Health Bill [HL]

I apologise to the Committee for not being at Second Reading but I was out of the country. I apologise to the noble Earl, Lord Howe, for missing the beginning of his remarks but I got the thrust of his arguments when I came in. He will not be surprised to hear that I am opposed to putting principles of this kind in a Bill unless it is absolutely necessary—I have made many speeches on that. There was more of a case with regard to the Mental Health Act, as it became; we were trying to change, quite fundamentally, pretty ancient legislation 25 years after it had been framed. There is not a strong case here. Not content with constructing a constitution, we have a handbook on it as well, both of which can be amended over time as circumstances change. The original authors of the NHS legislation—its founding fathers, if you like—were wise. They said that the Secretary of State would be under a duty to provide a comprehensive health service in England and Wales, as I recall, with a stony silence on precisely what ““comprehensive”” meant. That turned out to be very wise of the Labour Government of the time because three years later they had to introduce co-payments, which we call ““prescription charges””. That is what they had to do at the time of an economic crisis. Circumstances change and Governments have to respond to them. With the NHS now taking a very large chunk of the public finances, we have to be wise about not putting primary legislation on the books that unreasonably ties the hands of future Governments when dealing with the economic circumstances that they face. This set of principles has a lot of flaws, which were elegantly and eloquently described by the noble Lord, Lord Walton of Detchant. A big part of the NHS’s job is to provide the education and training of the next generation of doctors, nurses, scientists and other professions. Increasingly, its R&D role is incredibly important. With all the advances that we see in medical technology, it is important that the NHS plays its role in that area. I am all in favour of taking wonderful Labour documents and enshrining them in legislation. The NHS Plan for 2000 was a wonderful document, but a document of its time. It did not say much about choice and competition. After that, choice and competition were introduced, and for a purpose; choice was certainly now a major part of the agenda, not just in the NHS but in the way that modern Governments respond to their citizens’ needs in the way they provide public services. Choice is an important issue for the future of the NHS. We have moved on in many public services to accept a mixed economy of providers. Whether we like it or not, that is the world we live in. You could argue that we have always had mixed service providers in GPs, who are small business men and women from the private sector, so there is nothing very new about it. These are important issues, though, and the way that the amendment is framed, in terms of principles in primary legislation, would make it difficult for Governments to respond to changing circumstances and changing needs of societies. Often Governments make changes in something like the NHS because societies need change and they want, rightly, to be able to respond to that. These principles are too restrictive. I am afraid that while I understand the noble Earl’s thinking, and I have a high regard for him, those principles would tie us into a set of restrictions. If I were being unkind politically, I would wonder whether this was a picture of the NHS that a Conservative Government would bring before us—basically, the NHS Plan circa 2000.