My Lords, this has been a very significant debate, because when the Minister referred to the fact that Ministers needed to have the answers, I realised that the intention is to go back to command and control from the centre. It was quite clear: that is the intention. I think that is very depressing, because I do not believe that the NHS is going to benefit at all. When he said that this will strengthen local accountability—oh no, it will not. There is no local accountability whatever in this structure. I am sorry to say this again, but the fact that the Government are taking local authority councillors out of ICBs is a visible demonstration that this is a centrally driven health service from the Department of Health.
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In this debate and the next, we have two parallel lines of thinking. I have attempted to produce some constructive amendments to try to constrain the powers of the Secretary of State. The noble Lord, Lord Lansley, and the noble Baroness, Lady Walmsley—and I think my noble friend Lady Thornton—think that this is such a wrong route to go down that we should take Clause 39 out. I am absolutely persuaded now that that is the right approach. From what is being said, it is clear that whatever constraint we put in, basically Ministers want to run the NHS again. The same argument relates to Clause 40, because, again, the noble Baroness, Lady Cumberlege, has tabled what I believe are constructive amendments, and then there is a stand part debate.
The moment that the Government take this power, they will be expected to answer for everything that happens. We will expect it here. They will not be able to say, “This is a matter now for NHS England”—oh no, it is not. It is a matter for the Government. The moment the Government have power of direction, they change the whole dynamic and relationship.
We have said enough now, but I urge the Government to think again on this. I think that they do not understand the risk they take by going down this route. Having said that, I beg leave to withdraw my amendment.