Health Bill [HL]

I shall be brief, as I had not intended to speak at this point, but, having heard the debate, I felt that I wanted to come somewhere between the noble Earl, Lord Howe, and the noble Lord, Lord Stoddart. My first reaction is that I am very keen on principles being explicit in a Bill. I was anxious when I read this list and asked myself, ““What if they change?””. I suppose that we are saying that principles may not change. I think that principles in the health service are changing. As the noble Baroness, Lady Barker, said, the health service has changed during the past 60 years, and it will fundamentally change again during the next few years. There may be things that we hold dear and precious which through the next few years we want to hold on to and, for that reason, people may want some principles in the Bill to protect them. I agree absolutely with the noble Earl that the difficulty is that Parliament has not been able to debate the constitution, which is where the issues should be more clearly enunciated. Along with my noble friend, I think that there are serious omissions in the list. However, what has convinced me most today that these principles should not be in the Bill is the speech of the noble Lord, Lord Stoddart, which showed that, if they were included, we should spend much longer discussing detailed semantics than in the previous debate. For that reason, having principles on which many of us would disagree would lead to difficulty. Tomorrow, the House of Lords Select Committee of which I have been the chair will publish its report on cross-border healthcare. Some very interesting and controversial issues relating to payment, equality, authorisation and accessibility are in that document, which discusses the commission’s latest notice on this subject. However, it is important to recognise that other issues will come through, not only regarding the devolved nations—I agree absolutely with my noble friend Lady Finlay that we will learn from each other about different ways of managing health services through the devolved nations—but we are fast becoming much more European. Some of us may not like that, but it is a harsh reality. As borders fall, health services will change. My final point is about specialist services. The noble Lord, Lord Stoddart, talked about populations; the populations that concern me most are the small numbers of people who consume huge amounts of money, without which they would die. We have to hold on to that throughout our thinking. Equity and equal distribution are difficult concepts; postcode lotteries add to those difficult concepts and make principles difficult, sad as I am to have to say that.