My Lords, of course I accept that. We accept that in the NHS, do we not? You have only to look at the recent inquiries to know that the NHS is not perfect. What I am trying to put over is that by using a wider range of providers you can improve services for the NHS, but of course you need regulation and somebody ensuring that the quality is high. It is not perfect in all cases—of course I accept that—but it is not perfect in the NHS either. I do not think that any of your Lordships would not rejoice in better services that enhance patient care being provided. That is what we are all about. My view is that competition involves not a yes/no ideological choice but a pragmatic and nuanced judgment about how, or whether, to make use of it.
That is what brings me on to these regulations. There is much in them that will strengthen the NHS. I do not want to see them annulled or to see another delay. The NHS has been in something of a difficulty
with all the changes that are being made, and it is now time to settle down and get on with it. So I do not want to see further delay. On the detail of the regulations, first and foremost I think that Regulation 2 of Part 2, which sets out the procurement objectives, is very good. It says—and I paraphrase a little—that NHS England and CCGs, when procuring healthcare services, must consider the needs of the people who use the services. So it is not about the staff but about the needs of the people who use the services.
There is a lot of rhetoric, as there has been for years, about putting patients first. However, we know that that rhetoric is not always put into practice. Again, I refer to some of the recent inquiries that we have had. In fact, we should be very concerned, as is the King’s Fund, that the UK has the second highest rate of mortality amenable to healthcare of 16 high-income countries. We should be deeply worried that we have the second highest death rate among those comparable countries. The NHS does need to change and improve. The think tanks and the people who think endlessly about the NHS all agree that it needs change. The Labour Party agrees that it needs change. The debate is about how to do it.
Regulation 2(b) refers to,
“improving the quality of the services”,
as the purpose of the legislation. Surely that is what we all want. Poor care is very expensive. It involves returning to hospital to put right what has gone wrong in the first place, litigation, poor staff morale and misery for users, families and friends. Regulation 2(c) is about efficiency. We all have a duty to ensure that money is not wasted and services are efficient. The noble Baroness, Lady Hollins, has just talked about that and what we need to do to ensure that we have commissioners of the highest order. Surely that is what we are trying to achieve.
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The regulations have been vastly improved from the original set, as my noble friend Lady Williams and others have said. I, too, pay tribute to my noble friend the Minister who, without hesitation, saw the flaws and had them redrafted. The regulations now encompass transparency and proper accountability, fairness, value for money, integration, anti-competitive behaviour, patient choice and a whole section on potential conflicts of interest. They ensure a proper role for Monitor, which obviates the need to have matters resolved in expensive and very tardy courts of law and they make it quite clear that integration trumps competition.
Having said all that, I want to say to the noble Lord, Lord Hunt, that my experience is that some of the contracts in the private sector have produced integration. When I have said to the health service, “Why didn’t you produce the integration?”, I am told, “Well, we haven’t got the time to do it. We haven’t got the resources”, or whatever. It is not all one or the other. The thing should come together so that we get the best services possible.
I want to mention briefly the concerns expressed about Regulation 5. The debate seems to be around whether contracts have to be awarded for every single service. David Lock QC, in a briefing yesterday—I thank the noble Lord, Lord Hunt, for having ensured
that we were able to hear him—said, if I understood him correctly, that unless there was an existing contract people would be denied choice. He gave an example of a person requiring nursing home care. That person would be denied choice on which home to stay in unless there was a contract covering that nursing home. Perhaps the Minister will give us a definitive answer on that and whether any qualified provider plays into that situation. Of course, another consideration, which we have not debated in all the briefings we have had, is that if that person held a personal budget, he would have great freedom to choose what he wanted.
Lastly, there is concern in the voluntary organisations. I take the point mentioned by the noble Lord, Lord Turnberg, about cherry picking. My experience is that the private sector does not want all the hassle, cost or trouble of getting a contract together when the service is successful. Why should it? If the NHS is doing very well, leave it to the NHS. The place that the private sector goes is where the NHS is doing really badly and change is needed. I do not accept the argument about cherry picking. I am involved in voluntary organisations as well, and there are some concerns here. I understand that they want stability and it is hard, when one works for a voluntary organisation, that so much time is spent trying to get funding for it. There is again a great opportunity for co-operation here.
I run a very small concern. We provide for a niche market. My company would not exist if we did not work with others to provide comprehensive programmes. We work with the King’s Fund, Common Purpose, Manchester University and all sorts of different organisations on a contract—bundling together as it has been described. It is because we are all component parts in this contract that sometimes we win them—not often enough, but sometimes. People say to us, “We have chosen your consortium because each element of what you bring is something different”. There really is merit in the well known adage that the whole is more valuable than the component parts.
Tonight is another opportunity for my noble friend, as he has done so often in the past, to give some comfort to those who are anxious about these proposals. I admire the diligence of the noble Lord, Lord Hunt, who so often scrutinises these regulations. This needs to happen, but I share some of the views expressed by my noble friend Lady Williams that there has been so much misinformation. These regulations have caused so much angst and worry, which has been a real pity and unnecessary. However, there is room for clarity and I think this is on its way. Some further guidance, too, is necessary to enable a proper understanding of the regulations. Perhaps my noble friend would comment on that.