My Lords, I support these amendments and I especially support the noble Lord, Lord Mawson. It was typical of him that he started our thinking about what health is; I am sure there are many answers, but I think one of them might be integration—not just integration on the biggest scale but in terms of neighbourhoods, communities
and what we now call place. That is so important. Those are the building blocks of all we are trying to do in the hierarchy of the National Health Service.
I am inspired by the noble Lord. He is a man of infinite resource and sagacity, an entrepreneur and, above all, a great achiever, based on solid principles which he believes in and, like a man of the cloth, is anxious to spread to others. He does so with really good effect.
It is no accident that I entitled my first report to the Government, many years ago when I was Mrs Cumberlege, Neighbourhood Nursing: A Focus for Care, as I believe the neighbourhood—or, in today’s parlance, the place—is all-important. This is what colours how people think, behave, succeed and, sometimes, fail. The noble Lord, Lord Mawson, has shown how even the most deprived areas can be rejuvenated and thrive with strong leadership, purpose and commitment. The noble Lord’s deep unshakeable philosophy is that patients, people and the local community should be the movers and shakers and be in control.
I want to mention Bromley by Bow, because it was a really innovative and new way of thinking about things. I remember visiting it years ago, not quite when it first started but when it was beginning to really thrive. Bromley by Bow was the first health centre in the country to be owned by the patients. Founded in 1984, it began with just 12 elderly patients, a rundown church, and just £400 in the bank. Today, by applying entrepreneurial principles to challenge social and health issues, it now has more than 250 staff. It is responsible for 43,000 patients, as the noble Lord said, and four health centre sites across Poplar. It operates on 30 sites even more widely across east London. It has supported local entrepreneurs. What is really interesting is that it has built 93 small and medium-sized enterprises. This is people helping themselves and ensuring that there is employment through a charitable structure, a housing company, which is controlled by the residents and now owns 10,000 properties and 34% of the land in Poplar.
This is a remarkable achievement in a very poor part of London. It is effective because it recognises that health and wealth are profoundly connected—not in huge municipal buildings and ivory towers remote from their populations but by the people who live and work in that area. The schemes are intertwined with the population. They are neighbourhood schemes and recognised as such. They are valued by being part of the destiny of a place in which local people live and work.
I visited Bromley by Bow in the early days, as I said, and I am really disappointed by my GP practice in the village in which I live and grew up. My father, one of two GPs, knew his patients literally inside and out. He knew who was getting off with whom. As his children, the first thing we learned was confidentiality and how to respect it, because we heard all sorts of things. He managed to get a health centre built. It is called that: above the entrance to the building it says, “The Health Centre”, but today it has been renamed the medical centre. It is a service that is not about health but about transacting to patients what the doctors think they need. The practice even shuns social prescribing, which is prevalent in many areas. It is also very careful not to involve the community. The friends of the health
service have become disillusioned. They were established about 20 years ago and they are fed up with what is going on. Two weeks ago, they closed that organisation.
The noble Lord, Lord Mawson, in his Amendment 41A seeks to use the new world of integrated care boards to ensure that local representation is guaranteed. We have had a lot of debate in this Committee about who should be on what board and so on, but in listening to those debates—there was a big one last Tuesday—I was very struck by people talking about the big battalions. I could see that people were trying to ensure places on the integrated care boards that were represented by the big battalions. That is understandable. They are the component parts of the NHS. There are parliamentarians who see this as the only way forward.
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The noble Lord, Lord Mawson, has shown us other ways, but it is a struggle. Today, the Bromley by Bow Centre has to deal with far too many sources of funding from the public sector. The money from the Treasury is disbursed to the silos: education, local government and other agencies. The centre spends too much time trying to put it back together again to deliver integrated projects. The centre runs hand to mouth, even after all these years, because mainstream funders in government do not recognise what the centre actually does. Schools, treatment centres, tertiary colleges, hospitals and traditional health centres are well understood, but Bromley by Bow does not fit any of these traditional silos.
I welcome the amendment and the others that follow it. The noble Lord is trying to free up the claustrophobic, traditional ways of not only working but, equally importantly, thinking. But the dilemma we face is this: warm words are given that we must not stifle innovation, but innovation is challenging. It is uncomfortable. When Henry Ford was describing his new invention, the motor car, he asked the public what they thought of it and what they would like. The reply he got was, “Just give us faster horses.”
We have a serious dilemma, as big government departments, especially the Department of Health, are about providing the same standard of health and the same provision across our nation. Again, we have a debate on that concerning Scotland, Wales and Northern Ireland. But even the nation grumbles as soon as it perceives a postcode lottery appearing.
Trying to square this circle is really difficult. The department seeks change through laborious systems. Those are the tools it has. Big departments deliver to the nation through their own power lines. This amendment threatens a short circuit that might set the structure alight or give the department an electric shock. That is no reason not to try. People of stature and proven trustworthiness who are competent and prepared to take responsibility for their innovations and to report to the department, say, every two or three years an audited evaluation of the scheme’s progress and outcomes, should be supported. It might help to square the circle, because if the funders of public money have to be accountable, this is one way of doing it.
I support not only innovation but these amendments. I urge both Ministers to risk their all: to let new ideas for places in need, through special workable collaboration,
have their head. If we want to level up, then let us be brave and let sparks fly, because it is time to get behind people with a proven track record who are entrepreneurial, not people who talk and write reports about it.
The noble Lord, Lord Mawson, has taught us that the future is about creating a learning-by-doing culture, as he mentioned in his introduction. That is the culture that we want in the NHS, where the whole system learns through best practice on the ground, in real places with real people. Where things are not working, let people such as the noble Lord intervene and turn problems into opportunities. He has spent his life doing just that.
Seeing is believing. I encourage my noble friend on the Front Bench to visit Bromley-by-Bow, as a past Minister, Sir Brian Mawhinney, did. He ensured the future of this enterprise for a few more years and enabled it to flourish. I know that ministerial diaries are a real challenge, having had one, but I assure my noble friend that a visit to Bromley-by-Bow will never be forgotten and will make a deep impression.