David Penney is right to be concerned about the NHS. The combination of the 5% a year “efficiency savings” started by the Labour Government and the massive upheaval caused by the present Government’s Health and Social Care Bill (which is already well under way) is causing real problems at a time when the demand for high quality health care rises every year.
That is why I voted to stop the Bill in its tracks after the second reading debate in the House of Lords. But the majority voted to give the Bill its second reading and put it to a detailed scrutiny of the whole House in committee, which is what is now happening.
It is vital we get it as right as we possibly can, and we need pressure from public opinion. But we are not helped if opponents of the Bill don’t get their facts right. David is right to point to the importance of the words at the very start of the Bill (which is 445 pages long!) about the responsibilities of the Secretary of State, but he is wrong to say the choice is between “provide” and “promote”.
The 1946 National Health Act set out that the Health Minister had to “provide or ensure the provision of” a comprehensive national health service free at the point of use. That wording has lasted to the present day. But in practice the Minister (now the Secretary of State for Health) does not nowadays directly provide most of the services – apart from community services, most are now already contracted out to hospital trusts and other NHS providers, or in some cases to the private and voluntary sectors.
What we need to get into this Bill are the right words that reflect what a majority of peers want to see – the Secretary of State to retain the overall responsibility for funding, policy and strategy, to be responsible to Parliament for the NHS as a whole, and to have the power to step in when things go wrong or when there is a health crisis. We want to see a lot less micro-management but no break in the line of democratic responsibility, and no change in the basic purpose of the NHS - a high quality comprehensive service available free to everyone.
This is a very complex and difficult Bill, and getting it right is a challenging and difficult task (not helped by some of the voices off in both the Labour Party and on the Conservative right wing). But a lot of peers in all parties and none are working very hard to do so. I hope we will succeed, even though in my view it would have been better if much of the Bill had never seen the light of day. I don’t think that the destruction of the NHS is on the agenda of most members of the House of Lords.
As a postscript may I say that I am producing a summary of the debates in the Lords committee (which will cover at least 14 days and at least 60-70 hours
LORD TONY GREAVES