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Lord McIntosh of Haringey: My Lords, I am grateful to my noble friend Lord Borrie for his welcome for the Statement. I shall let him into a secret—I have not read the report either. I received it as late as anyone else and I have read as much of the surrounding documentation as I can.
My noble friend is right. The Competition Commission found, after a rather complicated accounting analysis, that the four principal banks have made excess profits of £725 million per year over the past three years. That is the period with which it was concerned. He asked why we have accepted the Competition Commission's recommendation that there should not be a windfall tax on the banks. Although there are good precedents for windfall taxes—after all, the noble and learned Lord, Lord Howe of Aberavon, imposed a windfall tax on banking profits in 1981, and so it is not unheard of even in the banking sector—we felt that, on balance, on this occasion it was more important to put matters right for the future rather than to seek penalties for the past. Small and medium enterprises are looking for action in the future.
Lord Skelmersdale: My Lords, I have declared my financial interests at the micro end of the small and medium enterprise scale many times before and I do so again today.
The Statement refers to a transitional remedy—or, rather, four transitional parts of a single remedy. My interest lies in two of those transitional parts. As I understand the Statement, the banks are either to pay interest on SME accounts, or they are to offer a current account free of money transmission charges, or a choice between the two. From the point of view of SMEs, the result will be a trade off between cash flow and lower costs.
Be that as it may, I am always slightly suspicious of the phrase "transitional remedy". Transitional remedies attached to Acts of Parliament and so on are sometimes of short-term duration and sometimes of long-term duration. Like everyone else, I have not read the detailed background to the Statement but I know that there is a whole string of long-term remedies. Does this mean that the transitional remedies will disappear when the long-term remedies are completely effective?
Lord McIntosh of Haringey: My Lords, I, too, should declare an interest. I have spent most of my
working life owning and running a small rather than medium sized enterprise. The noble Lord's analysis of the proposed remedies is right. Their intention is to secure greater competition. The matter will be kept under continuous review by the Office of Fair Trading. It is conceivable that, if the remedies are applied as we intend they shall be, after a period of time there will be evidence of greater competition in these markets and it will be no longer necessary for this undertaking to continue. But that is some way into the future. Let us get justice for small and medium enterprises first and then look at the effectiveness of the longer-term remedies.
Lord Brooke of Sutton Mandeville: My Lords, as the banking problem in rural areas is not so much a lack of access to bank branches for new entrants to the market as a lack of access to any bank branch for banking customers at large, can the Minister say what progress has been made on enhanced facilities through post offices in rural areas, without whom this Statement about competition remains somewhat academic?
Lord McIntosh of Haringey: My Lords, I said in response to the noble Earl, Lord Northesk, that there is no read-across from the proposals for a universal bank, which are still going ahead. The idea of a universal bank—to which I think the noble Lord, Lord Brooke, is referring—is that it should offer very basic banking services, particularly for those who are without bank facilities at the present time. It is unlikely that that will apply to many of the small and medium enterprises with which the report and the Statement are concerned.
The noble Lord is right. The reduction in the number of bank branches in rural areas is a serious problem, but as it is not seen as a competition issue the Competition Commission did not consider the matter. However, the Government are well aware of the problem and wish to see it resolved.
National Health Service Reform and Health Care Professions Bill
5.6 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
Moved, That the House do now resolve itself into Committee.—(Lord Hunt of Kings Heath.)
On Question, Motion agreed to.
House in Committee accordingly.
[The DEPUTY CHAIRMAN OF COMMITTEES (Lord Ampthill) in the Chair.]
Baroness Cumberlege moved Amendment No. 1:
- Before Clause 1, insert the following new clause—
NATIONAL HEALTH SERVICE AGENCY FOR ENGLAND
(1) There shall be a body corporate to be known as the National Health Service Agency for England (referred to in this Act as "the English Agency") for the purpose of carrying out the functions transferred or assigned to it by or under this Act.
(2) The functions of the English Agency are performed on behalf of the Crown."
The noble Baroness said: Before I speak to my amendments, I declare an interest as a board director of Huntsworth plc, as an associate of Quo Health, as an unpaid chair of St George's Medical School, and I am involved in a number of charities, also unpaid.
