Health and Social Care Bill

Lord Warner Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Warner]

My Lords, it is always a pleasure to follow the noble Baroness, Lady Murphy. I detect from her remarks that I may have been forgiven for her old SHA being one of the 18 that I abolished five years ago.

As you walk into Parliament from the Underground, you see a large poster telling the citizenry that they can find out how laws are passed here. Let us hope that this Bill is not used as a case study. The Government’s approach has done few favours to the cause of NHS reform, which many of us believe is still needed. The failure to produce a convincing narrative on why change is required on this scale has allowed the utterly predictable voices of reaction and vested interests to drive the agenda of opposition. They have made things worse by failing to show how their legislation will help the NHS to tackle the financial, demographic and public expectation challenges that it faces, particularly the £20 billion efficiency gain required over the next four years.

A key plank of Andrew Lansley's defence has been that he was just continuing the Blair health reforms. That has a slug of truth in it, but he fails to acknowledge that those of us implementing those reforms had a clear mandate to do so in our 2005 manifesto, with which, I say to my colleagues, we won an election.

It is very easy with this Bill and the Government’s handling to engage in political point-scoring. However, I suggest that our greater responsibility in this House should be to the current needs of the NHS and how we can best make this Bill more fit for purpose. NHS staff are in a no-man's land between a partially dismantled system and no clear and workable new system in place to which they can transition. This is a bad place to be, given the state of the public finances and the challenges that the NHS faces. Now, the NHS needs the maximum removal of uncertainty and the strategic leadership to take it forward confidently, as so eloquently advocated by my noble friend Lord Darzi. All that scrapping the Bill would do is worsen the chaos. The grown-up thing to do is to improve the Bill as quickly as possible so that the NHS can move forward with greater certainty. From my own inquiries, that is the view of the NHS Confederation, which has provided us all with an excellent briefing.

Of course, this House needs to discharge its functions of scrutinising the Bill, and it needs to do that thoroughly, speedily and with a clear sense of purpose. The guiding principle should be fashioning amendments that make the NHS more likely to be able to deal with the challenges that it faces over the coming years. That will certainly be my approach, drawing on expert help both inside and outside this House.

Neither of the amendments to the Motion of the noble Earl, Lord Howe, helps in this regard. My noble friend’s Motion is well intentioned but thoroughly misguided, given the needs of today’s NHS, and I cannot support it. Nor will I support the amendment of the noble Lord, Lord Owen.

We should recognise that we have enough evidence of the Bill’s strengths and shortcomings, as the noble Lord, Lord Rodgers of Quarry Bank, pointed out to us. We have now to settle down in a Committee of the whole House and work our way through the amendments to improve the Bill. In this regard, I hope we will find the Minister in a listening and negotiating mood. Perhaps he will recall that when I took another rather controversial health Bill through this House, on foundation trusts in 2003, I moved or accepted some 200 amendments. So that is the benchmark for judging the flexibility of the noble Earl opposite.

I shall comment briefly on the Constitution Committee’s report. The Secretary of State’s responsibility for health service provision has always been a bit of a fiction when it comes to accountability. Clause 1 seems to me a more accurate description of where the Secretary of State’s responsibility and accountability are now and where they should remain, although I shall certainly argue in Committee that his powers of mandation in the Bill are rather too unconstrained. I found the Minister’s response to the Constitution Committee convincing and cannot see much point spending too much further time on this issue.

I make it clear that I am proud of Labour’s improvements to the NHS and the external recognition of them. We have better buildings and equipment, including IT, much needed extra staff, better service access and a huge improvement in the clinical performance on the killer diseases: cancer, coronary heart disease and stroke. But NHS productivity was poor relative to the scale of that investment. Office for National Statistics figures show inputs growing by 60 per cent in real terms between 1997 and 2007 and output barely moving. That is not a good performance. A major programme of service reconfiguration is required quickly. Too many acute hospitals are not good enough for FT status now, let alone in the tougher climate ahead, and the 1960s all-purpose district general hospital is an out-of-date, failing business model. We need change in configuration. We need to give great attention to the part of the Bill that deals with it and to strengthen the ability of decisions to be taken locally, clinically and without too much political interference. We have talked the talk on integration, but the Bill needs to walk the walk, especially on integrating health and social care. We need to remember that social care is in the Bill’s title. NHS performance requirements need strengthening so that the public have access to much more useful information. We need to clarify, and simplify, the extremely complex set of arrangements in the Bill for fixing the NHS tariff.

These areas and others such as public health, the patient’s voice, social care reform, research, NICE and the NHS Information Centre all need attention, but those are things that we can deal with in Committee.

Perhaps I may say a few words about the vexed question of competition, which is not privatisation, is integrally linked with extending patient choice and is not incompatible with service integration. I end with a quotation from a recent study that was peer-reviewed and appeared in the Economic Journal. The study was undertaken by researchers at the London School of Economics, led by Zack Cooper. They looked at whether hospital competition under Labour saved lives. They stated:

“We find that after the reforms were implemented, mortality fell (i.e. quality improved) for patients living in more competitive markets. Our results suggest that hospital competition can lead to improvements in hospital quality”.

I hope that when we get to the nitty-gritty of the Bill on Monitor we will approach the issue of competition a little more dispassionately than in the recent past and will consider the evidence and not just our prejudices.