Health Bill [HL]

My Lords, I believe in the National Health Service. I married into it, my family have worked in it, and I use it regularly. I also recognise the aspirations that the Minister voiced when he introduced the Bill and all the work that he has put in since he took up his current position. Nevertheless, since the Bill’s primary purpose—it is certainly the primary purpose of Part 1—and driving force is to create a new constitution, attached to which are ““quality accounts”” which by any yardstick are a huge new bureaucratic dimension, it is highly questionable whether it will be of any benefit to patients. I agree that Part 2 contains some useful provisions but question why those cannot be dealt with by regulation. Part 3, which has been flagged up as involving public health, seems to be driving only on the smoking front, ignoring totally the impact of obesity and alcohol on young people. I shall deal first with the constitution. Ten years ago, the Government argued that they were ahead of other countries, "““in developing an integrated national strategic approach””" to many of the problems facing the health service, not least, at that time, MRSA. However, the Government were more interested in strategies and targets than results. The constitution attempts to set out the rights and responsibilities of our healthcare system, which has, as some would say, muddled through for the past 60 years. But there is a clear implied warning in the constitution: that those in our society who adhere to unhealthy habits, be it smoking, alcohol or obesity, may be refused NHS treatment. I think that that is morally outrageous and legally dubious, especially as it is all retrospective. It could never happen in the normal commercial world, where contracts are legally binding. What is the reality of this so-called constitution? It is far from short: at 48 pages, it is longer than the constitution of the United States. It does not offer the certainties that an average person would expect. It is really just declaratory and not legally binding. What hope does it offer practically? Let us take the example of MRSA, on which we have the worst record in Europe. We have a legally binding hygiene code and advice and guidance from the Chief Medical Officer but that is being ignored and flouted. How will the constitution solve that or other problems? The Minister mentioned the patient’s voice, but what do we find? Even the new Care Quality Commission has already had its wings clipped. There is great play about quality accounts—a meaningless concept which does not exist in normal commercial life. In any case we already have a whole raft of performance reviews, assessments and other forms of checking on performance. There is a terrible danger that it will be no more than box-ticking. The basic structure is not stable even now. We have gone almost full circle, back to the structure as it was in 1997, when we had eight regional health authorities. The number of health authorities was increased to 28 under this Government, but now we are back to 10. In 1997 we had GP fund-holding, but then non-market-oriented primary care groups took over. We then had partially market-oriented primary care trusts. Now, we have practice-based commissioning—which sounds very similar to GP fund-holding. All that is against the background of the four systems that we now have in England, Wales Scotland, and Northern Ireland. I hope the Minister will give us a definition of what ““Britain”” is in relation to those four areas. It is sad that the Swedes, in recent research done by Health Consumer Powerhouse, have found that our National Health Service rates 17th in the whole of Europe. We face no real increase in expenditure and capital projects being cut back. We also have the handicap of NICE. It is too slow, too cumbersome and not transparent. It duplicates the work of Scotland and uses the wrong models. It means that patients in our NHS get new products more slowly than anywhere else in Europe. It is true that there are excellent reports as well, such as that of Mike Richards. That is good—but they are still not really acted on. I am sorry to complain to the Minister, but I wrote to him on 21 November with a particular case arising from Mike Richards, and I have not even had an acknowledgment. I will put that on the board again for the Minister. The whole pharmaceutical area, which is usually ignored by the Government, is now in a mess. The proportion of the NHS budget set aside for drugs is falling. The PPRS contract was broken. We have more counterfeit drugs in this country than we have had since the NHS was started. We have more and more online uncontrolled drugs. We have the National Health Service buying the cheapest it can possibly find, with little control over poor bioavailability. We have evidence of research going overseas. And there is now a real risk of shortages—I mean this seriously—because the blanket 5 per cent cut that the Government have demanded, allied to the fall in the price of sterling, has created an incentive to export medicines from this country. I nearly forgot: mixed wards are back on the agenda. I have asked the Minister two Questions on that topic; both times he refuted the need for mixed wards to be removed, and now the Secretary of State announces, outside Parliament, that they are back on the agenda. They will be removed, he says. Perhaps in his wind-up the Minister will tell us what the new definition of ““mixed wards”” is. Lastly, at the same time as the Bill is going through, health budgets are to be reorganised yet again. That means more delay and more upheaval. I turn to Part 3 and the anti-smoking dimensions that allegedly come under public health. There is nothing on obesity, which affects some 60 per cent of our children, nor on alcohol abuse, which affects 10 per cent to 20 per cent of our children. The provision focuses solely on the 6 per cent of our children—which is still too many—who smoke. Against that background, it is surprising that you get bizarre occurrences such as that in the north-east, where there is a booklet now on how to use cannabis. It tells you about rolling cannabis and what the experiences of it are. On page 14 of this 20-page booklet, it finally mentions that cannabis is an illegal substance. Why do I speak up as I do, as a non-smoker not owning any tobacco shares? Because tobacco, whether we like it or not, is a legitimate product. It is not the role of government in a democratic society to hound those who wish to enjoy tobacco and want to make a living selling it. The issue is young people. The whole industry supports the reduction in the numbers of young people smoking. It is a product for adults and it may shorten people’s lives. But when one looks at the obituaries of those who went through the last war, they all seem to have been 90-plus. And if passive smoking were really as dangerous as it is described, most of us in this Chamber would have been long gone. With 6 per cent of young people smoking—the figure is coming down and we congratulate everyone involved who provided education to make that happen—these proposals, if they were sensible, would be supported by all of us, I suspect. But they are not. The Minister mentions consultations. There are not as many as he suggests in terms of the proportion of people involved. Evidence from abroad is, sadly, distorted by the Government. The economic effect on small tobacconists’ shops is totally ignored. You can go into any small tobacconist’s shop, today or tomorrow, and you will see a huge sign saying that it is illegal to sell to under-18s—““No ID, no sale””. But we should remember that cigarettes make up 25 per cent of the turnover of a small tobacconist’s business. What purpose is there in putting cigarettes under the counter, restricting consumer choice? You cannot even see the pack warnings if they are underneath the counter. The alterations will cost a couple of thousand, not the £500 that the Government indicate. Why do the Government not understand the real world? Putting those packs under the counter will simply result in a huge increase in illegal importation. Already 27 per cent of cigarettes are illegally imported, and it costs this country £3 billion to £4 billion in lost revenue. There is talk of blank packs, but the Government cannot infringe the intellectual property rights of legitimate products. I shall be moving amendments in Committee, and I just hope that the Government will listen this time. My forecasts on the previous tobacco Bill were too modest. Those provisions have had a huge impact, not on a reduction in smoking but on a whole way of life with regard to the numbers of people employed and the enjoyment people have from a British pub. They have resulted in more smoking at home. Let us contrast that with what happens on the continent, where they have been a lot more sensible in allowing smoking rooms with air conditioning. Here, the existing legislation is not being enforced, with regard to proxy buying, for example, and support is not overwhelming for these proposals. The economic and social adverse effects are far greater than the tiny perceived gains.