Health Bill [HL]

I am in serious danger because I forgot to declare my interests—I may feature in the Guardian tomorrow. I should declare that I am an executive director of Cumberlege Connections Limited, which is an organisation that concentrates on training. The noble Lord, Lord Walton, was talking about history. I remember chairing social services for a county council; I then became a district and regional health authority chair. In those days, I knew where the overlaps lay. I also knew where the voids between health and social services existed. I liked local government because it had a rigour about it. Knocking on 1,000 doors every four years is very salutary, especially when the resident goes in, reaches behind their clock, takes out your previous election manifesto and quizzes you on the promises that you made and broke. The NHS lacks that rigour, that local democracy, and so it has to seek other mechanisms. It compensates for it with a whole cat’s cradle of different regulations of targets, accountabilities, standards, carrots and sticks. It needs that to ensure that it performs and that the Government can see where their public money is being spent. My experience was a long time ago, but at the moment I am dealing weekly with local government and the NHS. I am not sure that an awful lot of progress has been made in knitting the two organisations together in the intervening time. Thirty years ago, I remember, we coined a phrase ““a network of care”” and professed our intention that needy people be caught by that net so that they would not fall between the two services. I am not sure quite what happened to the net, but I do not think that it really worked. Later on, we talked about a ““seamless service””, and we still do. We are anxious that people do not fall between the seams, but I am not sure where that has got us either. As the noble Baroness, Lady Barker, said, we need to strengthen the accountability in the NHS; we need to strengthen joint working with social and social care services. The overview and scrutiny committees have been a brave attempt to do that. From talking to the people who have been before them and who have run them from local government, I believe that in some places they are really working very well. The local authority is thoughtful, knowledgeable and constructive in its criticism of the NHS. In other places, the local authorities have proved to be ill informed, overly political and destructive, and have jeopardised any sort of joint working. But this is early days. We have a lot to learn from each other, to spread good practice. On commissioning, I think that the NHS has a lot to learn from local government, which embraced commissioning 25 years or so ago. I know that some joint commissioning is being trialled and I hope that will prove to be fruitful. However, I have a bit of a problem with the amendment. Although I absolutely support the intentions behind it, I am not sure about the last part of the amendment where it refers to, "““accountability to the local community through democratically elected councillors””." It is the word ““through”” that could raise a lot of problems. I should be interested to hear the Minister’ reply to the amendment. I share the sentiment behind it, but it may not be quite the way forward.