Health Bill [HL]

When I saw the amendment, it sparked the following questions in my mind: what happened in 1948? What were the core principles of the NHS that its founders believed should be stated and should endure? Was there a document in 1948? As far as I have been able to research it, there never was, which seems very strange when one considers the magnitude of the task which those brilliant men and women set for themselves; namely, to institute a comprehensive health service the like of which had never been seen. I have not been able to verify it, but I understand that the reason was that Winston Churchill decreed that, were there to be a set of principles for the NHS, they would be so general as to be meaningless. That thought led me to ask whether, 60 years on, we need some principles. I rather think we do. I am not sure that these principles are even those that the noble Earl, Lord Howe, if starting from scratch, would have arrived at. However, we need some principles, because, 60 years on and in the light of our experience and the policy and legislative developments over that period, there is now a body of evidence about what brings about change and progress within a national health service. I have spoken in the past three or four months about what I see as the looming issue for all of us, on whichever side of the House we sit, which is the grim prospect for public services expenditure over the next few years. I do not wish to be partisan in any way, but the question of public service expenditure will be top of the agenda for any Government of any hue. In light of that and what we have learnt in the past 60 years, it may be time for us to go back to establish what should be some founding principles of the NHS and be safe in the knowledge that any list of principles now exists within a context of the development of a body of policy, a context of clinical practice and expectation and a context of patient expectation. I perhaps take a slightly different view from that of the noble Baroness, Lady Finlay of Llandaff. Within the devolved system of the UK it is legitimate that we should begin to have different national health services which meet the needs of different populations. That said, I should be interested to know what should be the enduring principles that go across all four Administrations. For the future, there is a very interesting task to be done, which is to have a full consultation about what the enduring principles of the NHS might be. I said at Second Reading that the question of how patient data was used had been overlooked in the Bill. That has been an ongoing problem, probably since 1948, which has never properly been resolved: how do we deal with the conflicts between the need for individual patient confidentiality and the need to generate population data in order to facilitate research? That is a big question that, 60 years on, we could and should look at in an open way. I have a great deal of sympathy with what the noble Earl, Lord Howe, is trying to do. I am sorry that I have to direct my questions to him as the author of the amendment, rather than to the Government, but he has hit upon an issue—perhaps in not quite the right way—which is the gap at the heart of the NHS about what its principles should be in this day and age, and for the future. The idea should be taken forward in a slightly different way.