Health and Care Bill — House of Lords, 2021-12-07
Topic: Health
Simon Stevens (Crossbench, Unknown): My Lords, I thank noble Lords for the warm and generous welcome. I joined the NHS on its 40th anniversary, in 1988; it is therefore a huge privilege to participate in this important debate more than three decades later I know that time is tight so I will cut to the chase and make three brief points. First, the Bill does indeed go with the grain of what patients can see is needed and what people across the NHS have been trying to bring about for some time now. It is not a cure-all—no Act of Parliament ever could be—but it removes legal, bureaucratic barriers to more joined-up care. The fact is that, as we dig our way out of the consequences of the worst pandemic in a century, as your Lordships have just heard in Oral Questions, GPs, hospitals and community services will need to work together in radical and new ways. This Bill will facilitate that. It is also the case that, in an era when, despite fantastic advances in medicine and science, we are seeing growing inequalities and a far higher proportion of patients with long-term conditions, just about every health system in the industrialised world is trying to move towards more integrated and preventive care In that respect, I should perhaps depart slightly from the noble Baroness’s comments on fluoridation, if I am permitted to do so in a maiden speech. I welcome this move towards dental decay prevention. I should declare an interest on the part of my teeth, in that I happen to have had the good fortune to have been born in Birmingham just a few years after that great city introduced fluoridation. If the whole country now follows its lead, we have the potential to halve the dental decay of children in the poorest communities To get back to the point, my second observation is that a number of the concerns raised about the Bill are perhaps a little wide of the mark. It is hard to sustain the argument—it has not been made this afternoon, at least so far—that the Bill in some way advances the privatisation of the National Health Service when in fact it scraps the EU compulsory competitive tendering regime imposed on it. However, there is a case for the Government to consider potentially strengthening some of the safeguards in Clause 70, which would ensure that, where contracts are being let for the private sector, that is done in an open, transparent and fair way The Bill does not fragment the NHS. It brings together local funding for GP services, hospitals and community services. It removes the role of the Competition and Markets Authority, enabling hospitals to work together, as the pandemic has shown to be so necessary. It brings together the triple-headed Cerberus of Monitor, the Trust Development Authority and the Commissioning Board to create a unified and accountable NHS England The Bill puts on a statutory, transparent and accountable basis the informal local partnerships that have arisen between the NHS and local councils out of necessity. It rightly allows them local flexibility because, in a country as large and diverse as ours, one size does not fit all. To suggest that the mere existence of these local bodies somehow constitutes the fragmentation or destruction of a National Health Service makes sense only if you think that every decision in the NHS can be taken nationally. That has never been the case and would never work. As one commentator on the NHS said, in the event of a nuclear war, only two things will survive: cockroaches and the regional tier of the National Health Service My third and final point is that, notwithstanding its many merits, just like the NHS, the Bill is not yet perfect. There is an opportunity to strengthen the provisions in respect of social care and mental health. As a number of noble Lords have set out, just about everybody can agree that, in principle, the major challenge facing health and social care is the strength and resilience of the workforce. It is therefore ironic that, for many years now, we have been promised a detailed, funded and properly thought-through workforce plan for education and training, stretching out over five, 10 or 15 years, yet, on each occasion when that detailed plan is about to be produced, it is muzzled. Jeremy Hunt’s Commons amendment sought to remove the muzzle; I hope that your Lordships will consider something similar in this House Finally, in respect of the Secretary of State’s powers, care is needed to ensure that this does not end up inadvertently centralising a number of decisions on service configurations that are best made locally. I remember, early on in my NHS career, attending a public meeting at which the proposed closure of a small maternity unit in town was being discussed. It was a very well-attended public meeting; large numbers of people showed up. The director of public health tried to set out the case that there just were not enough births in this midwife-led unit. A voice came from the back of the hall: "How many do we need, then?" There was a bit of head-scratching and a puzzled look, then he spluttered an answer. The voice at the back of the hall came back: "In that case, give us 18 months". I can tell your Lordships that, in 18 months, that town did produce the requisite number of babies and the maternity unit is still open. That is not a decision that should have been taken in Whitehall. Yet, lurking near the back of the Bill, in Schedule 6 on page 197, are provisions that essentially do that. Nye Bevan may have said that he would like the sound of the dropped bedpan to reverberate around Whitehall, but not even he suggested that each hospital should write to him personally for permission to move the cupboard in which the bedpans are stored To conclude, despite all I have just said, there is considerable merit in the Bill. I believe that it is pragmatic, modest and evolutionary. It builds on many of the changes that people across the health service have looked to put in place over the past decade. Nye Bevan, the patron saint of the NHS, said that "legislation in this country … starts off by voluntary effort … by empirical experiment … by improvisation. It then establishes itself by merit, and ultimately at some stage or other the State steps in and makes what was started by voluntary action … a universal service." That is the legislative task before us.