bill. Yes, we have had a listening exercise; we have had the Future Forum; there has been debate and argument; yet the public remain confused and unconvinced of why the reforms are necessary. A decent analysis of why they are needed and what has gone wrong could win over the public, but it has not happened. I think that most of us in your Lordships' House would agree that, except in an emergency, forcing through legislation without convincing the public is usually both bad government and bad legislation—especially when, as my noble friends Lord Rea and Lady Thornton explained, the Government have no mandate.

Worse, the Bill ignores some of the lessons that we have recently learnt. I give a couple of examples. The Bill sets out to create a rather complicated structure of deals with the private sector to deliver some of our clinical services. We now know that the public service as presently organised is not set up effectively to manage such an arrangement. How do we know? We know because the Public Administration Select Committee has told us. So has the Institute for Government. So has the King's Fund and many others. They have all drawn our attention to the problems of additional complexity. The skills to oversee that sophisticated commissioning and contracting are just not there. According to the Select Committee, the Government are not responding to that. Indeed, cuts are leading to the loss of the very key skills required for the managerial complexity about which the noble Lord, Lord Darzi, spoke. Is the Minister listening and taking the necessary steps, or is he just hoping for the best?

We are told that all this will be regulated by Monitor—holding the ring, as the Minister put it. We now know that this kind of regulation does not always work, especially as the Bill does not lay down any licensing rules. In these days of dysfunctional markets, even regulated companies fail. Tighter regulation strangles competition. Loose regulation means that the public can be exploited. Get it wrong, and we know that the public will be the losers—in every way. We also know that we do not fully understand how to regulate this kind of market without it becoming permeated by the logic and interests of the participating businesses—all at the expense of the consumer and the benefit of the big players. For proof, I ask the Minister to look no further than the current situation in banking and at his next gas and electricity bills. That is why the public are becoming disillusioned with market solutions. I suspect that that is why the Government have been unable to have a meaningful dialogue with the public about the Bill. That is why I support the Motion of the noble Lord, Lord Owen, to send part of the Bill to a committee for further scrutiny. Let us take evidence and learn from recent experience.

You would have thought that with those problems of administration and regulation—problems central to the success of the Bill—a responsible Government would not implement change unless they were sure that they had all the tools, levers and skills in place. It is surely a mark of irresponsibility to do otherwise. Is there a crisis requiring urgent action? No. Does all this haste suggest that things are bad in the NHS? No. So why, as the noble Lord, Lord Williamson, asked? In 2001, 39 per cent of the public was satisfied or quite satisfied with the NHS. In 2009, that figure was 64 per cent. Those figures suggest that the task is not reform but to build on what is good. Surely, that is how to satisfy the rising demand, expectation and cost about which the Minister told us.

It is not as if now is an opportunity to be taken for reform. On the contrary: this is exactly the wrong time. The current Budget settlement requires the NHS to make year-on-year efficiency gains of 4 per cent for the next four years, yet the Government insist that spending on the NHS will increase by 3 per cent per year. No wonder NHS managers—to say nothing of the rest of us—are confused and worried about the lack of clarity and transparency in NHS finances.

In my other life, I spent 30 years building up a business, but it did not take me that long to learn that the discouragement and disarray presented by mixed objectives, confused budgeting or not carrying the staff with you meant that no objective was properly and fully achieved. As others have pointed out, it is also unclear who is in charge and who is accountable.

All of that is a sign of poor leadership and poor management by the Government: the kind of management that burns through money before you even know it has gone. We all know that, irrespective of whether we have had a life inside or outside of politics. I am sure that the Minister knows it as well.

Having demonstrated that this is a bad Bill, what should a competent and responsible Government do? With no mandate for radical change, it seems to me that the Government should be concentrating on incremental change to streamline and improve the performance of the NHS. The Secretary of State himself said that 90 per cent of what he wanted was possible in the existing structure.

I hesitate to trespass on clinicians’ ground, but we have all received authoritative briefing about obliging clinicians and nurses to follow best treatment guidelines; the huge concern about mental illness; the need to be a lot more active in improving public health by insisting on standards for healthier food; avoiding the need for medical treatment caused by passive smoking or the violence and injury that alcohol causes, by more responsible marketing that does not target children or glamorise consumption. The Government have an important role in giving leadership in all those areas. Indeed, the Minister himself was very positive about that when he responded to the debate on this very topic last Thursday, especially when a noble Lord suggested that it was that that could overwhelm the NHS.

I remind the House that one of the legacy promises attached to London's bid for the Olympic Games was that, through the National Health Service, 1 million extra people would be taking more exercise every week. That was a promise made on the grounds that that would radically improve the nation's health. Press reports say that that has been quietly dropped. Is that true?

This is an important Bill. Our task in your Lordships' House is not political point-scoring; it is to bring our experience to bear. I have tried to show that mine tells me that this is a bad Bill: badly thought through and badly timed. In an ideal world, Second Reading would be quietly dropped, perhaps like the Olympic health legacy. By convention in this House we do not vote down Bills at Second Reading, but on this occasion I shall be supporting my noble friend Lord Rea so that we can devote our time to far more pressing and difficult matters.