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Debate on the Address

My Lords, I congratulate the noble Lord, Lord Darzi, on his speech. I am delighted to see him here at the Dispatch Box. Before I address the issues in the Queen's Speech, I shall mention his interim report, Our NHS, Our Future, to which he referred in his opening speech today. It is said that this report had to be hurried. None the less, it is very interesting, because it comes from a surgeon. The noble Lord's skill is indisputable. He leads in his surgical field, and his reputation is international. The opening words of his report are: "““I'm a doctor not a politician””." Your Lordships must be sympathetic. After all, doctors and surgeons must be at the top of the popularity table and we politicians are, I fear, near the bottom. The traditions of this land require every Minister to be answerable to Parliament, and I find myself strangely at one with the right honourable Prime Minister, who, through the Queen's Speech, said: "““My Government is committed to openness and accountability, and to a strong Parliament able to hold the Government properly to account””.—[Official Report, 6/11/07; col. 3.]" The noble Lord, Lord Darzi, has for better or worse allowed himself to be appointed a Minister of the Crown, and therefore he is accountable to Parliament. In this House that is onerous—I know, I did the job for five years. In your Lordships' House the Minister is on his own, a solitary figure, whereas in another place there are cohorts—well, five—each with a portfolio of special interests. That luxury does not extend here. The Minister has to cover every aspect of health in every corner of England. I have no doubt that he can assimilate all the information very quickly while constantly checking on visits nationwide. Trying to manage a service that ultimately employs a staff of 1.3 million while attempting to meet the aspirations of the British public is taxing, in both senses of the word. That is especially true in an area that is so politically sensitive. Scarcely for a moment is the NHS out of the headlines. As a surgeon, the Minister may not wish to concern himself with the question so frequently asked within the service and outside: ““Where has all the money gone?””. That is a harsh political question for the Government—a Government whom he has chosen to join. In his opening statement, the Minister spoke about his passion for quality. That message is well known to this House and the NHS. The noble Baroness, Lady Jay of Paddington, who was the Minister of State for Health in September 1997, put out a press release with the headline: "““High-quality not 'bean counting' to be central NHS priority””." She went on to say: "““Too often in the past the emphasis has been on service activity and on a narrow definition of efficiency measurements: quantity, not quality. Managers and health care workers have all been asked—often against their own better judgement—to concentrate on targets like patient throughput and bottom line accountancy rather than measuring success by the quality of what they are offering””." The noble Lord, Lord Darzi, stated in his report 10 years later: "Patients have told me that they still sometimes feel like a number rather than a person””," and later, "““targets … [are ] not always the answer and sometimes they can seem perverse””." Although I have to say full marks for honesty, this Government are extremely slow learners. Having negotiated a fairytale contract for GPs, the Government are now having to entice them back to the awful grind. This acknowledges that illness does not strike in the 40 or 50 hours the practice may be open on five days a week but can occur in any one of the 1,268 hours in the week when the GP should be there as the lead health professional. The Minister endorses the idea of super-clinics—certainly an idea for fierce political debate if only because it is highly contentious and, according to the BMA, probably flawed. Why not build on the network of existing community hospitals rather than close them? Why close so many maternity units when even Ministers are marching in the streets to save them? Saving them, from themselves. I do not want to discuss these issues now but I remind the Minister that these are highly charged political questions that must be answered, in almost all cases, by him. Why? Because he is party, with his fellow Ministers in the department, to making these policy decisions. In the forthcoming parliamentary year we look forward to two major health Bills. The first, likely to start in this House, is the human fertilisation and embryos Bill which was published in draft form earlier this year. I agree with the noble Lord, Lord Harries of Pentregarth, that that is a very good process to follow. However, among other things, the Bill will contentiously remove references to the need for a father, as the noble Baroness, Lady Deech, said, and also recognise same-sex couples as the legal parents of children conceived through the use of donated sperm, eggs or embryos. I can see many hours of debate with contributions from those with great expertise, including the noble Baroness, Lady Deech. I am delighted that the Minister will be taking this Bill through your Lordships' House with, I am sure, huge clarity and skill. What concerns me is the second Bill, the Health and Social Care Bill, which has been dubbed the ““medical professions shake-up””. This could be equally contentious, with the big health battalions scrutinising every word. Apart from amalgamating two major commissions and part of a third, the new Care Quality Commission will have tougher powers and will allow a civil rather than a criminal standard of proof. There will be a new independent adjudicator to review decisions taken by the regulators. All healthcare organisations will have to appoint a responsible officer who will work with the General Medical Council to, "““identify and handle cases of poor professional performance by doctors””." Having spent a year leading a working party on medical professionalism for the Royal College of Physicians and a second year selling it through road shows to the profession, I know how fragile professionalism can be. The Bill must do nothing to jeopardise, but rather to strengthen, the trust that the public have in doctors. As I understand it, this challenging Bill will not be taken through by your Lordships' accountable Minister, as he is perceived to have a conflict of interest; and here is the rub. It would be a terrible loss to surgery if the Minister gave up his practice, but if he is to be effective as a Minister—a top-flight politician effectively answering to the people through Parliament—surely he must agree that he has accepted a post as a politician under our constitution. He is a Minister of the Crown in a Labour Government, a Government who have more than doubled the NHS budget, reduced output per employee, introduced real fear in patients going into hospital when hospital-acquired infections kill thousands, and made an incredible mess of junior doctors' employment. There is much political work on his plate. In conclusion, I am sure that the whole House wishes the noble Lord, Lord Darzi, every success, as do I. But it is fair to say that we in your Lordships' House have every right under the constitution to expect the Minister to take major Bills through this House and to attend when required. It is the duty of the Minister—crudely, it is part of the job—to be available, so that he can be called to account for his Government's policy. I appreciate and have great sympathy that the Minister has a serious dilemma, and a choice that he alone can make.