My Lords, “It’s a Sin”: I invite noble Lords to think back to 40 years ago, when a deadly virus came out of nowhere. The NHS had just gone through the most radical change in years; it had developed a purchaser/provider split. We should now go back and look at everything that followed from that. I congratulate the noble Lord, Lord Stevens, on his remarks, in which he talked about this legislation being “evolutionary”. We have a question to ask of this Bill: to what extent do its proposals bring about change?
Looking back over those 40 years, the big changes happened when there were panics and big challenges to providers to stop them doing things that they had always done in the way that they had done them, and, crucially, when people in communities—sometimes geographical, but sometimes communities of interest—went and found the scientists and the medics and worked together with enlightened providers to bring about change. Given where we are, and given the experience of the last year, to what extent does this Bill do that?
It is a rather curious Bill; its arrival in this place was very strange. We have had very odd White Papers and a funding settlement on something that was supposed to be quite strategic, but we have not yet had the integration papers. So on the one hand the legislation is attempting to be very big and strategic, but, on the other, it seems to be all rushed and muddled. As far as I can see, it does not, for example, fully take into account some very big changes in demography.
We know that, at the moment, that we have 1 million people aged over 60 who do not have any children, and that their number will double by 2030, yet we have a health and care system that is presaged on the fact that a person will have children to oversee and manage their care. That is not in the Bill at all. It also does not take into account the enormous development and change in therapeutics and diagnostics that we are on the edge of. I want to talk very briefly about HIV. As of last week, with the major breakthrough in injectable medicine, we know that we are on the cusp of some very big changes, yet this is not reflected in the structures of the Bill.
One thing we have learned in the last year is that data and the communication of data are absolutely the driver of integration and change. I do not know whether any noble Lord has recently tried to follow a patient around a hospital—good luck with that. As for trying to follow a patient between hospital and social care—just no. What the NHS does really well is acute things in big hospitals, and it measures the outcomes. But what nobody does at all is get that same data for mental health, primary care and social care. Unless and until we begin to address the fundamental
issue of information exchange, we are quite frankly rearranging some deckchairs, because we will never get it. Given the amount of effort and money that has gone into that over the last year because of the pandemic, we should be further along the way.
I want to very quickly highlight one area in which I will be assessing the Bill quite rigorously. Both providers of the service and women know that women’s access to reproductive health services and contraception has been utterly fragmented by the 2012 Act. It is now almost impossible for young women to get access to contraception in some parts of the country. We also know that, for every £1 invested in sexual and reproductive health, the NHS saves £49. Somewhere, in all our talk of place and of integration, we really have to get to grips with some of this basic information and put it into the hands of patients, who will challenge the providers to make the difference.
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