Health and Social Care Bill

These amendments have presented your Lordships’ House with a very difficult task. I join others in paying tribute to my noble friend the Minister, my noble and learned friend Lord Mackay, and to the noble Baronesses, Lady Thornton, Lady Williams and Lady Jay, for the wisdom they have shown in proposing to withdraw their amendments today. I shall take just a moment or two of your Lordships’ time, if I may, to say why I think these amendments present the Committee with such a difficult task. The point was made by the noble Baroness, Lady Jay, in her speech last week. The central feature of this part of the Bill is to transfer, by Clause 10, the duty under Section 3 of the 2006 Act to provide the specific services carried out by the NHS from the Secretary of State to the commissioning groups. The challenge that we now have to meet is to achieve a balance between ensuring a decentralised structure and retaining a truly National Health Service for which the Secretary of State has ultimate responsibility. Given that transfer of provision, what the Secretary of State has to do—and all he can do—is to exercise his functions specifically accorded to him by the Bill. He has to exercise them in such a way to ensure that services are provided, however Clause 1(2) is ultimately worded, and to fulfil his duty under Clause 1 to promote a comprehensive service. That is why the crucial task of this Committee is to look at those functions and ensure that his functions and powers are up to the task and meet that balance. A further point that I see as being of considerable importance are the proposed duties to provide autonomy by the Secretary of State under Clause 4 and on the board under the new Section 13F introduced by Clause 20. The problem is that the autonomy provisions in the Bill threaten to undermine the Secretary of State’s primary duty to secure the provision of services. We have to deal with what is at best tension and at worst inherent conflict between the Secretary of State’s overall responsibility, however expressed, and the duties to promote autonomy. That conflict must be expressed when we come to it, whatever we do about Clause 1(2). I have some confidence that your Lordships’ House and the department will be able to achieve consensus and I remind your Lordships that not only have we heard from Labour, Liberal Democrat and Cross-Bench Peers in favour of amending the Bill as presently drafted, we have also heard from my noble and learned friend Lord Mackay and from the noble Lords, Lord Newton and Lord Mawhinney, both former health Ministers, who yield to no one in their commitment to and understanding of the NHS. There remains much to be done but I suggest that there is reason for optimism that we might achieve a resolution of all these issues that is effective in helping to secure the future of the health service.