Health and Social Care Bill

Lord Hennessy of Nympsfield Excerpts

Wednesday 12th October 2011 Lords Chamber

[Lord Hennessy of Nympsfield]

My Lords, recasting the health service arouses more sensitivities than any other reform in our national life, as this Chamber has witnessed over the past 24 hours. Why? Because the National Health Service touches more of our people more intimately than any other state-funded activity. As the great RH Tawney once wrote:

“Only those institutions are loved which touch the imagination”.

No institution surpasses the NHS in meeting the Tawney criterion. No institution ever has, since 5 July 1948, the day the service came into being, lifting more anxiety off more shoulders than any other social reform in our history. That moment was the closest we have ever come to institutionalising altruism.

In Tawney terms, for 63 years it has been impossible to conceive of our country without the NHS as a key ingredient in the way we imagine ourselves. The creation of the health service was and remains the most lustrous achievement of what historians call “Mr Attlee’s Settlement”, part of the late war/early post-war British New Deal, although we never called it that, which embraced Rab Butler’s Education Act 1944 and the national insurance legislation, as well as the National Health Service Act 1946. And yet the tension that ripples through the Bill before us today flows from its attempt to sustain traces of those post-war principles while injecting the stimulus of markets, associated with that other great politico-economic weather-maker of our times, the noble Baroness, Lady Thatcher.

My own instincts are more towards the Attleean end of the spectrum on health matters but I understand and respect the motives of those possessing stronger market impulses than mine, although few see health as an area where the market should rip without inhibition. Even that most thoroughbred of free marketeers, Mr Enoch Powell, as Health Minister in the early 1960s, did not. Asked by his biographer, Simon Heffer, about the first big post-war hospital building programme, whose planning and funding he oversaw, Mr Powell replied,

“The people have willed it. Therefore, they must have it”.

I suspect there are many in our country who would wish Parliament now to find a way of fusing the best in both instincts—of sculpting an approach that does not involve the Secretary of State for Health abandoning his traditional role as the ultimate and direct guarantor of a comprehensive service free at the point of delivery. Equally, I think, the public wish the Secretary of State to retain his function as accounter-in-chief to Parliament for the sustenance of that principle and the care it distributes to all across England, whatever their location, their needs or their socio-economic status.

For these reasons, I am sure your Lordships’ House will apply the closest scrutiny to those clauses of the Bill which incorporate the constitutional functions of the Secretary of State. Your Lordships’ Select Committee on the Constitution, as we have heard many times in this debate, has raised serious concerns about both the legal status of the Secretary of State in the Bill before us and about the strength of his accountability to Parliament. I share those worries.

The Bill, too, needs to sustain the original DNA of the wartime Beveridge report of 1942 in which the provision of healthcare stood out as one of the,

“five giants on the road to reconstruction”—

ignorance, idleness, squalor, want, disease. Central to this scheme, Beveridge declared, was that,

“medical treatment covering all requirements will be provided for all citizens by a national health service organised under the health departments”.

Clause 1 of the National Health Service Act 1946 gave that crucial Beveridge-minted strand of institutional DNA statutory form.

I do not think our people wish us to abandon the Beveridge principle. Might it not be possible, if your Lordships support the idea of a Special Select Committee to examine the Secretary of State’s powers, constitutional functions and accountabilities, to find a form of drafting which meets those concerns? Perhaps Parliament could rediscover the value of that old device of a preamble to a statute which sets out the measure’s ethos and purpose. The current NHS constitution, in fact, carries a “preamble”, followed by a set of “principles” which are eloquent in this regard.

For these reasons, I urge noble Lords to support the amendment in the name of my noble friend Lord Owen to enable the creation of a Select Committee to run concurrently with the Committee stage of this Bill with a very tight remit and a requirement to report before Christmas. I do so not in the spirit of wrecking this Bill but of improving it. I am grateful to the noble Earl, Lord Howe, and the Leader of the House, the noble Lord, Lord Strathclyde, for the generous and courteous spirit in which they conducted their discussions with myself and the noble Lord, Lord Owen. I am grateful, too, to Mr Andrew Lansley for sending me a letter yesterday trying to assuage the anxieties about his proposed powers I expressed during an interview on the “Today” programme.

The NHS, to fulfil its purposes, needs to flourish and to work within the widest possible consensus, buttressed by the confidence of those it exists to serve and sustained by a Secretary of State whose constitutional position leaves him with the unambiguous duty of securing high-quality healthcare for all. I was encouraged yesterday by the pledge of the noble Earl, Lord Howe, to put the Secretary of State’s responsibilities beyond doubt, though his words did jar with the thrust of his reply to the Constitution Committee’s report.

I stress again that my noble friend Lord Owen and I are not in the business of wrecking. This is a very tight proposal for a bespoke Select Committee. I hope the Secretary of State’s powers will be put beyond doubt. A specially tasked Select Committee for the purpose will be the best instrument for achieving that. I urge your Lordships to support my noble friend Lord Owen’s amendment.