Health and Social Care Bill

But I did subscribe to it. There is a sort of collective responsibility on these Benches, too. This is a probing amendment—it could hardly be anything else in the circumstances—that tries to deal with what actually constitutes the health service. Of course, this phrase runs through the Bill but there is not within the Bill a definition of what constitutes the health service, let alone ““a comprehensive health service””—the words used in Clause 1, which we will be returning to on Report. The amendment seeks to add to Clause 1(3) and the intention is to reflect Section 3 of the 2006 Health Act, which laid out clearly, to a reasonable extent at any rate, the scope of the Secretary of State’s duties. The Secretary of State was obliged to, "““provide throughout England, to such extent as he considers necessary to meet all reasonable requirements””" broadly six categories of service, amplified in Schedule 1 to the Act by more detailed requirements around medical inspection for pupils at schools and issues of that kind. It clearly is impossible to lay down in legislation everything that might be brought within the purview of the Secretary of State or indeed any other body for the purposes of defining precisely what a national health service should be and what would constitute a comprehensive health service. Clause 10 in any event transfers some of those responsibilities to commissioning groups, as the noble Lord, Lord Marks, has pointed out, but it is not entirely clear from the clause, to put it mildly, what functions will be included in their responsibilities. The implicit suggestion in the amendment is therefore that at some point it would be helpful to have in the Bill not an exhaustive list, because that would be impossible, given the changes in medical needs and indeed in medical treatments, but an indication of which areas of responsibility for health should be prescribed as areas in which decisions must be made and policies and services delivered by whomever the Bill ultimately vests those responsibilities. The need for that, subject of course to the further discussions and debates that will ensue upon the Bill, is enhanced by the possibility—I put it no higher than that—that at the end of the day we might have not so much a single national health service but a series of services that are connected, if you will, and for which ultimately there will be responsibility at some level as yet to be determined, rather than a simple broad national agenda. In any event, it would clearly be wrong to make a provision that would restrict the service to any particular list of functions laid down at this time. It would need to be possible to extend that list to meet changes in circumstance, and that would clearly be a necessary condition of any move to create a more visible account of what the service should be about. We on this side of your Lordships' House are certainly looking to see the National Health Service as a comprehensive national service that is comprehensive in the sense of being accessible to all citizens but not necessarily providing every conceivable medical treatment for every conceivable medical condition.