Health Bill [HL]

Perhaps I may raise a note of caution in relation to this amendment, based upon historical experiences. One or two minor political points have been raised from both sides of the Committee and, as a Cross-Bencher, I do not take any political stance, as I am sure the Minister will appreciate. However, I hark back to when I was a member of the Newcastle Regional Hospital Board in the late 1960s. In 1970 in Newcastle-upon-Tyne the board of governors of the Royal Victoria Infirmary, which had direct access to the Ministry of Health, as it then was, gave up its governors’ status and a new hospital management committee was created to embrace all the hospitals in Newcastle-upon-Tyne. It was a university hospital management committee made up of one-third university members, one-third health service staff of all grades and one-third from the local community. For three years, from 1971 to 1974, it functioned superbly. Along came the Conservative Government, with Sir Keith Joseph—later Lord Joseph—as the Secretary of State for Health. On the basis of a report from the management consultancy firm McKinsey, he introduced a system of what he called ““consensus management”” in the National Health Service. That produced a system of district, area and regional health authorities. Consensus management resulted in a process whereby the decision-making machinery absolutely and totally congealed. There was no way of reaching a decision. You had to go through 14 committees if you wished to appoint a new registrar, for example. The system was an unmitigated disaster. We struggled along for a few years—I was dean of a medical school at the time—before, a few years later, the Labour Government came in. Mrs Barbara Castle, later Baroness Castle, was then the Secretary of State for Health. She published a White Paper entitled Democracy in the National Health Service, which doubled the number of local authority members on the health authorities, the result of which—let us not be pejorative about it—was that the local authorities tended to appoint to the health service bodies not the most able and outstanding of local councillors but those for whom they could not find any other job. The result of that was that the decision-making machinery became worse, in that many of the members of the local authorities appointed to those bodies spent most of the time arguing for the health services in their local constituencies and the situation became disastrous. The noble Lord, Lord Stoddart, who is not here, called for a Royal Commission on the National Health Service. In fact, a Royal Commission was established under the late Sir Alec Merrison and reported in 1980. It at last did something to sort out the appalling administrative mess resulting from those various actions. Since then, the reorganisation of the health service has been so much better, but I merely wish to strike a note of caution. There are now many members of local authorities who are non-executive directors of health bodies of various kinds and make an outstanding contribution, but I want to make it clear that that experience did not enamour me of the idea of major involvement of local authorities in the organisation of the NHS. It is right that they should be involved, but they should not dominate the bodies concerned with NHS delivery.