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Health and Social Care Bill

I support Amendments Nos. 25 and 93. In the event of the Bill being passed, I should like to see either of the amendments on the face of the Bill. No doubt the Committee will be relieved to hear that my remarks can also be applied to Clause 2 stand part and that I do not intend to speak when we get to that part of the proceedings. Amendment No. 25 goes a little way towards recognising that this reorganisation of the regulatory bodies is a bad thing—I am quite sure of that. We have heard from other noble Lords that social services will suffer and that certainly mental health services will suffer. I appreciate the Government’s attempts to reduce the number of quangos associated with the NHS. The other day I was sent a list of them; it is quite big. There are 65 quangos associated with the NHS. Twenty have been abolished in the last couple of years so there must have been many more than 25. The Government are doing well. I agree that there are far too many, but if these commissions are such a good idea and too many quangos are such a bad idea, why on earth did the Government not do what the Liberal Democrats suggested three years ago, which was to set up a commission to cover all three services? I cannot understand why the Government have done it this way. If we break again for a Division in the Chamber, the Minister will have another opportunity to check up on the exact cost of this reorganisation, because despite having seen various documents I am still not clear on precisely how much it is going to cost. The three bodies will have to disband the buildings they occupy, whether they lease or rent them, and be set up somewhere else. Staff will have to be paid off and new staff taken on. I would like to know what the costs are for doing all that, and perhaps be told, for example, how many midwives that money would pay for if it were used on them instead. The three bodies to be merged by the Bill have been in existence for only three years, which is a pretty short time. They have just settled down nicely and presumably are content with their offices and organisational structures. They probably have the right kettles to make tea, which in my experience is one of the most important things. The first consideration in a reorganisation is where you will be able to make the tea and eat your sandwiches. I hope that they have a clear idea of what they are doing. In my short time with this brief I have been impressed by the work of the Health Services Commission, CSCI and the Mental Health Act Commission, but instead of a merger being allowed to evolve, along comes a totally unnecessary reorganisation imposed from above. I have to say that it feels a bit like a job creation scheme for the Civil Service. I have enormous respect for the civil servants in the Department of Health but, as we plough through this Bill, I am beginning to wonder whether it is not just something to keep everyone occupied. I am going to speak from my personal professional experience, although no one could match the eminence of noble Lords in this House. I worked in the health service for 33 years and I was there at the coal-face. My husband was a hospital doctor working as a neuroradiologist, so my family never understood what he was talking about. But I think they understood what I did; indeed, they used to call me ““Barefoot Doc”” because I was in general practice, community services and family planning. During that time I was also a chair of social services for my borough, so I saw things from the lowest point of view possible. One of the problems I encountered during my last 20 years in the health service was implementing reorganisations. It took over almost two-thirds of my professional life. At first I managed women’s services, and then after a reorganisation I managed community health services, but they were reorganised into oblivion. I am still hoping that polyclinics will encourage a resurgence of what we used to call community health services. However, and this applies equally to the commissions as well as to government reorganisation, each new chief executive that appeared had to do his own little reorganisation. They would tinker with the structure, and sometimes it seemed to be something just to put on their CVs before they moved on to new positions. In my experience, reorganisation is the absolute curse of the health service. I hope that the noble Lord, Lipsey, will help me with this since I am supporting his amendment. We had permanently displayed in our offices and clinics the Latin tag attributed to Gaius Petronius, whoever he was, which translates into English as: "““Just as we had formed teams and were working well, along would come someone who would reorganise us and cause complete confusion while trying to give the appearance of progress””." Do civil servants or Ministers have any idea how damaging reorganisations can be, especially after such a short time—three years, barely time for them to know precisely what they are doing? Why do we not merely insist that the three existing commissions work from the same building? In my experience, I find that people who work from the same building, who share the same tea-making facilities and go to the same cafes at lunchtime, share ideas and get together much better. It certainly happened at local level with health and social services workers, so why not with the commission? Why oh why cannot it evolve instead of breaking up three very efficient organisations? I have listened very carefully to what Sir Ian Kennedy and Dame Denise Platt have said, and I respect those two individuals immensely. I repeat that this reorganisation will overshadow social care and mental health care in this country, because the commission will have to concentrate on the health service. The Government are taking a step too far, far too quickly, in an attempt to look busy. I am very happy to support the amendments in an attempt to retain some of the expertise in the commissions that will have to be disbanded.