Health and Social Care Bill

My Lords, I had not intended to participate in the debate because I did not arrive until it had started, but I have been here a long time now and want to share with people how it feels on the ground. What the noble Baroness, Lady Cumberlege, said is absolutely true. I do not envy the noble Earl because I think that the analysis that the noble Lord, Lord Darzi, gave is exactly how it feels. There is that dilemma. The noble Baroness congratulated us on now having a decision from the Secretary of State. We do, but the decision is bound up in another clause, which brings about another kind of action that we must take. It has not removed anything; it has just given us another dilemma and delay in what we must do. I say to the noble Lord, Lord Mawhinney, that I only wish that everybody in his position did what he did. Though I have five years of experience, I am not medically qualified; I am just somebody who cares about the people that I have responsibility for as the chair. My experience from those years was often of political interference. I ask noble Lords to forgive me for being emotive about this, but it is absolutely true. We had consultation for many years, authorised by the independent review body. The Secretary of State at the time, Alan Johnson, said, ““Whatever the review body says, we will go with it””. That was perfect. Then we had a hold-up and a change of government. The new Secretary of State, Andrew Lansley, then came to our trust and said, ““This isn’t going to happen. We want people on the ground to be able to say, ‘Yes, if I want this service, I can have it here, and, yes, if I want my baby here, I can have the baby here’””. Both those services were questionable in terms of their clinical reliability. They were not unsafe, because we would not be doing it otherwise, but certainly questionable. And so we started all over again. A year later, we have gone through not a consultation but the four tests, where the clinical members of the local authority team went through the same process as was involved in the previous consultation—is it clinically safe or is it not? It took a year or so for the Secretary of State to come back with another response to that. That was another stall, until, just a matter of weeks ago, we received a letter from the Secretary of State addressed to the local authority—because it had put the case to him—which said, ““Yes, I think that the BEH strategy should go ahead, but, actually, I think that you should consider other things as well””. Those things cut right through the BEH strategy. Local MPs are very open about the fact that they have interceded and expressed their views. They are very proud to say, ““I’ve spoken to Andrew about this and I’m not going to have that””. This goes on all the time—I am not sure that this is inappropriate language to use in this House, so I ask your Lordships to forgive me if I am saying things that I should not; I am just trying to tell you what it feels like as somebody who is working in the health service on behalf of patients. That is how it feels. I do not know whether political interference by the Secretary of State, as I see it, can be removed by having the national Commissioning Board make the decisions, because my view would be that MPs will always go to whoever can make an intervention in Parliament. That goes for MPs from all parties; it is not about the present Government. I do not envy the noble Earl in the decisions that he has to make about this, but the view of the noble Lord, Lord Darzi, is very much attuned to what I see in reality. There is a dilemma; there is that interference. But, on the other hand, there are major decisions that have to be made that can be made only by the Secretary of State in the sense of his or her national perspective. I have no words of wisdom, but I have a lot of feelings. Please can we get this right?