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Health and Social Care Bill

This has been a lengthy but immensely valuable debate. In summing up, I begin by saying that those of us who chose to put down amendments did so in the certain knowledge that before the ink is dry on this Bill, when it becomes an Act, there will be major change within the health service. Every one of us knew that, so what we proposed to the Committee did not fall into the trap of being time-specific or inappropriate. The only certainty in the NHS is that there will be change at an ever-increasing pace. One of the most helpful contributions was that of the noble Baroness, Lady Howarth of Breckland, when she repeated the statement that she made at Second Reading that this Bill is not about improving services but about improving regulation in order to improve services. That is a key point; it summarises the need for the Healthcare Commission to have not only functions but objectives, because those objectives will be realised only by other organisations. It cannot achieve them on its own. That is why I went down the route that I did, rather than the one proposed by the noble Earl, Lord Howe, whereby the duties are put on the commission itself. It is important that those objectives are explicit and are there for all to see. That includes providers who, as the Minister said, have to share those objectives, too. I disagree with him about there being too many objectives and that they are too tightly worded, but then I would. It was useful to listen to the experience of the noble Lord, Lord Sutherland, about the role of regulators and the key point about regulators providing advice to government. He will, I hope, understand that from where we started with the Bill, getting the duty to provide advice to government seemed a step too far to begin with. Nevertheless, he is absolutely right. I take the point made by the noble Baroness, Lady Finlay, about choice being wholly and utterly dependent on resources. If we had gone into that territory, we should simply have proposed a paragraph asking the regulator to perform miracles. It just cannot do that, but it can work with providers to extend the practice of choice within existing budgets. That picks up the point made by the noble Lord, Lord Harris. He is absolutely right to say that no regulator can function wholly outwith the scope of government policy. That is why the list of objectives is as it is. Some of us happen to think that promotion of choice in the health service is a bit ambitious, but it is the stated policy of all the major parties at the moment. There is a difference between the rational expectation that any regulator will work within the framework of government policy and laying it open to being dictated to by the Secretary of State—precisely for the reason that the noble Lord gave. We are talking here about such an immense field that it must be tempting for any Secretary of State to move the regulator's work from one area to another to suit political fashion. I hope that we can pick up on that point. The noble Baroness, Lady Masham, asked what happens when regulators get it wrong. The answer is: look at what happened to the Financial Services Authority. However, that reinforces the point that we need to ensure that there is independence. I disagree with the noble Lord, Lord Darzi. I do not think that we are just talking about functions; I think that we are talking about objectives, but I warmly welcome his response. He will be as aware as the rest of us of the extensive concern expressed by all parts of the lobby about the absence of such provision, but I listened to what he said and I look forward to having further discussion about including a statement of principles in the Bill. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn.