Health Bill [HL]

I hope that the amendment’s purpose will be immediately understood by the Committee. It is to suggest to the Government that the question of how much or how little of the NHS Constitution should be reflected in the Bill can be settled in a more satisfactory way than that which the Government have chosen. On looking at the available possibilities, there are two extremes at either end of the spectrum. One would be to place the entire NHS Constitution in the Bill. The Government have rejected that option for the perfectly understandable reason that it would ossify the constitution in primary legislation. The other extreme is not to include any of the constitution in the Bill. Ministers have opted for that course, ostensibly because they wish to leave scope for the constitution to be revised and amended from time to time without having to refer to Parliament. The problem with that option is that it will leave the law saying nothing about what kind of declaration the NHS Constitution should be. We are in a situation where Parliament is given no say in fashioning or shaping the constitution, even in the most general terms. That, to say the least, seems odd when the separate statement of NHS accountability, which the Government have published, makes it clear that at the national level the Department of Health is accountable to Parliament. Where is the accountability here? The NHS Constitution, as we heard in the preceding amendment, was written, signed off and published in an exercise that was completely detached from the parliamentary process. Given that we are dealing with a document of such apparent significance for the health service and for patients, I am disappointed and uncomfortable with that approach. The other problem with the resounding silence in this part of the Bill is that it carries with it the implicit assumption that there is nothing in the nature of an enduring or universally agreed statement of values that will serve to underpin the NHS Constitution over the long term. If there is literally nothing that we want Parliament to say about the values and core principles of the NHS, what message does that send out about the reliance that people should place on that document? It is as though the Government are saying that not even the principles on which the NHS is founded can be set in stone, lest they might in the future have to be changed. Hence, I have tabled the amendment. Its purpose is to suggest that there might be a sensible halfway house between the two extremes I have referred to. What we should try to do, indeed what we owe it to the country to do, is to encapsulate in the Bill those core principles without which the NHS would not be the NHS that we want it to be, and without which any constitution, to put it bluntly, would not be worth the paper it is written on. The set of principles I have included in the amendment are those that were articulated and agreed nine years ago in the NHS Plan. They are not my words, although I think that they are very good words. As in 2000 when the great and the good of medicine appended their names to the preface of the NHS Plan, they are principles with which no one will take serious issue. Interestingly, the amendment contains two principles that are not explicitly included in the NHS Constitution: first, that the NHS will support and value its staff, and, secondly, that public funds for healthcare will be devoted solely to NHS patients. Why does not the constitution expressly repeat these two core undertakings from the NHS Plan? We see in the constitution seven principles that, "““guide the NHS in all that it does””." The third principle refers to the NHS aspiring, "““to the highest standards of excellence and professionalism””," and staff are mentioned in that context. However, ensuring that staff achieve high standards is not the same as saying that those staff will be supported and valued. You have to turn to section 3a of the constitution to find anything resembling the words ““support”” and ““value””, and what you do find is expressed only in the form of a pledge and not a core principle. Why is that? As regards public funds for healthcare, we see a slightly weaselly version of the principle in the NHS Plan. Instead of an undertaking that public funds will be devoted solely to NHS patients, we see that public funds for healthcare will be, "““devoted solely to the benefit of the people that the NHS serves””." What is the significance of this change of wording? What other groups of people are embraced by the phrase, "““the people that the NHS serves””?" It seems to me a potentially much wider cohort than simply NHS patients. Therefore, my questions to the Minister are twofold. First, do the Government still subscribe to the core principles of the NHS Plan, and, if so, why have these not been transposed into the NHS Constitution? Secondly, if we agree that the core principles of the NHS Plan are good and enduring, will he agree to consider including them in this Bill as a means whereby Parliament can both endorse the constitution and warrant to the public that the values underpinning it are not ones that Governments of whatever political persuasion will tinker with? I beg to move.