Queen’s Speech

My Lords, I congratulate the Minister on his opening speech and on his leadership in taking forward the review of the NHS. Its concentration on quality is already proving to be a strong motivating force within the NHS workforce. I share many of the views and the aspirations of the noble Lord, Lord Warner, as well his concerns, but sadly I do not agree with his enthusiasm for the NHS constitution, on which I shall concentrate today. The constitution seeks to preserve the founding principles of the NHS. Sixty years ago my father joined the NHS and I remember his huge relief at its birth. Its values resonated with his own. His patients were grateful and respectful and they were ready to embrace the socialist ethic of 1948. His only problem was that remedies were very limited. The physician comforted while nature healed. The NHS was ineffective, safe and cheap. Today it is effective, dangerous and very expensive. The population are not overly grateful, they are not deferential and they expect a miracle. A baby born through IVF is a near miracle. Surgery carried out by the noble Lord, Lord Darzi, is a near miracle—but he knows that his work will be outdated in a decade and we will have moved on to new technologies and innovations, a point also made by the noble Lord, Lord Warner. One of this country’s leading scientists, in giving evidence to a working party that I chair, told us that by the next generation we will be able to find out the complete genome sequence of everyone, probably at birth. The information will tell us about the polygenic contributions to many diseases, such as diabetes, heart disease and susceptibility to tuberculosis. We will have identified the genes that cause autism and dyslexia. We will know about genetic variation associated with an individual’s ability as to whether they are good at maths, good at reading, good at writing or bad at them. It will be possible to have premarital genome sequencing of couples, with all sorts of predictions based on their genetic make-up. This is scary stuff and is in sharp contrast to 1948. The year 1948 was a different world. Today the NHS is about the only vestige of pure socialism. Founded on the principle of, "““From each according to his abilities, to each according to his needs””," the NHS is a vast co-operative. I do not believe that either socialism or the co-operative ethic resonate with people today. The part that might be remembered is, "““to each according to his needs””." The forgotten part is, "““From each according to his abilities””." A co-operative is about balancing inputs with outputs, and both are exercises in unselfishness. With the ““I want”” society, I can understand why the Government are anxious to re-instil the underlying ethic of the NHS. My disappointment is that it has chosen legislation as its tool. With such a fast-changing world we need flexibility, inspiration and dynamic leadership. Legislation is none of those things. It is reductionist and rigid and it kills the spirit. A nurse going into a ward does not think, ““I am here to give this patient his rights””; she goes in to give care. In the NHS constitution almost every right and pledge has its caveat. For example: "““You have the right to access local NHS services. You will not be refused access on unreasonable grounds””." What is unreasonable? Who is to judge? Certainly not the patient. "““You have the right to expect your local NHS to assess the health requirements of the local community and to put in place the services to meet those needs as considered necessary””." Who is to judge what is necessary? Certainly not the public. This is in sharp contrast with the Medical Schools Council, which has taken on the Herculean task of defining the role of the doctor. With clarity it states that it is the patient and the patient’s interests that must define the role of the doctor. The constitution uses the word ““strive””, which it explains is a ““pledge””: "““The NHS will strive””—" or pledge— "““to provide all staff with well-designed and rewarding jobs that make a difference to patients””." Why employ people if they are not going to make a difference to patients? That is a banality. I thought that the whole purpose of the NHS was to treat and care for patients. Again: "““The NHS will strive””—" or pledge— "““to provide support and opportunities for staff to keep themselves healthy and safe””." Surely no employer, let alone the largest in this country involved in the business of health, sets out to ensure that its staff are unsafe and unwell. I use Pledge. It comes in an aerosol made by SC Johnson and omits a thin film of polish. These pledges are a thin film that tries to give a shine to this sad little document. It seems that the Government are too frightened to declare their roots. More importantly, the constitution abandons the discipline required to make either the socialist or co-operative models work. Do the Government consider that these twin ethics are so outdated and so compromised that the NHS is based on unacceptable, and therefore unworkable, principles? If the Government want to hold to good principles, they cannot declare, as they do in paragraph 4.33 of their consultation document on the constitution, that: "““We have firmly ruled out linking access to NHS services to any sort of sanction for people not looking after their own health””." I understand what a minefield this is. I also acknowledge that more and more doctors and nurses say, ““In effect, you are wasting resources, or are untreatable, unless you get your weight down, change your diet, stop binge drinking and so on. Put your own health in order first””. There is no common sense and no courage within the constitution to absolve people from taking charge of their health. I would have more respect for it if it said, ““We will give you a maximum of 10 minutes to tell you how to put your health right. Do it. Come back in six months””. At least we would have some honesty and some grip. In the section on the principles that guide the NHS, we are told that the NHS aspires to train to the highest standards. Medical schools are now scared to fail pupils for fear of being sued. Those schools receive some of the brightest and best, but common sense says that not all the brightest and best will, regardless of commitment, make good doctors. Pass rates are now nearly 100 per cent. The Medical Schools Council understands this; in its document it states that doctors must have strong intellectual skills and must have the capacity to work out solutions from first principles. Here is rigour. Throughout its document, it uses the word ““must””. If the Government are set on having a constitution, they must at least ensure that it says something. How about, ““The NHS aspires to the highest standards. We carefully select the best for training and expect 75 per cent to qualify. All trainees must accept the school’s decision as final””. If you want the best, you have to cull the weakest. I have taken a few examples from what I think is a weak and ineffectual document. Your Lordships may think that I am being too tough, but the trouble with socialism and co-operatives is that they become coupled with inefficiency and lack of commercial rigour and discipline. Perhaps, too, I have got it all wrong. To be fair, socialism and co-operatives get no mention in the constitution. Yet we all know that, deep down in people’s psyche, there is an innate desire for fairness in the NHS. It would be arrogant to think that the NHS is solely a creature of government. Untold millions of hours are given by carers who put in so much more than they take out. Millions of hours are given by volunteers—directly, or indirectly via charities—for the nation’s health. Most doctors, nurses and people who work in the NHS are generous with their time and want their commitment encouraged. They understand, "““From each according to his abilities””." They are givers and reluctant takers. Most want the failures out and the NHS to be the best. The British have an inherent distrust of constitutions. Most recently, regarding the EU, we fought against a constitution. The Americans are rightly inspired by theirs, but the NHS constitution rates alongside the wishes of a seven year-old in Father Christmas’s grotto. It disgraces the word ““constitution””. It has no grip, ambition to be edgy or 21st-century determination; it has nothing of distinction. Instead, it strives for somewhere just below average. Neither staff nor people should accept it. We deserve something better—much better.