In moving Amendment No. 1, I shall speak also to Amendments Nos. 2 to 6. I do so with great optimism. I have no doubt whatever that the Minister will embrace them with the fondness of a familiar friend. In his former life as chief executive of the NHS Confederation, the Minister promoted a similar model. I am not looking backwards; I am looking forwards and seek to modernise. The purpose of the proposed new clauses is to remove politicians from the direct management of the NHS and to set up an agency for that task.
So, with a bit of luck, I could have the support of the Minister and the Secretary of State's special adviser. Better still, I know that I have the support of the noble Lord, Lord Desai, who is an internationally distinguished economist and sits on the Government Benches. He is launching a special and important book tonight. His book contains well over 300 pages, and I am sure that it will be read in academic circles and beyond. I am grateful to him for being here today and supporting these amendments.
I also have the support of the twin Baronesses of Llandaff, if I may call them that. Llandaff is clearly a place of great resource and sagacity. They also have put their names to these amendments. That is very important to me because the noble Baroness, Lady McFarlane, was the first professor of nursing in the UK and has been an outstanding leader of nurses, and the noble Baroness, Lady Finlay, is a medic with an international reputation in the field of cancer care. In tabling these amendments, I was anxious to obtain the support of health professionals because I believe that health professionals really know the consequences of political interference, and, of course, there is nothing more compelling than personal experience.
It is true that politics and politicians have never been able to sustain the reputation for goodness. But political input into the NHS is, of course, necessary, since the wise men from the Treasury bring the great and essential gift of money. Therefore, political accountability is a major issue. However, politicians are handicapped. They have to run the NHS in four or five year races between elections. That in itself is incompatible with managing a huge and complex organisation. The dash to do something when targets are not met or when things seem to go awry is irresistible. As the press cuttings mount, the panic increases and another ill-thought-through initiative is directed through the system, another reorganisation of the management, as if that will solve the problem.
As the noble Lord, Lord Clement-Jones, said at Second Reading, health Ministers have gone into initiative overdrive, and the right reverend Prelate the Bishop of Birmingham pleaded for the NHS to be left alone. That view was echoed by the former Secretary of State, the right honourable Mr Frank Dobson, who recently wrote in the February edition of the Nursing Standard:
Effective managers know that successful change is brought about not by endless tinkering with the systems but by inspiring leadership and well-motivated staff. Real change has to be effected from the bottom up. What really matters is what doctors, nurses and managers do, how they are trained, how they are motivated, what they feel about the world; and at the moment it is not good.
I suspect that the Minister will know from his many travels around the country that NHS managers have had to re-apply for their own jobs sometimes five or six times in 10 years. As a result, too many of the best find something better to do and leave. We are losing a whole cohort of experience, knowledge and wisdom from the NHS.
When the NHS trusts were introduced they were an innovation; they devolved power. I remember that as a former regional chairman I considered that my most important role was to seek out the best people to chair those new trust boards and to ensure that the non-executives would make a significant input, bringing wisdom, knowledge and a wider perspective to the management of those boards. We were successful, too. We appointed the noble Baroness, Lady Hayman, to chair a trust, the noble Baroness, Lady Dean, to be a non-executive, and the noble Baroness, Lady Jay, to be a member of a health authority, to name but a few. It was very important for us to get the best people, because the chairs and the trust boards appointed the chief executive and the management team. The boards made the strategic decisions, and when things went wrong the chairs fell on their swords.
That has now changed. Today the word "trust" is a misnomer. Trusts are not to be trusted. The trust boards do not appoint chief executives—Ministers do. When things go wrong, Richmond House sacks the chief executive by e-mail. Even the department is not trusted. Decisions are taken by the Cabinet Office special advisers, unseen people known only to the most high.
The clauses that I move today do not further disrupt the delivery of services to patients. They do not give birth to another quango. Rather, they are there to build a new relationship between patients, politicians and NHS staff. They are about transferring one part of the organisation into a different position, transferring those powers and responsibilities.
The amendments that I propose are mirrored in the clauses to be moved by the noble Baroness, Lady Finlay, reflecting the Welsh dimension. My first amendment inserts a new clause before Clause 1 of the Bill. That clause establishes a new corporate body, to be known as the National Health Service Agency for England, whose functions are performed on behalf of the Crown.
