Health and Social Care Bill

My Lords, I agree considerably with the suggestion of the noble Baroness, Lady Thornton, that some of us might have a sense of déjà vu about the setting down of a list of principles pre-Clause 1. She is right that it is what opposition parties tend to do—and the response, as the noble Baroness, Lady Morgan, pointed out, is that Governments tend to resist them. Her Government were no different from how I suspect the Minister will be in this respect. However, I hope that when Liberal Democrats and Conservatives in the past put down such amendments, they were a little more careful about the wording. As a number of noble Lords who are susceptible to the notion of a statement of principles pointed out, the statements before us are not very well put. The first states that the health service, "““must have regard to the principles and values outlined in the NHS Constitution””." I have no doubt that if this had come forward as a government proposal rather than an opposition amendment, the Opposition’s place would have been so say, ““Only having regard to the principles and values? What about all the other aspects of the NHS constitution? Will they not be set aside now that we have a subsequent piece of legislation?””. Legally, that would be a perfectly legitimate point. The second one identifies a number of principles—quality, equity, integration and accountability —and then speaks of the market, which is not a principle at all. It is a mechanism, as my noble friend Lord Ribeiro rightly said. Indeed, the noble Baroness then pointed out that actually a little care was lacking in the setting down of the original words. If a statement of principles is needed, and there may well be a case for it, we have to be very careful about what we set down. If it is the case, and it may very well be, that the noble Baroness has set this down, as one often does in Committee, not in order to press things to a vote but to press the Minister for a response which may then issue forth to something further on Report, I would not want to press my comments any further because that is a completely legitimate thing to do. However, if one was to seriously consider that some of these words came from a political notion or speeches at anybody’s party conference and that does not necessarily make them appropriate for a piece of justiciable legislation, that is of course a wholly different matter. The noble Lord, Lord Owen, who never speaks more passionately than when he speaks about the health service, has rightly drawn our attention to important matters of concern when it comes to dealing with commercial requirements, as is inevitably the case in the National Health Service. As he quite rightly says, and with an interest which he has announced, the pharmaceutical companies are not National Health Service companies, they are commercial companies. It is true that no matter what you do there is going to have to be an interaction and an engagement. He raises the question of how could a single clinical commissioning group hold to account a major multinational pharmaceutical organisation, and he is absolutely right. That is not where it would be done. It is for the national NHS Commissioning Board to set down tariffs, and if it sets down tariffs at an appropriate level that gives a modest return but no big cut to any of these international healthcare organisations, I think you will find that they will not be half so interested in engaging for business as some noble Lords fear. I understand that there are always a lot of fears around when we talk about our health system and healthcare. We are here to try to consider it as dispassionately and as reflectively as possible. I encourage your Lordships, whenever we look at any change to the National Health Service, not to jump to the conclusion that the only other model is the healthcare system in the United States of America, nor that we have nothing to learn from any other healthcare systems anywhere else in the world. Some noble Lords have mentioned their adverse experiences in the United States. Indeed, I have had those experiences too. On the contrary, my experiences in the French healthcare system are extremely positive and sometimes rather better than my experiences in the National Health Service within which I worked, as do many members of my family. We need to be careful that we do not shut out light from other quarters where it is genuinely light and we do not get panicked by suggestions that the only alternative is the United States healthcare system that neither we here nor many people in the United States, including the President of the United States, think is a particularly good system at all. We are in Committee, and if this amendment has been put forward in the spirit of Committee—not as something to vote upon but to press the Minister on—I think many of us will have some sympathy with that and perhaps something more suitable will come back at a later stage. However, one must agree that it is not suitable to go into the Bill, certainly in this form.