Health and Social Care Bill

My name is not attached to these amendments, but I have a great deal of sympathy for them. I say to the noble Baroness, Lady Cumberlege, that health promotion can be deadly boring, principally when it is carried out by the NHS. When it is done by other people, it is somehow emancipated and in my experience it can be good fun, particularly when it is carried out by voluntary organisations. The same applies to social care, a great deal of which is preventive, although it may be of preventive value simply in preventing people who have a problem from becoming worse and enabling them to maintain their level of social and personal functioning. The question to which I want to return is: who does health promotion and on what terms? In my previous job, I sat down with a bunch of voluntary organisations to try to work out some output and impact measures for their health promotion schemes. The example that I was most profoundly affected by was the person who had been given £4,000 and six months in which to achieve a healthy outcome for an ageing population. Strangely, she did not manage to. The way in which PCTs deal with voluntary organisations on health promotion is one of the most unrealistic things that I have come across. That is because voluntary organisations get the fag end of budgets at the end of the year. That is the truth. The noble Earl, Lord Howe, was right about my Amendment No. 74. It is precisely because health promotion and prevention must be longitudinal that they are so important. The further one moves away from acute interventions, the more difficult they become to measure; one is dependent on population and international studies. It is extremely difficult for any organisation to receive funding for health promotion when all the time it is being asked to prove that by its intervention something will not happen. That is often what goes on in health promotion. That is almost as difficult as—dare I say?—persuading the world that you do not have weapons of mass destruction when you do not have them. You cannot show them if you do not have them. That is why the noble Baroness and the noble Earl are right to site this responsibility with the Healthcare Commission. It is the one strategic body that might just have a hope of ensuring that health promotion activities are not carried out in an ad hoc and piecemeal way and that we eventually begin to get some of the data that would back up the arguments that Sir Derek Wanless made in his report. Finally, I entirely understand what the noble Earl is trying to do in Amendment No. 35, in which he mentions ““commercial terms””. A great deal of social care is provided not on commercial terms but by voluntary organisations, which subsidise it enormously. I understand what he is trying to say, although it is an unfortunate way of saying it. If he could come up with a better phraseology to encapsulate what he means, that would do everyone a great service.