NHS: White Paper

Lord Walton of Detchant Excerpts

Monday 12th July 2010 Lords Chamber

[Lord Walton of Detchant]

My Lords, does the Minister recall and accept that I have said on a number of occasions in the past few years that what the NHS needs least is another major reorganisation? We have been beset by too many reorganisations over the years, but, having made that point, I should say that there are many valuable things in this White Paper on which we shall all wish to reflect over the coming months before the legislation is laid before the House. The development of outcomes, measurement and framework is very important.

There is also a case to be made for making all trusts foundation trusts, but only if Monitor and the Care Quality Commission have the strength and improved ability to monitor behaviour so that we avoid the kind of disasters that have occurred in one or two foundation trusts in the past few months.

I have said on a number of occasions that the NHS is beset by the activities of an intolerable quangocracy. There are far too many quangos, which have the right to examine and assess the performance of health service bodies, and a reduction in the number of these will be very valuable. However, we wish to know which quangos the Government have in mind. Valuable, too, will be the reduction in bureaucracy.

Many of those who are so proud of the NHS have major concerns about the GP-commissioning element of the White Paper. No doubt the Minister will remember GP fund-holding under the previous Conservative Government, which was not a great success and had to be withdrawn in the end because it failed to fulfil the objectives. I know, and the Minister will agree, that a number of general practitioners are very enthusiastic about this idea, but many are deeply concerned and anxious about the new responsibilities that will be imposed on them. What administrative support will the GP consortia be given to enable them to fulfil this very arduous responsibility? Is it really right that every form of regional strategic planning should be abolished? What is to prevent overambitious foundation trusts embarking on programmes to bring in highly expensive—

[Lord Campbell-Savours]

My Lords, with all respect, could someone remind the House that we are discussing a Statement?

[Lord Walton of Detchant]

Will the Minister say whether he believes that abolishing all regional planning is absolutely right? I believe that it could be dangerous.

[Earl Howe]

My Lords, I am grateful to the noble Lord for his questions. He will know that our plans do not constitute reorganisation for its own sake. The only purpose of the reorganisations that we are proposing is to embed higher-quality practice and better outcomes for patients, and for no other reason.

The noble Lord asked several questions about GP commissioning. As he will know, the previous Administration introduced practice-based commissioning more than five years ago. Some consortia are doing an excellent job, but many GPs have been frustrated by not having clear responsibility and control. They find very often that PCTs get in their way rather than help them. I think that it will be music to their ears that they will be able to create structures and management systems for themselves that will help them rather than get in their way. We are going to enable them to learn from the past. We are engaged in talks with the profession about how we implement the change, which will, I emphasise, be bottom up.

The noble Lord also referred to GP fund-holding, which as the House will know was a policy introduced by the Conservative Government. There were good points and bad points about fund-holding. The good points were that it empowered GPs and, in many cases, delivered good quality care. But the criticisms revolved around high transaction costs, bureaucracy and, in many ways, inequalities that resulted. We want to avoid those pitfalls. The support that GPs will get will not be prescribed from the centre. A range of support is already available for commissioning, including PCT teams, local authorities and independent commissioning support organisations. There will be no shortage of help out there.