Health and Social Care Bill

Lord Rodgers of Quarry Bank Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Rodgers of Quarry Bank]

My Lords, on the occasion of a debate in the House on 16 December last, I said that I had been agnostic about the merits of the July 2010 Liberating the NHS White Paper and nor had I been persuaded since. Ten months later, I have moved on, but I am still uneasy about the Bill. That is the way I shall remain, long after the legislation is passed and when the policy is finally implemented. Only time will show fully the outcome of the Bill and the balance of advantage. There will certainly be rough edges and mistakes, and lessons will have to be learnt. The NHS is an immensely complex and living institution and we cannot know the extent of change for the better.

There have been legitimate and strong differences about the health service ever since it was established in 1948. Two years later, NHS costs and the decisions to charge for teeth and spectacles divided the Attlee Cabinet and damaged the Government. Wide differences on this Bill will remain, including over the role and extent of the private market within the public sector. I am impressed that the country has already been covered by the shadow clinical commissioning groups. There are now 250 of them. Some are small groupings but others—like the London Borough of Camden, Oxfordshire and now Sheffield—are large and, in effect, conglomerates. A lot of GPs are enthusiastic and well informed, despite the unbending criticism of the Bill by the chairman of the council of the Royal College of General Practitioners.

However, the picture is patchy and there are also dissident and unhappy GPs. They say that they are clinical experts and do not wish to become experienced commissioners, and are not interested and competent in administration. It is not clear what happens when a shadow CCG fails to meet the statutory requirement. On the face of it, the Secretary of State wants CCGs to get on with it but it could end in a confused picture by 2013.

In the July White Paper, it was said that the new Commissioning Board would be a “lean and expert organisation”. Sir David’s board may be expert but it will certainly not be lean. I make no complaint, as it seems to me that Sir David will have to take a grip on problems arising from failures by the CCGs. There could be tension between letting go and retaining control at the board, and we should be aware of the limits of localism.

In the debate of 16 December, I referred to the ending of the primary care trusts. I drew attention to a success story in PCTs reaching agreement about having fewer and more sophisticated stroke units in London hospitals. In contrast, there had been an all-party outcry against the possibility of closing the A&E departments in the Whittington Hospital—near to my home—and elsewhere. The closure of Chase Farm A&E has recently made news and is an object lesson of short-term politics and pointless delay. The role of CCGs in respect of closures, and whether they will have a constructive role in those decisions, is far from clear.

The chief executive of the NHS Confederation reminded us that the health service is facing £20 billion of efficiency savings by 2015—a huge sum in a very short time. Moving services and closing complete hospitals may be essential while raising standards for the benefit of the patients. It could be said that these priorities and tasks in saving the NHS should have been treated ahead of the Bill. There is deep concern about whether the NHS can deliver greater efficiency and quality while overhauling the NHS structures in the Bill.

In successive Governments since Gladstone, the Treasury has thrown up its hands in horror at the possibility of hypothecated taxation in a major area of policy. However, it may now be right to consider hypothecated taxation for the NHS. This would make NHS expenditure more transparent, showing the public—the taxpayer—the awkward choices when the demand for services is at above the rate of inflation due to rising expectations, an ageing population and increased technological costs.

Meanwhile, we have the Second Reading today and tomorrow in the knowledge of much still to be done in scrutinising the Bill in the hope of agreed amendments that will lead to further improvements and relieve some of the anxieties. However, I cannot support the amendments in the names of the noble Lords, Lord Rea and Lord Owen. Since the publication of the July 2010 White Paper, there has been a deluge of consultation papers and memoranda. Following the White Paper, the Secretary of State published a sheaf of separate documents covering every aspect of his proposals and invited a response. In due course, every medical professional body expressed their views and the trade unions and many lobbyists on behalf of good medical causes began a steady and lengthy campaign. This was entirely appropriate, as it exposed in detail the importance of these distinct issues.

In due course, the Bill was published and reached the Commons for Second Reading. Again, there was another flood of paper prior to the beginning of parliamentary scrutiny. At the same time, my noble friend Lady Williams of Crosby took up the cudgels on key controversial aspects of the Bill and the Liberal Democrats made the running for amendments. After that, the NHS Future Forum, led by Professor Field, was devised and during what was called a “pause”, there was a further set of documents independent of the Secretary of State and the department.

I will not tell the story of the White Paper and the Bill any further, as noble Lords are very familiar with the whole saga. However, I will mention the report of the Constitution Committee. As the noble Baroness, Lady Jay—the chairman of the committee—said this morning, the committee has expressed its concern that the Bill might dilute the Government’s constitutional responsibilities with regard to the NHS. Despite today’s disappointing government response, I hope Ministers will think again.

By lunchtime tomorrow, there will have been over 90 speeches advocating many shades of opinion. I am a lay man in a debate dominated by medical experts. I have heard speeches critical of the Bill and others as uneasy as I personally remain. However, I find no advantage in another Select Committee. We shall give thorough scrutiny to the Bill in Committee and on Report; it will be the end of a long, perhaps unique, process of argument and examination. The House is now able to make fully informed decisions. Whether we like them or not, we should not duck or delay them further.