Health and Social Care Bill

My Lords, I have not seen any evidence from MORI or any other polling organisation that has put that question to the public, so it is left in the air. I have seen the MORI poll that very recently showed that 88 per cent of people who were questioned said that doctors were the most trusted profession to tell the truth, whereas only 14 per cent thought that the truth was told by politicians. I think that is really sad—sad for democracy and sad when it comes to trying to build the confidence of people who are in charge of the National Health Service. One real problem, which exists even if the same party is in power for a length of time, is a lack of a consistency of leadership. The Secretaries of State are here one minute and gone the next. Really successful organisations—I am thinking of schools, hospitals, companies—benefit from continuity in leadership. I read the other day that Sir Alex Ferguson has been in charge of Manchester United for 25 years. If we had had that inspiring leadership for a real length of time, I wonder what difference it might have made to the NHS. Since 1997 we have had seven Secretaries of State. Frank Dobson was in charge for 17 months. Alan Milburn, the longest serving Secretary of State, served for four and a half years and some might think that he was the most successful. At least he had time to draw up the NHS Plan, which made an impact on the service and he had time partially to implement it. John Reid—now the noble Lord, Lord Reid—Patricia Hewitt and Alan Johnson all served two years, and Andy Burnham less than a year. Those of us who have served in government know, as Ministers, that you take up your post with enormous enthusiasm and unrealistic aspirations. You want to do things. Above all, you want to improve the NHS. You believe that you are in charge and that you can set policy. But, no, the first thing that happens is that you inherit the policies of your predecessor, which are not your policies that you know and love. They are not yours, but you do your very best to implement them. Then you have a chance to set your own policy but, before you have had time to implement it, you are off again. In the mean time, you are expected to make some very courageous, unpopular decisions about institutions that you may know very little about and about people whom you have rarely met. So how do you exercise judgment and build relationships when you are there for such a very short time, possibly just two years? That contributes to an NHS that gets confused and fed up and is mistrustful of its masters. The NHS Confederation, the organisation representing chairs, non-executives and managers, has stated in its briefing for the Bill: "““Providing the Secretary of State’s overall accountability is clear””—" on which your Lordships are working at the moment— "““we strongly support these clauses as they should discourage unnecessary micro-management of the system. For example, political interference on previous decisions to reconfigure services has in some instances led to significant delays in the process which can only damage patient care””." Having listened to the noble Lord, Lord Patel, I followed this up and asked the confederation for some examples. Many of us know them: Chase Farm, the south London reconfiguration and a number of others. The noble Baroness, Lady Wall, who is in her place, is the chair of Chase Farm. After years of dithering and of advice that it was an unsafe place to be treated, she has now almost resolved the problems, and I am delighted. The response from the confederation was: ““How many examples do you want? We have so many and they cross all three political parties””. I can quote examples where herculean efforts have borne fruit in that the public, staff, clinicians, the media and others involved have agreed to a change in service only to find that the party-political systems have overturned those decisions, in one instance—and I know it well because I was a regional chair at the time—overnight. I am sure that the noble Lord, Lord Hunt, will say to me—because we have had similar debates to this in the past—that individual MPs who are rightly concerned about local facilities and may not agree with the decisions that are being taken will represent their views not only to the NHS Commissioning Board, which will be their right, but also to the Secretary of State and Ministers. That is part of the democratic process and, quite rightly, Clause 4 does not stop that happening. But what Clause 4 does is give the Secretary of State an opportunity to exercise his duty to promote autonomy and resist the temptation to meddle in and micromanage the NHS when he feels it appropriate so far as it is consistent with the interests of the health service. In my early days, when I was working in the NHS, I felt that there was much more trust in governing boards. To be honest, I do not think that the calibre of members was any higher at that time than it is now, but when people asked the Department of Health to intervene, the stock answer was always: ““This is a local matter””. Knowing that there was confidence in our judgment made a huge difference to us in reaching decisions and implementing them, and to our willingness to take a bit of a risk and innovate. It was no accident that the White Paper setting out the philosophy for the Bill was called Liberating the NHS. We should not be timid in allowing liberation: indeed, I think we should encourage it. I am confident that when we have worked through these issues on the Secretary of State’s accountability, as suggested by my noble friend, that will come into place and be much clearer. However, I am concerned that in negotiations we do not lose the spirit that is in Clause 4, and that we protect the NHS from the whims and wishes of politicians to meddle, micromanage and maul the NHS to its undoubted detriment. I am, therefore, seeking an assurance from my noble friend that he will safeguard the spirit of liberation that is contained in this and related clauses. When he negotiates with noble Lords in seeking an agreement on the Secretary of State’s powers of intervention, I hope he will hold on to this very important principle: to allow managers to manage and to ensure that, although the democratic process takes place, we have enough safeguards to enable those who are really determined to make and implement decisions to do so. We must ensure that they will be much more free to put into place what they know is right on the ground, and that we do not lose that spirit.