Health and Social Care Bill

My Lords, I have for most of this Committee so far been listening to and reading what people have said and have been astonished, as I always am, by the immense amount of expertise and distinction there is in this House. There are all the professionals, and there seem to be more former Health Ministers in this House than in any other place that could be gathered together. Most of the debate so far has been about high-level, national-level principles and structures, and we are now moving on to the area that I have been trying to get my mind around since I first obtained a copy of this extraordinarily huge Bill. That is the new structures that are being set up at all levels and how they are all going to work together. At Second Reading, I laid some claim for my party for some of the improvements that were made to this Bill after the pause in the House of Commons, but one thing that certainly happened to the Bill after that pause is that it became more complex as the number of different organisations and bodies became greater. The need for this House is to sort out how this new galaxy, or kaleidoscope, of new bodies within the health service are going to relate to each other and how it is going to work—I use the word ““work”” in a neutral sort of way—how it is going to happen in practice and how they are going to relate to those bodies which continue to exist, such as the hospital trusts, the PCTs, the strange clusters of PCTs that will stagger on for a certain amount of time and then disappear by some means that is not completely understood yet and, of course, local authorities and the whole of the voluntary and private sector involved in healthcare. I was interested to hear the comments of the noble Lord, Lord Harris of Haringey, on HealthWatch and its relationship at national level—and, indeed at local level—to these other bodies. That is an important issue which I hope we will go on to talk about before long. The Committee is beginning to bring expertise and experience from all sorts of personal levels to the debate, not just political stand-offs. That is what we should be doing. Personally, I support what the noble Lord said about the importance of HealthWatch being sufficiently independent and detached while also being able to be present at the table at all levels of bodies and at the national Commissioning Board, without necessarily being part of the collective responsibility for decisions. Noble Lords may want to think carefully about that principle. We will no doubt come back to it when we talk about HealthWatch specifically. There has also been discussion of the question of having a public health professional on the national Commissioning Board. This raises questions, which we will come to fairly soon when we talk about Clause 8, on the different ways in which the public health functions of the health service are to be dealt with compared with its clinical commissioning functions. In Clause 8, the public health functions of the health service are in future to be mainly divided between the Secretary of State, who will keep direct responsibility in this area, and local authorities, which will have enhanced responsibilities for public health and entirely new ones—though in many cases they regain functions lost in the 1974 reorganisation of local government. I have not yet got my mind round what the function and responsibility is of the national Commissioning Board in relation to public health. How will that work? Whether a specific public health professional should be required to be on the national Commissioning Board may depend on what the functions are of the NCB in relation to public health. It is impossible to put a clear dividing line between public health and clinical health issues. They overlap and are obviously incredibly interconnected. Nevertheless, how the administration will take place in future raises these questions. They need to be thought about carefully before a final decision is made on whether there should be public health representation on the national Commissioning Board. The particular amendment that I wanted to speak to before I started listening to the debate—which is always fatal: you should never do that but just stand up and say what you wanted to say—is Amendment 153ZA, presented to us by the noble Lord, Lord Hunt of Kings Heath, which goes under the beguiling title, ““Duty to reduce bureaucracy””. I could not help an ironic smile at that and could not help wondering why, if the noble Lord is so keen on that, he did not do a bit more to assist in it when he was a Health Minister. Perhaps that is an unkind thing to say—perhaps he did.