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Lord Clement-Jones: Is not the fact that more and more powers are taken by Ministers in this
Government precisely the reason why many Members of this Chamber, including myself, are keen to question the Minister?
Lord Hunt of Kings Heath: No, I do not think that that follows. My point is that the inevitable impact of parliamentary scrutiny, given public concern about the National Health Service, is a tendency of Members of both Houses to ask the Government to take further action in relation to the health service, whatever its structure at any one time.
Baroness Carnegy of Lour: The Minister mentioned the Manpower Services Commission. I was a commissioner of that body when I came to this House. The government of the day was scrutinised the whole time concerning what the Manpower Services Commission was doing. I was not always very happy about what the Minister said because I thought that he sometimes knew what the commission was doing and sometimes he did not. But the Government's actions could be scrutinised totally. I would suggest that there is nothing here to prevent that.
6.15 p.m.
Lord Hunt of Kings Heath: The reference to the Manpower Services Commission was in relation to the report by the Royal Commission in 1979. The Royal Commission looked at the model of the Manpower Services Commission and asked whether that would be a suitable one for the National Health Service. It felt that because of the large sums of public money voted by Parliament for the NHS, intense parliamentary scrutiny would be inevitable. Therefore, it felt that that kind of model was not appropriate for the National Health Service.
I do not believe that a national agency, as proposed by the noble Baroness, Lady Cumberlege, is an appropriate way forward. The challenge for me and for the Bill is to identify a structure to enable parliamentary accountability to be discharged, which sets national standards, allows for effective performance management of the NHS—as it must be because the NHS spends money voted by Parliament—while allowing considerable freedom of action at a local level. My contention is that that is what the Government have done.
The emphasis in our first term in office was to set up a national framework in which standards were set through the National Institute for Clinical Excellence, through national service frameworks, and inspected by the Commission for Health Improvement. Therefore, there is a strong set of national standards with an independent inspectorate. The NHS Modernisation Agency can help improve performance at local levels. Within that context, by setting that national framework, one can then allow much more freedom at a local level. That is what the Bill proposes by the establishment of strategic health authorities and principally by ensuring that primary care trusts, which are close to the frontline, have the bulk of NHS resources.
I say to the noble Earl, Lord Howe—and we shall debate primary care trusts in due course—that my view is that, given that primary care is the crucial influence on activity in the National Health Service, devolving the budget to the primary care level makes a great deal of sense. It matches clinical responsibility with financial responsibility. I am convinced that, given the structure at national level, the commissioning of services at primary care level, we have the foundations to produce the right balance between the centre and locality.
My right honourable friend the Secretary of State has made it clear that we are keen to look at current responsibilities and freedoms of NHS trusts. In the future, he wants those trusts that are performing well to have much less intervention from the centre. We are currently developing plans for foundation hospitals, independent not-for-profit institutions with just an annual cash for performance contract and no further form of performance management from the centre, and mutuals or public interest companies within rather than outside the public services and, particularly, the NHS.
The foundation that is set in the Bill will allow that structure to flow. It will, rightly, keep accountability to Parliament for the running of the NHS but will allow much greater devolvement to the local level. That is a better response than a national corporation which—however much I sympathise with the reasons put forward by the noble Baroness—risks more centralisation and tensions between such an agency and Ministers. In the end it would not serve the purpose desired by the noble Baroness.
Baroness Pitkeathley: I offer an apology to the Chamber. It has been pointed out to me that I should have my registered an interest. I work as a very part-time consultant to a company providing nursing and residential care. I should have declared that. I meant no discourtesy to the Committee. I apologise if any was shown.
Baroness Cumberlege: I thank all Members of the Committee who have taken part in the debate. It has been an interesting debate, especially in its historical context. I particularly thank those who attached their names to the amendments.
One of the points made by the noble Lord, Lord Desai—who unfortunately has had to leave—is particularly worth mentioning. It really is fairly disgraceful that the cases of individual are dragged across the Floor of the House, discussed in great detail and then blown up in the national press. No one felt proud of the Rose Alice case. Of course there are others.
That is one of the penalties that we pay when we have politicians so much involved in running the NHS. The noble Baroness, Lady MacFarlane, was absolutely right that it was not a case of whether Parliament was involved, but the nature and the extent
to which it is involved and how it should be involved. There should be a greater distance between the Government and the NHS.I am not trying to negate any accountability, but perhaps I may address the point made by the noble Baroness, Lady Pitkeathley. She said that she felt that one could not take politics out of health. No country's parliament does not get involved in health care but it is a question of degree and how it is done. The noble Lord, Lord Clement-Jones, explained how confusion between the political and the executive has increased over the years. He made a plea for clear and common boundaries. I agree. There are many models that we can explore. The King's Fund, on which I have built much of my work, is the first to say that it must go further and that there is much more work to be done.
My noble friend Lady Carnegy of Lour drew extremely interesting parallels with the way that the further and higher education funding councils and their predecessor, the university grants committee, evolved over the years. We now see universities set free. My noble friend used the word "miraculous". I want to achieve the same for the National Health Service—a miraculous change in its effectiveness, morale and the way it is run.
I thank my noble friend Lord Howe for his thoughtful exposition of the history of the NHS and the lessons to be learnt. He was so right to draw attention to morale and the waste of resources. He was absolutely on stream but we need a strong political and intellectual debate—not just in both Houses but outside.
The Minister said that micro management is neither sensible nor feasible. We agree. But past legislation has intensified it. That is the impression within the NHS. Ministerial teams have consistently bypassed chairs and boards to take direct action in sacking chief executives. If that is not micro management, I do not know what is.
I was grateful to the Minister for referring to past reports. The reports from Guillebaud, the Royal Commission, the Manpower Services Commission and Sir Roy Griffiths were all important but from another age. The Guillebaud report was produced at a time when we still had the vestiges of post-war rationing. That was a very different world. We have to move on.
I worked closely with Sir Roy. I was the only person who sat through all the years of the NHS policy board that Sir Roy established. That board was supposed to serve as an umbrella, to protect the NHS from politicians. It was meant to be an intervening mechanism. At that time Sir Roy felt that there could not be a separate corporation or agency of the kind that I am promoting, but he was a realist. He understood not only the health service but industry, commerce and the wider world. He knew that one could not do everything at once but had to take a step-by-step approach.
The time has come for my proposal to take off. It is an idea of its time. We have many robust intellects within this nation in the King's Fund and far beyond.
I do not believe that we lack the wit to devise something that will improve the NHS enormously, help the people who work within it and give patients a much better deal.
Lord Hunt of Kings Heath: The kind of national corporation that the noble Baroness espouses might turn out as centralist as any other feature of the health service's structure through the years. Does she not think that the foundation trusts proposed by my right honourable friend the Secretary of State, which are about creating new types of local organisation, would be given considerably more freedom than current organisations provided they met performance criteria? Does not the noble Baroness accept that that could be a highly successful way of achieving sensible management of the NHS at local level?
Baroness Cumberlege: However the agency or corporation worked would depend entirely on its rules of engagement. The amendment gives power to the Secretary of State to draw up an agreed constitution. Foundation trusts could be set free but for how long? When will there be intervention? When will the Secretary of State decide that a trust's performance is not up to scratch? What will be the criteria? Many of us are concerned that decisions will be made but not according to clear and concise criteria, so that one will not know exactly when the Secretary of State will intervene.
I thank noble Lords for an interesting debate. I shall read Hansard carefully but at this time I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
[Amendments Nos. 2 to 6 not moved.]
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