Health and Social Care Bill

My Lords, I fully understand the fervour and passion with which my noble friend Lord Clement-Jones spoke, because he feels very strongly that he, with the help of others, brought about a real change in Part 3. I make no pretence about the fact that I began by being totally opposed to Part 3. I was on public record as saying that I thought it was a very bad thing indeed, but very sweeping changes have been made to it, and on that I agree with the noble Lord, Lord Newton of Braintree. However, I do not want to stop at that point. My noble friend said that we were at a watershed and I believe that we are. I pay tribute to the noble Baroness, Lady Thornton, and her colleague, the noble Lord, Lord Beecham, for tabling this important amendment, and I shall explain why. In this House, we have a great deal of trust in the Minister. Repeatedly and rightly, huge tribute has been paid to him throughout these debates for his understanding, his patience, his willingness to go a very long way to meet the needs and requirements of other people and, if I may say so, his permanent consciousness and awareness of why the British public love the NHS so much. More than virtually any other politician that I can think of, he has real empathy with what people want and expect from their health service and it is important to recognise that. The noble Earl has punched—if I may say so politely—well above his weight. His weight is not, of course, that great but his punch is terrific. He has persuaded a great many of us—not, I suspect, only on this side of the House—with the elegant and generous way in which he has put forward compromises and concessions. Many of us have accepted these or, like the noble Baroness, Lady Greengross, decided to wait a little longer to see what might come out of what he said. That is an immense personal contribution. We would be in a world of illusion if we did not recognise that outside this House and the other place, where my honourable friend Mr Burstow is doing his very best on the social care side, there is, as the noble Baroness, Lady Thornton, rightly said, massive distrust and disbelief in what we are trying to do. We have to address that or we can forget altogether about doing what the noble Lord, Lord Newton of Braintree, rightly said we need to do—to give the National Health Service some stability, some confidence and some sense that it has a future. This is the most labour-intensive public service. Our whole capacity for addressing the Nicholson challenge and the problems of an ageing and often chronically troubled society, and for delivering what most of us want and which is enshrined in the words that we wrote into the Bill at the very beginning of its passage in this House—the responsibility and accountability of the Secretary of State for a comprehensive health service free at the point of need—will go with the wind without the support and morale of the professional services, the staff and the public. As Members of this House will remember, we owe a great deal to the noble and learned Lord, Lord Mackay of Clashfern, for the Conservative Party, we owe a great deal to the noble Baroness, Lady Thornton, and her team for the Labour Party, and we owe a very great deal to the Cross-Benchers for the steady support they have given to maintaining the stability and future of the National Health Service, which all of us recognise as probably the greatest single social achievement of this country since the Second World War. What I like very much about the amendment is the second section, where the noble Baroness, Lady Thornton, and the noble Lord, Lord Beecham, point to the need for consultation before there is a move towards bringing Part 3 into full effect—I would go wider and say before bringing into full effect the Bill itself. It is vital that, when the Bill has completed its passage, the Government and the Department of Health in particular seek to hold a wider consensual discussion, bringing in the main bodies but also the main people who have been involved in the Bill, regardless of whether they stood for or against it, in order to give the National Health Service the foundation it needs to address the huge scale of the problems it faces. I agree about sequencing. I suspect that it is really difficult to demand that the NHS seeks both to meet the Nicholson challenge right away and to deal with the effects of reorganisation. In so far as there can be some delay in the second of those—I have in mind, for example, whether strategic health authorities should be got rid of as quickly as the Bill currently proposes—there is clearly room for some meeting of minds about the best way to bring about the necessary changes without affecting the central issue of how that is done in the face of financial stringency. I do not wish to hold up the House for long but I do want to say that we need, once again, to engage the royal colleges. I take the point of the noble Baroness, Lady Thornton, that they have, to a great extent, been alienated. It is crucial that we get across the changes that have been made. I will be among the first to say—because I paid the price for this—that many of the public do not know very much at all about the changes that this House has made. We have certainly been poor at communication. That is not entirely our fault because the Government, understandably, made their concessions at the very last moment of the procedures in this House—often, literally, just before we started debating. Understandable though that is, the drawback is that there is a total failure of communication, and the press—usually somewhat thinly represented in the Press Gallery of this House—is not terribly good at conveying what is happening as distinct from the scope and passion of contention, much of it totally beside the point. In conclusion, it is now contingent upon us all, regardless of our party, to make a real effort to make this reformed Bill work. I do not like the Bill very much but I like it a great deal better now than I did when we began this long process. It has been a long and arduous process. I hope that we can turn our minds to the deep consultation with all those involved referred to in the middle part of the amendment, which I strongly applaud. That is the essential bridge across the watershed to which my noble friend Lord Clement-Jones and the noble Lord, Lord Owen referred. I hope that we can end on a note which will say how much this matters, and I hope that the Government will consider it very sensitively and carefully, because I think they will need it as much as the rest of us do.