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NHS: White Paper

My Lords, I am sure that the House will be grateful for the noble Baroness’s questions, although I have to express considerable disappointment that she finds so little to commend in the White Paper, which to me is a very exciting document, and one which builds in many important respects on the structures which her Government put in place. Lest it be thought otherwise, I am the first to knowledge the improvements in the health service which the previous Administration effected. They did so with the benefit of a great deal of extra public funding and no doubt we should be grateful for that. The problem that we perceive is that despite the progress that was undoubtedly made during the 13 years of the Labour Government, one thing did not keep up with funding: the outcomes that we saw emerging from that increased investment. The fact is that we are not matching the performance of our counterparts in Europe in a number of respects: in cancer survival rates and an array of other conditions. That has to change. We have asked ourselves how we can best deliver those outcomes and the quality of care that the noble Lord, Lord Darzi, envisioned in his strategy when he became a Minister. We want to build on the work of the noble Lord, Lord Darzi, and we believe that this programme of action will do that. Our plans for GP consortia are very much based on practice-based commissioning arrangements and clusters. Our plans for economic regulation build on the work of Monitor. Currently, many of the functions of the NHS commissioning board already exist within the Department of Health. We are carving them out and slimming them down by stripping out avoidable layers of management. We have always been clear that we want to have GP commissioning, and our plans are the logical extension of that. I must comment on the noble Baroness’s first remarks about the leaks to the press. I very much regret them. We do not know where they came from and are making the kind of investigations that she would expect. Our policy and our aim are always to make announcements of this kind to Parliament in the first instance. I am sorry that that has not happened in some cases. The press coverage has not been accurate in all respects. I hope that when the noble Baroness digests this White Paper, she will come to view it rather more favourably than she has indicated. She suggested that our proposals are ideologically driven. There are only two pieces of ideology here: the desire to continue the quality agenda that the noble Lord, Lord Darzi, started and a desire to bring health and social care much closer together. The proposals for the role of local authorities will achieve that and, at the same time, they will introduce a greater degree of democratic accountability. Accountability will operate on several levels, and the noble Baroness asked me about it. There will be accountability to Parliament through the Secretary of State via the NHS commissioning board, which will hold GP consortia to account for the money they receive. At a local level, there will be accountability through HealthWatch and local authorities. That dimension of local authorities’ remit to enable them to have a say in the planning and configuration of services at a local level is a very important development because it will enable public health, social care and the NHS to be looked at in the round. The noble Baroness asked whether we envisage any limit on the use of the private sector by GP consortia. The principle that we will adopt is that GP consortia should take on as much responsibility as they wish. The national commissioning board will support them in developing the necessary expertise but, if they want to, we are proposing that they should be able to seek support from elsewhere, including the private sector, within their budgets. In no sense are we proposing a privatisation of the NHS. In particular, lest anyone should think otherwise, our proposals for foundation trusts do not do this. I refer noble Lords to paragraph 4.21 of the White Paper, which makes this unequivocally clear. There are certainly risks in managing the transition. Indeed, managing risk is not a new problem in the health service—it has happened since time immemorial—but the NHS chief executive and Ministers are extremely mindful of the need to control and manage risks, particularly during the transition. David Nicholson has set out the framework for implementation, with clear plans to minimise risk such as shadow-running bodies for a period of time. It will take time for these changes to become fully embedded. That is a good thing. We recognise that not all GPs will be able to go at the pace of the fastest, and those who are not in the vanguard will be supported appropriately, but we are clear that GP commissioning is the way forward. It will align decision-making for clinical care with decision-making for financial flows. These are segregated at the moment. If you bring them together, commissioning is much more likely to be cost-effective and in the better interests of patients. While I recognise that the noble Baroness has anxieties, I hope that my colleagues and I can reassure her over the weeks and months ahead that this is a programme to be excited about, rather than the reverse.