Health and Social Care Bill

Lord Lucas Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Lucas]

My Lords, the Royal College of General Practitioners should know better than to publish phooey surveys like that; they are supposed to understand what evidence-based medicine is. The same applies to polling: a random collection of self-selected GPs answering a poll online does not produce valid answers. But I will be just as rude about the Department of Health, which employed one poll to produce a similar low-quality piece of work and then trumpeted its results. We really ought to insist that a group of professionals who propose to believe in evidence-based medicine apply the same standards to their politics as they apply to their medicine.

There seems to be widespread acceptance that commissioning groups in one form or another are a good idea. I certainly share that view: I want my GP to have a real influence on the provision of care in the area where I live. I want my concerns and the concerns of his other patients to be reflected in the way that the NHS evolves locally. It seems to me that the structural changes we are looking at in this Bill largely flow from that change. If we are going to have real decision-taking at that sort of level, we have to push a good deal of power down from the Secretary of State.

I also accept what I think many other people agree with—that patient choice is important; that being able to choose between different remedies, different hospitals and different styles of doing things is important. I had a long view of hospitals in the course of my late wife’s illness; it is astonishing, as the noble Lord, Lord Crisp, said, how variable care is. St George’s Hospital had a wonderful ward for kidney patients; it had one of the worst wards I have ever encountered a few paces away. To be able to choose, to be able not just to suffer what is thrown at you but to have a voice in it, seems to be a very important part of the way that I would like my NHS to be.

If one is to have choice then—as the noble Lord, Lord Darzi, and others have pointed out—competition flows from that. You cannot have choice between two alternatives without those alternatives being in some way in competition with each other.

I think that the basics of this Bill flow from things that fundamentally we seem to agree with all around this House. I was very persuaded by the speeches of the noble Lords, Lord Warner and Lord Darzi, in that regard. There is a lot of common ground and I do not think that we should be too put off by the layer of political manure which the opposition Front Bench is attempting to spread on this. As the noble Lord, Lord Darzi, said, to believe in the NHS is to believe in the reform of the NHS—words which could well apply to this House in similar form—and I think that that is the basic understanding that we should approach this Bill with.

A lot of reservations have been expressed about detailed elements of this Bill, and listening to those who have expertise in those various areas, I am sure that I will take a close interest in them as we go through. There seems to be a lot of worthwhile discussion ahead. It is not clear to me, for instance, how integrated provision for people with complex needs is proposed to be dealt with under the structures that we have in the Bill. I have similar interests in how freedom of information will be dealt with in a health service with a much greater variety of providers, and I am keen to make sure that the structures encourage what one might call commissioning a community—getting the real community very much more involved in providing healthcare, looking after the elderly and looking after its own. That seems to me to be an expression of localism and community care that we ought to encourage and that ought to be possible once you get commissioning down to much more local entities than we have at the moment.

I do not know what the answer is to the question posed by the noble Lord, Lord Owen, about the Secretary of State’s responsibility. He made a serious and thoughtful speech, as have others in this House, and I shall listen to the debates on that subject with great interest, but I do not see the argument for a separate committee to examine it. It seems to me to be a question which is deeply embedded in many aspects of this Bill, and I cannot see how we can separate discussion of it. I have been very impressed by the speeches that I have listened to today. I think that we have the expertise and understanding in this House to do justice to the questions that he raises. So I shall not be supporting his amendment or, indeed, that of the noble Lord, Lord Rea.