The second proposed new clause sets out the composition of the agency, with 12 members, a chairman, a deputy chairman, five non-executive members and five executive members. The chairman of the agency will appoint a chief executive, the appointment to be approved by the Secretary of State. That follows the pattern of other agencies and seeks to get the commitment of both the board and the Secretary of State. Without the confidence of both those parties, the chief executive could have no hope of success. Since this body will be pivotal in managing the NHS, I have given the Secretary of State the power to prescribe its constitution by regulation.
The third proposed new clause describes the functions of the English agency and gives power to the Secretary of State to amend the functions through affirmative regulations and to give directions on strategic matters relating to its functions. The fourth new clause concerns the transfer of property, rights and liabilities necessary for the discharge of its functions. The fifth concerns the financing of the agency and its accountability for the spending of public money. The sixth and final clause ensures that the agency is accountable to Parliament. It will be open to the committees of both Houses to scrutinise the agency's activities.
In drawing up these clauses, I have taken a great deal of advice, and I am grateful to all those who have helped me—not least the King's Fund. However, I am under no illusion that they are probably imperfect and could be improved. Therefore, my purpose today is not to produce a blueprint but to keep the King's Fund initiative going and to instil in people's minds the fact that there is another way, a third way, a better way to run the NHS.
This is not new territory. There are a number of models, such as the Higher Education Funding Council for England, the Medical Research Council, the Food Standards Agency, the Audit Commission,
When the King's Fund produced its report, the response in the national media was amazing. The headline in the Independent, above an editorial by Donald Macintyre, was:
In summing up, I want to be fair to politicians but governments have a pretty disastrous record of managing organisations. They are poor at it because the majority of them have no experience. I exclude the Minister, who has very successfully run an organisation with a commercial element to it, but that is an exception and he is exceptional. Politicians have to work within an impossible electoral cycle, and they are nomadic. Ministers and Secretaries of State do not last, so there is no continuity. On Second Reading, my noble and learned friend Lord Howe of Aberavon told the story of a civil servant who had worked for 17 different departments for 43 Ministers, but always in the same room.
The speed of change in medicine is a huge challenge, and change needs a robust organisation to manage it. My amendments are a first step to a separation between politics and health, to take the day-to-day management of the NHS seriously. I am not advocating a private NHS run for profit, but a competent, effective board of directors to appoint the best managers—a board that will be accountable to the Secretary of State and to Parliament; a board that will establish and run, on a day-to-day basis, an organisation that suits the needs of the health service, not the imperatives of a manifesto.
The organisation that I am advocating is not one further to disrupt the delivery of service to patients. I ask all noble Lords, and Members of another place, to look deeply at the performance of politicians, and at the political system, as to its suitability and effectiveness in running the NHS; and to ask the following questions. Do we have a health service that befits the fourth largest economy on earth? Is the taxpayer getting value for money? Is each person getting what he or she needs from the National Health Service? After a period of introspection, perhaps we the politicians ought to have the courage to fall on our swords and leave the detailed management of healthcare to others. I beg to move.
"The public want accountability but are not very keen on the fact that the responsibility for it lies with the elected politicians, whom they don't altogether trust".
The words are not mine but those of Mr Paul Corrigan, written only last summer, in regard to a new model for the NHS. Members of the Committee who are Whitehall watchers will know that Mr Paul Corrigan is now the special adviser to the Secretary of State—and all noble Lords will surely be aware of how special a special adviser is.
"Most people in the NHS don't want another round of management reorganisation. They want to be left alone . . . By the time I ceased to be Health Secretary, I realised that NHS management and staff needed more discretion to be able to respond to the varying needs of local patients, make best use of new methods of working and new equipment and play to the strengths of local clinical teams".
I think it is sad that he did not stay a little longer.
"If only politicians could keep their hands off the NHS";
in the Evening Standard,
"Politicians are crippling NHS, warns Lord Haskins";
and on the BBC website,
"Ministers should stay out of the NHS".
I could quote many more examples. This is a very popular initiative among the public. It is even more popular among those who work in the NHS.
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