Debate on the Address

My Lords, I am still such a new boy here that I do not know where to stand on the Bench, although I may not be a new boy for very much longer in the sense that I can still regard the House from the same perspective as the vast majority of the citizens of this nation. That means that, never having set foot in this Chamber before my introduction, I have now witnessed first hand—I would almost say that it has been a revelation—the wealth of experience, the depth of knowledge and the fierce independence at work in this Chamber, which are almost certainly beyond the recognition and appreciation of the wider British public. It would be a tragedy if the public discovered what they had had only by losing it. Yet they depend on this House to provide vital safeguards to the liberties and workings of the British constitution without in any way understanding the vital role played by your Lordships. Perhaps someone needs reminding of an old American saying, which can be paraphrased as, ““This ain’t broke. Don’t try to mend it””. I thank all noble Lords and the wonderfully helpful staff for their extraordinary warmth and kindness in helping all us new arrivals to begin to feel comfortable. It is gratifying that both the Government and the Opposition appear to support a broad commitment to sustaining funding for the National Health Service at levels equal to, or even enhancing, current allocations from fiscal revenue. This accord, however, should not be taken as a licence for the National Health Service and all responsible Government officers to depart from diligently seeking to curtail unnecessary expenditure wherever it can be identified. This brings us to the interesting case that arises from the gracious Speech. I can refer to it only by echoing Sherlock Holmes’s famous piece of evidence as the mysterious case of the dog that did not bark in the night. Before the last election, the Government undertook considerable work with their own Gershon report, which sought to identify potential areas of cuts and economies to reduce the cost burden of the National Health Service on all taxpayers. Separately, the Opposition undertook a parallel assessment of potential departmental savings. I had the privilege of chairing that process on behalf of Michael Howard, who, from the outset, was adamant that the aim was not tax cuts but a programme of bureaucratic simplification that would improve efficiency of service delivery and release funding for redeployment elsewhere in the NHS. The James report broadly supported Gershon’s assumption of £6.5 billion savings for the NHS, but added another £1.5 billion of its own recommendations, making a total considered achievable of just on£8 billion, which was a buffer that one might expect the Government to be able to employ to compensate for any overruns on their NHS budget calculations. Instead, perhaps surprisingly, in the year since returning to power the Government have embarked on a radical series of direct cuts to the NHS, which directly affects nursing levels, will close beds and hospitals, and will do virtually nothing to improve service delivery for the taxpaying public. Action is urgently needed. The finances of the NHS are getting progressively worse as we wait. The NHS has been suffering an ever-worsening financial crisis for years, with a decline from a surplus of £96 million in 2002-03 to the predicted deficit of £650 million in 2005-06, which is the worst figurein the history of the NHS. As a result of the NHS financial crisis, patients are suffering. It now looks like a most brazen and cynical act for the Government to have claimed that the Conservative-proposed economies were aimed solely at funding tax cuts, while seekingto fund budget overruns due to their own NHS mismanagement by simply slashing 9,000 staff from the sharp end of delivery in NHS hospitals and so ignoring the better way that was set out for them by their own Gershon report. North Staffordshire has been hit with the loss of 1,000 staff; Worcester has lost 720; Durham and Darlington have lost 700; Norfolk and Norwich have lost 700; West Hertfordshire has lost 700; and the Royal Free Hospital in Hampstead has lost 480 staff. Yet the Secretary of State for Health, to justify these cuts, claims that deficits are arising in such areas, which are healthier and wealthier. That must be a big comfort and probably an even bigger surprise to the citizens of the locations that I have just listed. The financial problems of the NHS are of the Government’s own making. The Government underestimated the costs of their new staff contracts by almost £500 million, failed to provide the NHS with its central price list of treatments for 2006-07 until just 10 working days before the start of the new financial year, and allowed local NHS bosses to freeze the NHS budget in real terms in order to recover the deficit. As a result of this financial mismanagement, productivity has declined by up to 1.3 per cent in each of the years since this Government came to power in 1997—a record about which we do not hear much boasting. The dog that did not bark in the gracious Speech is that nothing was said to commit the Government to revisit and implement the most achievable and constructive cost-saving strategies for the NHS resulting from even the recommendations of their own Gershon report, even without the Conservative additions. The Opposition rightly took the view that this issue was too important to become mired in party politics. They were prepared to offer the Government every assistance to achieve positive benefits for taxpayers. Accordingly, the Opposition decided freely to offer the services of their advisers, together with their working papers, to support and assist the new committee of senior government officers formed under Gershon’s successor, John Oughton, to review the Gershon and James reports with a view to implementing a programme for further NHS cost savings. The Queen’s Speech was completely silent on any resumption of the process of John Oughton’s committee or any acceptance of the need for progressive and further economies to balance the books of the NHS. Just continuing fully through the implementation of parts of the recommendations would have produced already more than enough cash savings to avoid the 9,000 staff losses that have been inflicted on the locations that I noted. We argued for the abolition of strategic health authorities: there was a reduction from 28 to 10 at the beginning of July. We also argued for a reduction in the number of primary care trusts, which fell from 303 to 152 at the beginning of October. So the basic strategy for economies was clearly accepted. Yet these reforms were intended to reduce headcount by 30,000 and to yield savings to spend on patient care of more than £1 billion. I neither see the restructuring costs of 30,000 fewer bureaucrats nor notice the NHS benefiting from an improved cash flow of £1 billion. We also suggested a significant reduction of over 1,000 staff at the core Department of Health. Just two weeks ago, the Minister of Health reported to the other place that the department had indeed achieved almost that reduction since 2003—yet with only24 redundancies made in 2004-05 and just eight last year, noble Lords may ask what has happened to therest. In the spirit of redirecting resources to the front line, a policy supported by this Government, those bureaucrats, secretaries and press officers must have all been retrained in record time, perhaps as brain surgeons or anaesthetists—or, horror of horrors, are the missing heads now to be found lurking somewhere in Whitehall as perhaps a new department for setting and monitoring silly targets and useless statistics? Implementation of the full sequence of these and similar savings now would release the same funds to be recycled to provide for the proper business of nursing the sick. Funding would become available for investment in vital life-saving equipment and costly medication and adequate levels of pay could be maintained to ensure continuity of appropriate numbers and quality of nursing staff. The proposed Gershon cuts alone would have freed revenue sufficient to double the pay of the entire nursing population of Great Britain. I would not suggest that it be used for that, but at least a proportion of it would have saved the 9,000 jobs whose loss has afflicted so many of the areas that we have talked about. The already overstretched number of beds available in the UK could have been maintained, we would have avoided the inflationary effect that will be an inevitable consequence of maintaining redundant levels of bureaucratic overhead, and medical staff would be released from unnecessary bureaucracy to apply their skills where most needed—in treating the sick. We are here concerned literally with protecting both the health and wealth of this nation. It remains a subject too important to suffer from the confines of party politics and I urge the Government to consider not only reactivating the Oughton committee, but also embracing the offer of help from the Opposition with regard to the data and accompanying analyses that surrounded their own recommendations. The Opposition should not be too proud to offer help and the Government should not be too proud to accept it. Finally, I thank noble Lords for listening to me on the first occasion that I have addressed the House. The last piece of advice that I received from a friendly noble Lord on arriving here was given when I asked him how I should properly avoid contentious matter in my maiden speech, and how would I be able to judge whether I had succeeded. His reply to me was this: ““Just remember the advice of Sir Harry Lauder about performing at the Glasgow Music Hall on a difficult Saturday night. He said, ‘If you do not offend them too much, they usually let you live’””. I thank noble Lords for their courtesy and patience, and hope to live and debate among them for many years to come.