Health Bill [HL]

This amendment is designed to highlight an anomalous fact as regards this part of the Bill, a fact to which I referred earlier, which is that Parliament is being asked to enshrine ““regard to the NHS Constitution”” in primary legislation, but at the same time has no present or prospective opportunity to consider the contents of that constitution. This is not just an academic objection. In the end, what it means is that the rights of patients and staff in the NHS are whatever the Secretary of State says they are, not what Parliament says they should be. In this sense, Parliament is being asked to sign a blank cheque to Ministers, whether of this Government or of a future Government. Bearing in mind how seminal a document and how far reaching in its effects the constitution is meant to be, I find that troubling and difficult to accept. The Minister may reply that the Secretary of State is accountable to Parliament in all that he does, which is certainly true. I accept—how could I not?—that it would be completely impossible for a Secretary of State to refer to Parliament before implementing each and every executive decision that he takes. He has to be allowed to get on with his job. However, the constitution is different from an ordinary executive ministerial decision. It is meant to underpin for the long term everything that the NHS does and a great deal of what Ministers are able to do or not to do. With each right that the constitution defines or creates, it shapes ipso facto future health policy. Are these not matters which Parliament should be given an automatic opportunity to scrutinise? One has only to think of the right to choice that the constitution enshrines for the very first time to appreciate that these are in no sense trivial matters for health policy. However, according to the Bill, Parliament is out of the frame as regards approving the document. The Government have published a separate statement of NHS accountability which makes considerable play of the fact that Ministers are accountable to Parliament. The NHS Constitution itself states, near the beginning, as part of the seventh key principle that, "““it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation””." That is true up to a point, yes, but surely not totally. We do not say that it is up to the Government to set the framework for the NHS in any way that they want. They cannot, for example, invent foundation trusts or abolish a health regulator without first obtaining the approval of Parliament. Parliament has a role in defining the framework for the NHS. Equally, some ministerial decisions have to come before Parliament in the form of a statutory instrument and cannot become law unless and until Parliament has signified its approval or absence of disapproval. The question for us is whether the NHS Constitution is of a kind which merits some form of nod to the sovereignty Parliament or whether it is not. I have to say that I think it is. The Minister has previously argued that he does not believe it is appropriate to include any element of the NHS Constitution in the Bill. We can continue to discuss that. However, the amendment proposes something much more modest. It is merely saying that once the constitution has been revised, a copy of it should be placed before Parliament. That duty of placing it before Parliament ties in the legislature, even if only in a loose way, to the content of the constitution. I do not think that this is a great deal to ask. I beg to move.