Health and Social Care Bill

Lord Mawhinney Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Mawhinney]

My Lords, as this is a debate, I thank the noble Baroness, Lady Murphy, the noble Lord, Lord Warner, and my noble friend Lady Cumberlege for their speeches. All three recognised that there are serious issues that need to be addressed in and by the Bill. However, across the House they also dealt robustly with the probably unprecedented, in my experience, level of scaremongering that has been attached to this legislation. As I listened to my noble friend Lady Bottomley, I thought of when we worked together in Richmond House and her skill in taking a complex set of issues and having a timely word to say on each of them.

I shall focus my remarks rather more. I join others in congratulating my noble friend Lord Howe on the masterful way in which he introduced the debate. On a Bill that is, as we have heard, contentious, he carried the whole House with him. Everybody listened attentively, which reflects the personal standing in which he is held. I thank him. I am sorry that the noble Baroness, Lady Thornton, has just left; I want to congratulate her, too. I hope that the noble Lord, Lord Hunt, will tell her that while I did not agree with everything she said, the tone that she adopted was excellent. I say to her and my noble friend the Minister that if they are able to persuade the House to maintain that tone through what are likely to be very long hours, this place will do a service to the British people.

Turning to the Bill itself, I start by welcoming the emphasis that my noble friend placed on outcomes. Those of us who have served in Richmond House have had the slightly depressing experience of being forced, not least in the other place, to talk about health in terms of beds, buildings and money, as though they were the characteristics that determined the excellence of the health service. They all play their part but nobody would talk about outcomes. If this legislation leads to that cultural and significant change in this country—so that we start talking about outcomes—the work of this House and the Government will long be remembered. What we are concerned about are patient convenience, patients treated and patient outcomes.

Secondly, I welcome the fact that this legislation includes real delegation from the Secretary of State. I say real delegation because we live in a slightly make-believe world, in which SHAs and other bodies claim to have delegated power. I was not sure when I was in the department and am still not sure how real that delegation is. However, now it will be real. I hope that the Government understand that real delegation means legal liability, responsibility and accountability, judicial reviews and all the other aspects that go with a statutory framework. That will be a positive development but we ought not to skip over the likely consequences of this significant change.

I very much welcome commissioning. The Minister commended it and the important role that GPs have in developing healthcare. So did the noble Baroness, Lady Thornton, on behalf of the Opposition. This particular bit of the legislation got off to a slightly inauspicious start when, in the Second Reading speech in the House of Commons, the Secretary of State talked about fundholding having “failed to promote quality”. Having told him to his face that that is not my memory and having been encouraged by my noble friend Lady Bottomley in that conversation, my main evidence that putting GPs in charge of fundholding improved quality lies with the honourable and right honourable friends of noble Lords opposite. As fundholding increased, all they did was to complain and whinge about the fact that we now had a two-tier system. If my memory serves me right, Liberal Democrat colleagues joined in.

We had a two-tier system because the quality being delivered by fundholding GPs was so much better than that which was being produced by non-fundholding GPs that the difference was stark. If I have a regret about the Major Administration it was that in the summer of 1994, when more than 50 per cent of GPs were already in fundholding, the Prime Minister—how do I put this delicately?—did not see the need to drive the successful programme to a conclusion. Had he done so, by the summer of 1995 all GPs would have been fundholders and we would not be having this debate today.

I understand the need and case for a national Commissioning Board. I am not sure what is going to be the relationship between the national Commissioning Board and the CCGs and the relationship between the CCGs and the individual GPs. I see a lot of opportunity for conflict and I hope that, as we go through Committee, the Minister will be able to clarify those relationships. We do not need a new set of bureaucratic institutions which get in the way of the demonstrable ability of GPs to do what is best for their patients. In the health service, GPs are probably the only people who genuinely personally care for patients.

Can I tell my noble friend how pleased I am that PCTs and SHAs are going? This is long overdue. I read stories about the health service in the media and I do not know whether they are true, but I know what is going on in my old constituency. I am not impressed—and I do not think that a lot of people are—by a PCT that managed to get itself £20 million into debt, and an SHA that did not notice and does not know who was responsible and does not care because it is in the past. So well done for getting rid of them, but you need to do something about them between now and the implementation of this Bill.

A lot of nice things have been said about Sir David Nicholson and the Nicholson challenge. There is one small example. The East of England SHA has decided to amalgamate the Peterborough and Cambridge PCTs. Nobody wants this. In Peterborough it did not consult the primary care trust. It did not consult the Peterborough hospital. It did not consult the Peterborough council. It just did it, Sir Neil McKay tells me, because it would save some money. This is probably a small bit of the Nicholson challenge. When I asked the Government about this in Parliamentary Questions, I was told to go and ask Sir Neil McKay, whose behaviour within the SHA prompted a lot of the questions in the first place.

Minister, there is much to welcome and much to discuss and clarify, but thank you for an excellent start.