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Health and Social Care Bill

My Lords, I begin by declaring my interests as set out in the Register of Lords’ Interests, in particular my role as chairman of BUPA, which provides independent health and social care to 8 million people worldwide. I also passionately believe in and support the National Health Service. Both elements—publicly-owned and independent—are, and always will be, indispensable parts of a single national system for taking care of all the citizens in our country. When we debate healthcare in the UK, all too often the focus is on the NHS alone. Yet the independent sector is more important than ever, providing services directly to patients, residents, insurers, and to the NHS itself. Going forward, all of us must think in terms of partnership, not rivalry. Sir Thomas Beecham once remarked at dinner, ““This pudding has no theme””, but I believe that this Bill has a very clear theme. To my mind, the theme here is precisely one of breaking down redundant barriers and replacing confusion with continuity. In particular, I hope that this legislation will help consign to the dustbin of history the false dichotomies between public and private, and also between healthcare and social care. Though I may, in due course, raise slight doubts about some of the detail, I offer the principles underpinning the Bill my wholehearted support. In future, all healthcare and social care service providers will be covered by a single body using consistent methods as that encourages, in the words of the Bill, "““the improvement of activities to which its functions relate””." The word ““improvement”” is critically important. The new Care Quality Commission must build on established best practice within its predecessor bodies, while also remaining flexible and ready to devise new approaches in response to the new challenges as they inexorably emerge. That will enable it to develop its critically important core responsibility; namely, guaranteeing minimum standards of acceptable care for everyone. The people of this country—all the people of this country—deserve nothing less. I am mindful that CSCI in particular has expressed reservations, not so much about the principle of amalgamation but more about its timing. I support the proposed schedule for the merger, while also recognising that there is attendant risk if the merger process does not run smoothly. We must be alert to that risk. From bitter personal experience in many mergers over time, I know that they always take longer than you expected, they are always more complicated than you expected, and the surprises that they spring are always unwelcome. A merger as important as this one must go smoothly and to plan. That will necessitate everyone going into the process with both their eyes and their minds open. Exemplary management will be essential for success and the immediate priority must be to ensure continuity of effective but judicious regulation. In the medium term, we must also ensure that social care is not treated as the Cinderella of this story. Social care providers are under considerable financial pressure, having received a substantially lower average increase from local authorities than the NHS has received in the coming year. The state inevitably creates considerable strains when it places additional requirements on providers without commensurate increases in income. We all know that demand for care will go on rising relentlessly. We must acknowledge, however, that the NHS and social care are now entering a period in which the annual growth in their budgets will roughly halve compared with the extraordinary surges of recent years. In 2006, a BUPA report forecast that scenario and explored how pressures on funding were likely to build up further in future. Given the likely constraints on public expenditure, the report predicted a 10 per cent funding shortfall by 2015. Those fundamental numbers have not changed. Good regulation is therefore essential, but health and social care in this country cannot and will not improve sufficiently through better regulation alone. Financial carrots and regulatory sticks work best not independently of one another, but in tandem. Nor will our care sectors achieve the high ambitions we set for them if the new Care Quality Commission takes too narrow a view of its remit. For instance, the commission must give due priority to looking at how more effective prevention of ill health can be achieved. Prevention is better than cure, and cheaper for the nation. One of the best opportunities to influence people's well-being comes while they are at work. The Government's initiative on health at work, headed by Dame Carol Black, has been very timely and her positive conclusions must not be allowed to gather dust. Preventing workplace accidents is of course important, but on its own that is a slightly old tune. The key now is also to engage employers fully in a positive and active campaign to promote better health in and through the workplace. When at its best, care in this country is already as good as you will find anywhere. That excellence at the cutting edge must be maintained and developed, but we must also endeavour to reduce the inequalities in the standard of care. That is why the new commission is so important. It will ensure that all care comes up to an acceptable minimum standard, through rigorous inspections, especially of the weakest performers. It will apply common minimum standards across different operators, sectors and regions. Those minimum standards should be just that—no more, no less—but providers should routinely seek to exceed them as the general standard of care improves over time. To conjure with that great Liverpool manager Bill Shankly's famous quip, I say that health and social care policies are not just matters of life and death—they are even more important than that. They enshrine our nation's social contract with the sick, vulnerable and infirm. They create a healthier nation, and a healthier nation is not only a happier nation but a more competitive and productive nation. The Bill represents a crucial step on a long, arduous and endlessly challenging journey. Of course that journey never ends, but our aspiration must be for the United Kingdom to have nothing less than the best health and social care anywhere in the developed world. We must aim to deliver that. The Bill marks a significant milestone on that critical journey for our country. On that basis, it is my sincere hope that it will enjoy the broad support it deserves from all parts of the House.