My Lords, in many ways we are drifting back to 1946, when the NHS started on three legs: hospitals, services such as health visitors and ambulances provided by local authorities, and services that were contracted out, such as GPs, dentistry, ophthalmology, pharmacy and so.
5 pm
This debate, of course, has been about integration again. The noble Lords, Lord Low and Lord Crisp, my noble friend Lord Hunt—to whose Amendment 117 I added my name—all talked about primary health care in its different forms. Before I talk about primary health care—and I am sorry if I am repeating myself—there is a point I made, I think when the noble Baroness, Lady Hollins, was speaking earlier: we know that when an area gets services for those with learning disabilities right, everybody benefits in that area, not just those with learning disabilities. That is because it changes the mindset and priorities of the way that healthcare is delivered in that area. It is absolutely the right thing to do. The truth is that primary care services—I should retrospectively declare an interest as a member of a CCG for three years—deal with the vast majority of patient interactions. They are often underplayed; they are not in the big expensive buildings with the massive machinery.
Although the 2012 Act went some way to restoring the balance, by putting primary health care professions in the driving seat for commissioning with our clinical commissioning groups, in fact the big hospital trusts continued to dominate. Primary care, along with mental health and other community-based services, continued be underresourced and underplanned. Again, this Bill offers an opportunity to turn that around and look for proper integration with primary and community healthcare. They need a boost if we are to deal with health inequalities.
So we see merit in the amendments in this group. The only thing the groups lacks, as far as I can see, is anything that bigs up the poor state of dentistry—but I hope we will return to that matter in due course. As my noble friend Lord Hunt said, the distribution of GPs is another issue that needs to be highlighted and to which attention must be drawn. We talk about how to represent the voice of primary care in planning by the ICB. Having a local representation committee could do that—they have a long history and they could be given a place in the system’s planning, so I think they are deserving of consideration.