Health and Social Care Bill

Lord Williamson of Horton Excerpts

Tuesday 11th October 2011 Lords Chamber

[Lord Williamson of Horton]

My Lords, we all have a profound interest in our national universal health service, which in my view is one of our national treasures. This interest is demonstrated today by the very large number of letters that we have received and by the number of speeches in the debate. I shall try to restrict my comments to a limited number of points because evidently this package of 720 pages—that is to say, a Bill of 445 pages and an explanatory note of 275 pages, which are often difficult to comprehend—is likely to have a long life in Committee, where it requires, and will no doubt receive, detailed examination.

The first main question to the Minister is not about what is being proposed—although that is evidently important—but why is it being proposed? In short, why are the Government considering so substantially revising the current system, in particular the strategic health authorities, the primary care trust—which are now to be abolished under Clauses 30 and 31 of the Bill—the whole current provision of health services generally and the administration of hospitals? Obviously improvements in the National Health Service are highly desirable. We have them all the time, in terms of medical knowledge and patient care.

I know that the Minister dealt with the reasoning. However, he was somewhat overwhelmed by the myriad changes to which he had to refer that, perhaps in winding up he will have another try at telling us why such a massive change is to be made, bearing in mind that changes on this scale are bound to cause some disruption and possibly an adverse effect on the morale of the people who really matter—that is to say, doctors, nurses, healthcare assistants, social workers and all the people who comprise the system of care for the whole nation. However, because the Bill’s proposals are so large, I put it back to the Minister in the words of Tom Jones: “Why, why, why, Delilah?”—which I am unfortunately not allowed to sing here. This is my first question.

In addition to the basic question—why are we having all these changes?—I would like the Minister to respond to three points that I have selected either from recent parliamentary discussion or from the 445 pages of the Bill. From recent discussions, I ask what has happened to the practical steps for improving the services to patients that were presented to the House by the noble Lord, Lord Darzi, towards the end of the period of office of the previous Government. If I recall rightly, these included the possibility of strengthening patients’ services through the establishment, particularly in some inner cities, of GP clinics that would provide a wider range of services at one site—for example, radiology, nursing and physiotherapy—which could have the effect of reducing the overload on hospital A&E services. This system works well in some countries.

Evidently, there are many people in Britain, particularly in the inner cities, who look to the A&E services as the first point of call if they have a health problem. The result is an inevitable overload. In the medium term, do the Government support the proposals of the noble Lord, Lord Darzi? Secondly, have the Government a view on the possibility of establishing more separate specialist units to deal, for example, with the limited number of major health conditions associated with the ageing population, thus also reducing the potential blocking of beds in general hospitals? It might be effective and good for patient confidence for such persons to look to dedicated units or clinics of which we do not have very many at the present time.

From the text of the Bill, I make one major point. The clinical commissioning groups, which are not necessarily large groups—we are told there may be 300 or 450, we simply do not know—are none the less the bedrock of the new system. There really is concern about how in practice they will be able to assess and provide for, to quote the Bill,

“such services and facilities as it considers appropriate for the purposes of the health service that relate to securing improvement… in the physical and mental health of the persons for whom it has responsibility, or… in the prevention, diagnosis and treatment of illness in those persons”.

I am quite sure that there will be good will, but can this task be easily done at the level of, for example, a single large GP practice?

We do not know the size of these clinical commissioning groups, how much advice they will get or how they will operate on the ground. After all, the members of these clinical commissioning groups—at least, the clinicians—have to care for their own patients as well as having an enormous number of duties that are cited in the Bill in Clause 23—“effectiveness”, “efficiency”, “improvement in quality of services”, “reducing inequalities”, involving each patient, giving “patient choice”, obtaining “appropriate advice”, promoting “innovation”, “research”, “integration” and the NHS constitution. These all relate to the clinical commissioning groups. They may relate to others as well, but in the Bill they also relate to them. Is it fully workable? Will the Minister comment on the workability of these desirable objectives all at once at this basic level?

On the why and workability, I have some concerns. As an independent and always open-minded Cross-Bencher—as the Minister knows—I come to two points that I welcome. First, it is indispensable as the population ages and medicine becomes more complex to ensure the most efficient integration of medical and social care. There is room for improvements. For many patients, it is the most important element of their health, mobility and daily living problems. Therefore, I note with satisfaction that Clauses 191 and 192 of the Bill establish the health and well-being boards, which must encourage persons who arrange for the provision of any health or social care services to work in an integrated manner and to provide advice, assistance or other support. This is good.

In view of my long-standing interest in mental health, my final point is to welcome Clause 40, which makes local social service authorities responsible in relation to independent mental health advocates and inserts a provision into the Mental Health Act 1983,

“making arrangements to enable mental health advocates to be available to help qualifying patients”.

This is also an improvement.