Health Bill [HL]

My Lords, I begin by congratulating my noble friend Lord Darzi on being the driving force behind change in the National Health Service. It is frequently said that Parliamentary Under-Secretaries do not have a great deal of influence in departments, but my noble friend’s track record shows where the drive and initiative for change have come from. I congratulate him not only on that but also on the exceptional stamina that he has shown in sitting right the way through this debate. Sometimes he must have felt a little twinge of regret about it; nevertheless, he has done it. During the debate, a number of flights of fancy have taken us quite a long way from the subject. I shall start with my preferred one, which is that this reform of the National Heath Service does not come from a point of view of overall crisis in the NHS. If we look at the record of this Government since 1997, we see enormous progress: in real terms, the NHS budget has gone up by 96 per cent; waiting times for operations have been dramatically reduced, while waiting lists, which had gone up by 400,000 during the tenure of the previous Government, have fallen by 600,000 during the tenure of this one; operations carried out in the health service are up by 1 million post-1997; the number of nurses in employment in the NHS is up by 80,000; and there are 38,000 additional doctors in the NHS. All that has been achieved alongside a massive improvement in the National Health Service estate and innovative actions leading to the creation of things that did not exist before, such as the 90-plus NHS walk-in clinics. Therefore, it is from a position of enormous achievement that we are now looking at the next drive forward, and I congratulate my noble friend on that. I welcome the idea of a National Health Service constitution, although I did not think that I would until I saw it. It is a very good start, but I have one or two concerns about it. There is an imbalance between rights and responsibilities as expressed. I think that we should emphasise a lot of the responsibilities that come with access to the health service, as well as people’s rights. I am a little doubtful about the full expression of these rights, particularly in the handbook to the constitution, my concern being that it may become a charter for litigants. We already have too many vexatious litigants knocking around the National Health Service. My other concern about the constitution is where it talks about rights. Time after time it states, ““You have the right””, but it does not specify who ““you”” is. That is quite important. ““You”” has to be defined. Is it a British citizen who acquires the right or is it any legal resident? Is it anyone who is legally in this country but not as a resident, or are we just going to rely on the exception that we can charge overseas visitors? What about asylum seekers, and what about failed asylum seekers who should have been sent home but have not yet gone? A whole series of questions has to be asked about who the ““you”” is. One reason why I am a strong supporter of a compulsory identity card is that I would like to see it become a statement of entitlement to the benefits and services in this country for people who are legally entitled to be here. For other people, there would be other ways of accessing the services that they need. Therefore, I welcome the constitution but I have some doubts about it. For example, 56 pages in the handbook cover rights and pledges relating to the patient, but, when it comes to responsibilities, there are only six pages. That is an imbalance. A very useful additional management tool is the measurement and publication of data and the whole question of quality accounts. My only caveat about that is the imperative of keeping systems both accurate enough to be useful and simple enough to avoid the creation of another layer of bureaucracy. Such a bureaucratic overlay might just consume resources, which will continue to be scarce, rather than give value in terms of the benefits arising. I found it difficult to get enthusiastic about personal budgets and direct payments, but I listened with great care to the noble Baroness, Lady Campbell of Surbiton, who gave an interesting and moving personal example. However, it depends on how far and how wide the question of personal budgets and direct payments goes. We all know from experience that the National Health Service is not the best at operating large-scale computer systems or securing patient information at the necessary level of confidentiality. Therefore, when I see new systems being introduced for personal budgets and direct payments, although I am willing to give the whole idea a fair wind in our examination of the Bill, I certainly have some doubts about size, scale, propensity to fraud and the ability to manage data inside as complex an organisation as the National Health Service. However, I do not like the idea of a large number of people directly receiving cash to provide their own health service; I remain to be convinced about that. I hope that innovative prizes are widely based and are not limited to the great and the good in the National Health Service who in the past have been the recipients of merit payments. There has to be a wider base, because it is not only expert doctors in the NHS who can have good ideas about innovation. I hope that we will include in the scheme ambulance men and women, paramedics, cleaners, caterers and porters. Even patients may have ideas about innovation and how to change things for the better. Of course, I totally welcome the contribution that doctors, nurses and other health professionals can make, but I do not think that their contribution to innovation is exclusive. I am all in favour of reducing smoking as much as possible and I listened with great interest to all the arguments about tackling the problem of tobacco at the point of sale. I am convinced that the only alternative to doing that, if we are to discourage young people from smoking, is to deter through taxation. There has never been a better time than today for punitive additional taxes on tobacco: there is very low inflation; it will not have a seriously detrimental effect on the rate of inflation to be declared during the next year; and we will not see it feeding through into inflationary pay claims. If we do not do something about reducing smoking, as is suggested in the Bill, or if there is an attempt to knock out Part 3 of the Bill, I will perhaps look to make some suggestions to the Government about what they should do in the next Budget in relation to taxation on tobacco. While the Government are at it on tobacco, I find it quite illogical for them to be seeking to deter smoking without in parallel seeking to deter the consumption of alcohol. The cost of alcohol-fuelled accidents and the carnage that we see in so many of our towns and cities, particularly on Friday, Saturday and Sunday nights, when enormous alcohol-fuelled damage is done, are borne partly by the police and substantially by the National Health Service. I look for the Government, if not now, then at some other time, to say that they regard alcohol as a threat to the financial interests of the National Health Service and to the health of our people. The Bill has clear purposes to ensure the highest possible standards of care and to empower individuals to help shape the care that they receive. I agree with those purposes and support driving up the quality of the health service through the proposed quality accounts. Despite the caveats that I have expressed, I welcome the Bill and the main purposes that lie behind it, and I will give it my support during its passage through this House.