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Health and Social Care Bill

I am spurred on by the fact that I want to get this right and the House wants to get this right—and by the fact that the noble Lord, Lord Sutherland, thinks we might be back here in 18 months’ time. I am sure that the Minister and the Government are aware of the great concern among parliamentarians, the current regulators, those working in health and social services and the voluntary groups associated with health and social care which have given us comprehensive briefings. I take the point of the noble Baroness, Lady Howarth. There is a concern that if we do not get this right, we shall see health take over the whole agenda of the new commission. For example, if something goes wrong at St Thomas’s Hospital and something goes wrong at ““The Laurels”” down Acacia Avenue, which is going to get the attention? I am afraid the National Health Service hospital will get the attention. We need to get this absolutely right. I agree with other noble Lords that if we are to win the confidence of those who are wary of the Bill, we have to instil clarity and certainty. I agree that we need the principles, the underlying philosophy, the purpose, the duties, the mission and, above all, the vision that should underpin the Bill. Looking wider, other organisations—well-run companies, law firms, universities, NHS trusts, charities and many others—not only articulate their vision and their principles for the benefit of those whom they serve, their customers or their users, but equally they instil in their staff the vision and values that drive them. One hears phrases such as, ““These are the things that matter to us””. This is what we believe in; this is what we want to achieve. It is the anchor, it is the clarity, it is the something against which to test the appropriateness of an action, the probity of a decision, the legitimacy of a new policy or innovation. It is necessary to keep the organisation fit for purpose. I am very impressed by Cancer Research UK, of which I was a trustee for 10 years. It is the largest cancer charity in the world—it raises £1 million every working day—and it has to be very clear about what it is doing, otherwise it will not raise that kind of money. Its vision statement is very simple: ““Together we will beat cancer””. Bill Gates, the founder of Microsoft, had as his vision a computer on every desk. When I was pioneering nurse prescribing, I had to have a vision, which took 20 years to bring about: a prescription pad in every nurse’s hand. Changing Childbirth was much more difficult. After much thought, we decided our vision was that the woman giving birth should have three things: choice, continuity and control. That was adopted as the ““three Cs””. I used to go to conferences where people would not even say those words; they would just say, ““It’s the three Cs””. The Medical Professionalism project is more difficult still. What is it? Do we care about it? Does it exist? Medical professionalism signifies a set of, "““values, behaviours and relationships that underpins the trust the public has in doctors””." Imperial College Healthcare NHS Trust has a mission statement, which I am sure that the pioneer of minimal invasive surgery can recite in his sleep—although I shall not tempt him this afternoon. It states: "““Our mission is to lead the world in improving human health and to be universally recognised as one of the world’s top academic health centres. We will achieve this by providing world-class healthcare for our patients, through excellence in research, education and training””." That is clear and to the point. I am sure the Minister understands what we are trying to get at. We believe that the Bill lacks a clear statement of purpose. There is no clear framework and no criteria by which to judge the effectiveness of a regulator. Members of the Committee have put down eight amendments and more have spoken to those amendments. Many have thought about this issue deeply and have used the words ““objectives””, ““principles””, ““duty”” and ““functions””. According to the Oxford English Dictionary, an objective is something that exhibits actual facts, "““uncoloured by feeling or opinions””." I find that a bit difficult. A principle is a ““fundamental source””, a ““primary element””, a fundamental truth based on reasoning. That is better. I am sure that in replying to this debate, as the noble Lord, Lord Harris, has said, the Minister will point us to Clause 2, which concerns the commission’s functions, and say, ““That’s it. That’s what noble Lords are looking for””. But it is not. Functions are something else, although it is necessary that they are included in the Bill. I am delighted to see in Clause 2(3)(c) the words, "““the need to ensure that action by the Commission in relation to such activities is proportionate to the risks against which it would afford safeguards and is targeted only where it is needed””." During the passage of the Bill, those words will be a constant refrain of mine. They underline my thinking that less means more. However, functions are not about vision, principles and duty. The OED describes a function as an activity, a mode of action which fulfils its purpose. We are searching for a clear description not of the activity but of the purpose these functions are to fulfil. My noble friend Lord Howe has used the word ““duty””. I like that word. It is defined as a binding force of what is right and a moral or legal obligation. It is what one is bound or ought to do. To me that has clarity; there is no messing about. I believe that, in years gone by, soldiers could be shot for failing to do their duty, although that would be a bit extreme in today’s world. I like the idea that a duty is a binding force of what is right and a moral or legal obligation. I think the noble Lord, Lord Harris, used that in his amendment. I go with Amendment No. 4. It is comprehensive and succinct. The new clause would give the commission a clear mandate to act on behalf of patients, service users and the public. It would provide them with an explicit assurance that the regulator is acting on their behalf and would enable it to resolve conflicts of interest between stakeholders. It would also clarify what Parliament would like the commission to achieve rather than merely state its functions. We should not be precious about the wording as the Government are perfectly able to craft their own words, but it needs to encapsulate all that we are trying to achieve. This is not a novel idea—noble Lords have pointed to other organisations, such as the FSA and Ofcom. But I hope that the Minister and his colleagues will be sympathetic to the force of the arguments put not only by those in this House but by those whose concern has been so evident in the many briefings that we have received. I hope that the suggestions on wording are helpful, as they are sincere, and that we see clarity and certainty in the principles and duties that underlie the Bill.