Health and Social Care Bill

My Lords, I have two amendments in this group, Amendments 163C and 166B, which also stand in the name of my noble friend Lord Marks. However, before I address those relatively short amendments, I should like to say a word or two about the broader issues that we have been discussing. I begin by perhaps giving a little comfort to the noble Baroness, Lady Thornton, by saying that my understanding is that we will be discussing the whole issue of the relationship of Monitor to foundation trusts later in the proceedings. Our amendment on this matter, which is not far removed from hers, addresses an amendment to the government amendment on this issue, which itself comprises a considerable advance in the position that we have had up till now. I shall not try to get into that debate because it is complicated and I think that it would be better conducted a little later in the light of the various proposals. I want to say a word about competition, and it is appropriate to do so given that the noble Lord, Lord Warner, has just been speaking. He has always spoken with some courage on this issue, which I recognise is not exactly popular with his party. However, I say quite directly that I feel very strongly that we have allowed the issue of competition to become quite different from the reality that we have encountered in the Bill, in this House and from the argument that is going on outside. That is because we have tried to treat competition as an absolute—either we have a competitive market for the National Health Service or we have no competition at all—and we all know that to be false. We all know that there is a role for competition but the argument is about how limited it should be, what it should be addressed to and whether it is then balanced by, for example, equally strong duties in relation to co-operation, integration and the bringing together of services. I think we all recognise that competition can make a significant contribution in innovation and bringing in new ideas. For example, we have only to look at the recent developments in the treatment of stroke victims and victims of heart conditions to see that there has often been an innovatory role for the private sector. However, many of us also believe, as I certainly do, that the National Health Service should continue to be primarily a public service, that it should be available free of charge and that it should be accessible to all. Therefore, competition must exist but essentially it must be balanced by other considerations which, in the case of what we have been discussing recently, are clearly of great significance—particularly the role of the integration of services and the role of co-operation, which in terms of our main priorities, including the care of the elderly, are absolutely central and crucial. If we can get the debate on to those issues, what will the outcomes be and what will the practical effects be? We may then be able to contribute to a National Health Service which remains a public service but which is also capable of advancing and moving in innovatory and new directions. Frankly, that is what many of us on our Benches and, to be fair, many on other Benches—the Labour Benches, the Cross Benches and the Conservative Benches—want to see as well. I am thoroughly fed up with reading pieces on social network sites, such as Twitter, which have presented this debate in terms of how we voted on the last amendment and if we did not vote for it then we must be in favour of the marketisation of the NHS. That is simply absurd and it makes me very angry. It adds to what has become a silly debate, a fictional debate which has led a great many people to believe that what is being discussed here is not at all what is being discussed, but some other strange, nightmare battle between marketisers and publicisers and no possible compromise can properly be reached between the two. I feel very strongly about that. I am fed up with reading about how I am actually a secret marketiser, when I know perfectly well that I am not. Many others may feel the same way. Let us turn back to the rather limited procedure in my own amendments, as I do not wish to waste the time of House. Our amendments are quite simple and appropriate. On the basis of what is in the Health Act 2006, they say that it should be possible to insist that Monitor says, in statements, precisely what it has done in terms of two of the 2006 Act's main objectives. The first of those is a comprehensive health service—here we go—and I am delighted to see the noble Baroness, Lady Jay, in her place. She built the commitment to a comprehensive health service right back in the initial constitutional structures of the NHS and, in my view, for that we are all greatly in her debt. The second addresses the issue of the quality of health services across the board. A statement should be made by Monitor on both those points. That is the first of our amendments. The second of our amendments states that, those statements having been made, guidance should be issued by Monitor to ensure that they are implemented and become the case. Again, I think that it is an unexceptional amendment. It takes very seriously the mandate that many of us in this House have attempted: to enrich and embolden an essential weapon or tool for setting out the objectives of the NHS from the Secretary of State in each year. Effectively, these amendments say that Monitor shall make the statements; that Monitor shall ensure that those statements are carried out; and that it will do that within the structure and on a mandate, with the Secretary of State's overall objectives, that will be reflected and clear. That is exactly what we want. We want clear objectives, agreed by all; we want a commitment by the House and by many beyond it, including the professional bodies, to do exactly those things. We want a comprehensive health service, directed towards increasing and improving quality; directed towards accepting innovation that will not threaten the health service but enrich it; directed, not least, to dealing with the inequalities that still exist; and directed to ensuring that we address them in a wholehearted and determined spirit. I beg to move.