My Lords, in moving Amendment 46, I will speak also to Amendments 168 and 169 in my name. In an earlier group this morning we were talking about democratic accountability at the local or ICB level, particularly in relation to Amendment 23 from the noble Baroness, Lady Thornton. We were also, through the agency of Amendment 45 from the noble Lord, Lord Davies of Brixton, looking at the risk that people in England could be left without NHS cover. Those amendments were about the ways in which this Bill could go horribly wrong—certainly, I have no doubt, in terms of what the public want, if not necessarily in the unintended consequences of where the Health Secretary and the Chancellor are apparently thinking of taking our NHS.
A couple of hours ago, the noble Lord, Lord Hunt of Kings Heath, talked about how the Government are centralising power, with ICBs having to look upwards to the hierarchies above them. He used the phrase that they will be “beaten up by the centre”. As he was saying that, I was struck that a briefing arrived in my inbox at that moment from the NHS Confederation, NHS Providers and the King’s Fund, which very much focused on that concern about the Secretary of State’s power to direct. It is clear that the Bill will give the Secretary of State enormous power potentially to interfere in the most minute aspects of healthcare locally. That concerns a great many people. I think it is already clear that your Lordships’ House will keep talking about this and, very likely, try to change it in future, but we know we are unlikely to be able to entirely transform this Bill and the relationships between the centre and the local.
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I come to a phrase: with power comes responsibility, and with great power comes great responsibility. I went looking for the origins of that phrase and it can be attributed back at least to the French revolutionary national convention or possibly to the King James Bible. The fact that it is to be found in many political contexts across the political spectrum perhaps shows that it might be considered uncontroversial.
I ask the Minister: where is the attribution of central responsibility in this Bill? That is a serious question. Where does the Minister think the responsibility of the Secretary of State to ensure that healthcare is available to every person in England resides in the Bill, or does he want to say that such a responsibility does not exist? If Americanisation steams ahead—and let us not forget the US has astonishingly high healthcare costs, with results resembling those of countries with vastly less funds—who will be held to account for that? That is what this group of amendments seek to achieve; to ensure that the Secretary of State is responsible for the outcomes of the Government’s Bill.
This group of amendments aims to restore the NHS in England as a public system as it continues to be in the rest of the UK and as it used to be in England. I do not want to get too far into the weeds and noble Lords can read the amendments and explanations for themselves, but I am aware that the meaning of the amendments is not particularly obvious in the text, particularly the first, so I will briefly run through them.
Amendment 46 replaces the word “it”, which refers to integrated care boards and their duties, so the amendment makes it the duty of the Secretary of State to commission health services
“to meet the reasonable requirements of the people for whom it has responsibility”.
That means the Health Secretary having responsibility for the people in England.
Amendment 168 restores the wording of Section 1 of the NHS Act 2006, giving the Secretary of State the duty to promote the comprehensive health service. It very closely echoes the wording in the founding National Health Service Act 1946.
Amendment 169 says that the Secretary of State must provide, to a level
“necessary to meet all reasonable requirements”,
services including hospital, medical, dental, ophthalmic, nursing and ambulance. I note particularly proposed new subsection (d), which refers to
“the care of pregnant women … and young children”
and picks up some of the issues we were referring to in the first group today. On reflection, we could perhaps improve the wording of that, but it is a start in terms of acknowledging the needs of children in the Bill.
The wording in both these amendments very closely reflects what was found in the 1946 Act, and in every Act up until 2012. I think it is worth reflecting a little on why that wording disappeared from the 2012 Act. It was because there was a move towards market-based structures and so we were relying on the market to provide. That has in this case, as in so many others, proved to be a disaster. Indeed, in bringing forward this Bill in this moment the Government are acknowledging that disaster.
The timing of this Bill is very interesting. As both Opposition Front-Benchers have noted, it comes at a time when the NHS is struggling to cope, yet it is facing this massive reorganisation. In terms of Amendments 168 and 169 I find myself in a situation I am not in very often; I am advocating to the Committee that we revert to
the old, the tried and the tested—the kind of NHS that there is bountiful evidence the public actually want.
Similar amendments to these were moved in the other place. I note that in the discussion there it emerged that in the 2012 Act there was a compromise amendment. This arose, at least in part, out of the Constitution Committee. The compromise wording was:
“The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England.”
I cannot see similar wording in this Bill, but it is long and complex, so I would be interested if the Minister could point me to anything that he sees as similar to that 2012 compromise.
In the debate in the other place, the Minister said that this change was
“unnecessary as law. The Secretary of State has the duty to promote the competence of the health service in practice. He is accountable to Parliament for the comprehensive health service”.
Those words, “in practice”, are rather telling. We find ourselves, as we so often do, hearing from the Government, “Don’t worry; things will work out. You can trust us. This does not need to be on the face of the Bill”. That is something your Lordships’ House very often—I would say rightly—expresses great scepticism about. We want to see things in law to which the Government can be held to account.
We know all too well how creaky parliamentary accountability can be: how stretched and limited scrutiny in your Lordships’ House can be, let alone in the other place, where 44% of the vote in 2019 delivered 100% of the power to the Government. There is brilliant work done by Select Committees and brilliant questions asked by individual MPs to highlight issues, but the practical reality is that the Government can just ignore all those things and bulldoze through, and very frequently do.
I note that in the other place, the Minister further said that
“we should be wary about being overly prescriptive in primary legislation.”—[Official Report, Commons, Health and Care Bill Committee, 14/9/21; col. 183.]
But surely being prescriptive about the fact that we have a National Health Service is what the public unarguably want. The Government are being prescriptive about how they can control ICBs to control local services, but I would say that we have to be prescriptive about what the Government must do. That is a responsibility we must live up to. This is surely not overly prescriptive. I beg to move.