Health and Social Care Bill

My Lords, I rise first to express my regrets to the House that, ironically for reasons connected to an NHS commitment, I shall not be able to be present for a lot of our proceedings later on. Secondly, and related to that commitment, I should declare my interest as chair of the Suffolk Mental Health Partnership NHS Trust Board. Thirdly, I do not seek, nor am I qualified, to follow the three speeches that have preceded mine: I refer to the detail into which the noble Baroness, Lady Thornton, went, the important legal points of my noble friend Lord Clement-Jones, and the many of the points which the noble Lord, Lord Owen, discussed. I have a good deal of sympathy with many but not all of the points that each of them made and I hope that they will be carefully addressed by the Minister when he comes to wind up. My purpose, however, is rather more limited and pragmatic. I say to my noble friend the Minister that I would not reject out of hand the interpretation and explanation of context that he gave in the early part of this debate. I think that there are questions that still need to be answered, as has been made clear, but I am prone to give him the benefit of the doubt on the general approach that he outlined. I particularly welcome—it is very important, given the uncertainties that we all face about the import of this Bill, underlined by the noble Lord, Lord Owen—that my noble friend gave some clear indications of areas where he thought clarification was possible and where he would give serious consideration to some of these amendments. In the light of that, I would be disinclined to try to shoot him down today, but I would not be disinclined to shoot him down—or try to shoot him down, at any rate— if we do not see some changes and improvements related to these concerns before the Report stage. I would like to make a few pragmatic points. First, we ought to acknowledge that what is in this Bill about Monitor is a lot better than what was the previous legal situation about Monitor, where the Secretary of State had no power to intervene at all. I will come back in a different way in a moment to what Monitor took into account, but we should recognise that there are already some signs—and this relates to my experience—that Monitor has got some of the message that is emerging from this debate. I refer back to my own personal interests and experience. I have been chair of two trusts, which have been through the Monitor process. The first of them—the Royal Brompton and Harefield—did happily become a foundation trust after I had become time expired as its chair. The second one—the one I chair at the moment—was in the process of trying to become a foundation trust at the time. Indeed, I was told when I was recruited for it that my task was to get it to be a foundation trust. For reasons I will not go into, that did not prove possible and we went down a different route. My observation—it is related to my comment just now about Monitor—is that in the intervening period there had been a sharp shift in Monitor’s attitude. When I first embarked on this, there was a clear feeling—Bill Moyes, the previous chairman would not thank me for saying this—that all that mattered was the money. Bill Moyes would have denied that, but I can only tell you that that is what it felt like. Then came Mid-Staffs and the whole situation changed, as I judge it, for the better. Patient safety and quality and all those issues began to be as important, if not more important, than the financial ones—not that the financial ones are unimportant. At any rate, I come back to the story and the plus point for Monitor. Once we had decided at SMHP that foundation trust status of our own did not look likely, we decided that the best bet was merger with the neighbouring trust, Norfolk and Waveney, because East Anglia is a coherent whole, with all sorts of synergy and the rest of it—I will not go into the arguments. So we set about getting together with them as a joint venture. The rhetoric was merger: the legality was acquisition. They were an FT and we were not— I will come back to that point in a moment as well. I have no way of describing to the House just how difficult that proved and how many obstacles were planted in the way by the process. We were advised that acquisition was simpler than merger, which is one of the reasons we went for it. I can only say that if the Minister wants to get the many remaining trusts that are not FTs into FT status through mergers, he is going to need to make sure that it can be done more easily than was the case in the one of which I have experience. If acquisitions are easy, mergers must be a nightmare. We originally wanted to merge last April. We have not yet merged and are now due to merge at the turn of the year, the Secretary of State willing but I believe he has signed the orders. That is very nearly nine months later than we intended. It has been attended by all sorts of certainty, uncertainties and difficulties for morale and the service. Why? Not because it was not supported by the PCT, the SHA, the department, the two county councils, everybody, but because the Co-operation and Competition Panel issued an adverse report in the early part of the year which threw the whole process back by at last six months and, in my view, was adverse to the interests of patients. That is a tendentious view; they probably would not agree but that is my view. The good point for Monitor, backing up my earlier point, is that almost exactly two months ago Monitor came to a decision, taking account of all the factors, including the opposition of the Co-operation and Competition Panel, and it overruled the panel on the basis that the interests of patients suggested that the merger was sensible and right and should go through. That validates my suggestion that there has already been some learning. I now come back to my other general points against the background of that experience. The most important point is that we need to be as sure as we can that patient quality and safety is given the real priority it deserves, whatever the detail of this legislation may say. That is nowhere more important than in mental health, where it is so easy to disrupt the care pathway that is now the basic way of approaching the treatment of mentally ill people. I know from my own experience that if you have different bits of care being provided in different ways by different packets of service, there is the risk of disaster if they do not all know what is going on. You need an integrated care pathway to deal successfully with these problems. So, while I have no problem in principle about competition and even less so about choice, I think it is important that where there is any doubt about which factor is going to be paramount, it has to be patient safety and quality not competition that wins the day. I hope that is what I will be hearing in the course of my noble friend’s wind-up. If not, I, along with others, will not hesitate to want to come back to this matter on Report.