Health Bill [HL]

On Second Reading I said that I believed we should have had a Royal Commission on the health service. I believe that we should have had it a long time ago so we knew exactly what the health service was about, what it should do, what it should cost, who should pay for it and what have you. But since we have not had a Royal Commission we now have the NHS Constitution and we have an amendment before us that we are now considering. I am old enough, of course, to have known Aneurin Bevan. He was kind enough to come to the Newbury constituency when I was fighting that hopeless seat to speak for me in the Corn Exchange there. I well remember that when he walked down the centre aisle, as he always did, he was jeered—and I also remember that when he walked out he was cheered. He was a great man and responsible for our present health service. I am not at all sure that he would have welcomed this handbook. Aneurin Bevan believed that the health service should be run by local people for local people and should be financed through taxation. I am not at all sure that he would have welcomed the centralisation of decision-making that has taken place over the years. All the research for the health service, or a good part of it, done by Bevan himself and by Beveridge, was done in the localities. The first thing that Harold Wilson said to me when I arrived at the House of Commons in 1970 was that he knew Swindon well; he had been the research assistant to Beveridge, who examined the system that the Great Western Railway put into position for its workers. The whole concept of the health service was one which, although financed through national taxation, was in the hands of local people for local people. But of course things have changed; one understands that. Because things are as they are, I said again at Second Reading that perhaps we have the second best with regard to rights and duties of people under the present National Health Service through this constitution. I do not know whether the amendment before us wants to build on the constitution or whether it is necessary. The constitution probably sets out what people can expect and what duties they have, as well as what the staff should do, how they should be treated and how they should treat others. I am not at all sure that we want another amendment to be added to the Bill. However, if we are to add it, it needs to be looked at again. There are phrases in the amendment that need to be tidied up. Proposed subsection (2)(a), for example, says that, "““the NHS will provide a universal service for all based on clinical need, not ability to pay””." The fact of the matter is that the NHS core principle is that it should be free at the point of use. Again, at Second Reading, I said that I believe that people should know how much they are paying for it. When people know that, they will demand a better service. The noble Earl might consider taking out ““not ability to pay”” and adding ““paid for by taxation”” so that people understand exactly where the money is coming from. When talking about the health service—which is a great service; do not make any mistakes about that—I often say to people, ““How much do you think you pay for it? How much do you think the National Health Service costs?””, and I am amazed at some of the answers I get from people who should be up to date with the costs of the health service. At a dinner—I do not often attend dinners but nevertheless I was at one—I was talking to someone about the health service and I asked him, ““How much do you think it costs?”” He said, ““Oh, £4 billion a year””. I said, ““Just go up a bit””. He said, ““Well, it must be £6 billion a year””. I said, ““You are still not there””. He said, ““Then it must be £10 billion a year””. I said, ““Would it surprise you to know that it is £100 billion a year?”” That really put him off his dinner. I said, ““You are paying for it. No one else is paying for it””. The other day I asked someone in the House of Commons how much the National Health Service was costing. He is responsible for raising the money, but he did not know; he thought it was about £50 billion. There is a need for people to understand how much it costs because I am convinced that if they know how much it is costing them individually they will press for a better service. It happens elsewhere; there is no reason why it should not happen in the National Health Service. I do not want to keep the Committee for too long but there are one or two other things that I really do not like about the amendment. The principle in proposed subsection (2)(d) states: "““the NHS will respond to different needs of different populations””." There is only one population in the United Kingdom and it is made up of British people. These people are not ““populations””, they are people. They may have different needs but they are part of the population. The Government, correctly, want to see integration and, if we are going to refer to ““populations””, particularly on the face of the Bill, we will be going against the policy of integration which the Government, as I have said, quite rightly want to pursue. The principle in proposed subsection (2)(e) states: "““the NHS will work continuously to improve quality services and to minimise errors””." Of course it will; that is its duty. That principle is simply verbiage. You do not need something like that on the face of the Bill. The principle in subsection (2)(g) states: "““public funds for healthcare will be devoted solely to NHS patients””." Who else will the funds be designated to? National health funds are for national health patients whether the services are provided in national health hospitals and other organisations or in private organisations, which seems to be an increasing possibility. I am not sure that the amendment is necessary. Finally, the principle contained in proposed subsection (2)(j) states: "““the NHS will respect the confidentiality of individual patients and provide open access to information about services, treatment and performance””." I agree with that, but I am not at all sure that it can be achieved by the £12 billion which is being spent on the centralised computer system, which seems to fall behind year by year and seems difficult if not impossible to achieve. I am also very worried, bearing in mind the loss of people’s data in so many government departments and elsewhere, that patients’ confidential records will be lost or leaked and seen by people who should not see them. I read in the newspapers—perhaps the Minister will give us some assurance on this—that patients’ records are to be seen by pharmacists, which would be outrageous. I hope that the Minister can assure the Committee and the country that pharmacists and pharmacies are not to have access to people’s medical records through the computer system. I hope in relation to the present plans for centralised medical records that people will be able to contract in and not contract out, because inertia often means that people suddenly find that their medical records have been leaked to someone, having not understood that they could have requested an exemption from having their medical records shared throughout the country. I appreciate that the noble Earl, Lord Howe, is trying to be helpful, but I am not sure that his amendment would help in any way. Perhaps he could think about it and reword it following our discussion in this Committee.