Health and Social Care Bill

My Lords, it is indeed rare for this Motion to be moved in your Lordships' House. We have come to the final stage and the final reckoning of this Health and Social Care Bill. I have thought long and hard about whether this was the right thing to do. We have to balance the reasons for moving this Motion against the reasons for allowing the Bill to pass with the ritual congratulations and mutual sighs of relief. The test for the House surely is whether this Bill will deliver an NHS that is better for patients. Most importantly, does this Bill fulfil the Government's stated policy aims? Much as I wish that were the case, I think that this Bill does not pass that test. That being said, there is no doubt that the Minister has achieved a remarkable result. No one else but he could probably have achieved so much. The politics of the Bill, and the relationships in this House between the coalition partners and between the Government and the Cross Benches could not have been dealt with more gracefully than by the Minister. The Government owe the noble Earl, Lord Howe, a huge debt of gratitude and, indeed, so does this House. There is no doubt that this House has made this Bill more respectable in some areas. We know that for example, astonishingly, it came to us with little or no mention of health education, training or research—remarkable, really. We have undoubtedly made some progress on issues such as the Secretary of State's powers and there is no doubt that many noble Lords, particularly on the Cross Benches, have worked incredibly hard and tried to put right as much as they could. I congratulate them all. The tipping point for me, and what decided me to consider this action, was quite recent. It was when I realised with the further dozens of amendments proposed by the Minister on the arrangements for local healthwatch, the patient's voice, the Government had vanquished all hope of any coherent, strong, local patient organisation. We all recall the mantra at the start of this journey, ““No decision about me, without me””. At the end of this journey, what do we find? The national independence of the patient's voice, HealthWatch, is a mere sub-committee of the CQC. We have the complete removal of the statutory basis for local healthwatch, which it now appears will be run as some kind of local authority franchise and will not deliver a strong patient voice any time soon. We should stop pretending that, ““No decision about me, without me,”” holds any credibility at all. The second major platform for the Ministers who introduced this Bill was another mantra—the liberation of GPs and more recently, clinicians. Greater involvement of clinicians in commissioning is a laudable aim, with widespread support. This House should look beyond that aim to ask if the Bill will deliver this in reality. As the Bill has progressed, GPs and other clinicians have become increasingly aware that the promised liberation will not come. GPs have no greater commissioning powers than existing PCTs and less support in delivering their functions and many have come to realise that they are being set up to be the local fall guys for commissioning services from a budget that must be cut by 4 per cent per year. Clinical commissioning groups are complaining that this is not what they signed up for. They are being offered all the responsibility and none of the power. We need to remember that these two factors—liberating patients and liberating GPs—were the cloak behind which the rest of the Bill stood. However, we on these Benches were never deceived. We have said from the outset that the purpose behind this Bill was to prepare the way for ultimately—though perhaps not for several years—for the fragmentation of the NHS, with hospitals competing instead of co-operating and using the rule of contract and lawyers instead of collaboration to solve problems. The Liberal Democrats have speeded Andrew Lansley on his way. Thirdly, we were promised less bureaucracy. We now have a veritable alphabetti spaghetti of a structure. We have the Secretary of State, the Department of Health, the national Commissioning Board, four regional hubs, 30 clinical support units, 250 clinical commissioning groups, 50 national Commissioning Board outposts, 15 senates, HealthWatch, health and well-being boards, the CQC, Monitor and the new public health structure. Again, Ministers have comprehensively failed to deliver their own promises of less bureaucracy. Finally, we have precious little coherence to the interface between health and social care in this Bill. When some of us tried to improve the working together of health and social care, which is vital to the success of both sides, the Minister refused and the government parties voted against it. It is the case that Part 3, the introduction of the forces of market competition into a fragmented NHS, where the inserted duties of co-operation will inevitably wither in the face of competitive commercial pressures, is still there and is still coherent. The proposed biggest experiment on the NHS ever is reaching its conclusion, but unlike most experiments, we have not been allowed to know all the evidence. Last Tuesday on the final day of Report the Minister made a final and devastating admission, and I thank him for his honesty. He said: "““The Government are undoubtedly fighting a battle to convince the medical community of the merits of the Bill, a battle that we have so far not won””.—[Official Report, 13/3/12; col. 258.]" That sends a chilling message from this Chamber to the professions and to the public. We have the cliff edge in front of us and the Government finally acknowledging that nothing they have done has won over those who now have to make this tangled mess work. Nothing has persuaded the professionals or the public—all of this time, the pause, the concessions. Nothing has worked. Last week the Minister went on to promise more consultation. I have a question for him. Given that the Royal College of Physicians has come out with very grave reservations only this weekend and that No. 10 and Department of Health appear to be refusing to talk to any organisation that has asked for the Bill to be dropped, who is this consultation to be with? Can the Minister confirm that, for example, the following organisations will be on the invitation list this time—the Royal College of General Practitioners, the BMA and the Faculty of Public Health, to name one or two that have made their views on this Bill known? It is often said that this is a House of wisdom and expertise. I invite noble Lords to listen to the wisdom and expertise of those in the NHS whose message is deafening in its consistency—they do not want this Bill. I would not have thought it possible, but this Bill has been haemorrhaging support for almost two years, and now has very few friends. Despite that, we need to be deeply grateful that we can rely on the professionalism and the conscientiousness of doctors, nurses, physios, surgeons and many others who are now considering how they can salvage this Bill and keep the show on the road. There is no doubt that many noble Lords have worked incredibly hard to try to turn this sow's ear of a Bill into a silk purse worthy of passing from your Lordship's House. I pay huge tribute to those efforts, to which we on these Benches have contributed. However, improving a bad Bill into a Bill that is marginally less destructive is not a good reason to vote for its passage. We have to look at the whole Bill, not just the parts that individuals have championed, and ask whether we have succeeded. I regret our failure on these Benches, but I regret more that noble Lords on the Liberal Democrat Benches were unable to find their way to vote for measures that could really have protected the NHS. We tried and we failed, but at least we tried. The patients and staff of the NHS know that we have tried and that we have not been diverted from that purpose. The people know that it was the Labour Party which created the NHS. It has been the Labour Party in opposition which has tried so hard to protect our NHS from the worst ravages of this Bill. We have done our duty and people will remember that. I beg to move.