Rough transcript of Lord Stevens of Birmingham's maiden House of Lords speech on the Health and Care Bill 7.12.21
The followng is a rough transcript of the maiden Lords speech by Lord Stevens of Birmingham (the artist formerly known as Simon Stevens).
This Bill is not a panacea (no legislation can be), but it removes bureaucratic impediments on working together.
Every health system in the world is moving towards more integrated care. (Shout-out here for fluoridation in Birmingham.)
A number of concerns raised about this Bill are wide of the mark. It's hard to sustain the argument this Bill moves the NHS towards privatisation; rather, it removes the EU-imposed requirement for competitive tendering.
There is a case for the Government to strengthen the Section 70 clauses, so where contracts are let to the private sector, it is done with appropriate transparency.
This Bill does not fragment the NHS. Rather, it brings together funding in localities through ICSs; removes the Competition and Markets Authority role in mergers, making hospitals better able to work together; and removes the triple-headed Cerberus of Monitor, the NHS Commissioning Board and the Trust Development Authority into NHS England.
It puts Integrated Care Systems onto a statutory basis, and allows them local flexibility: in a country as diverse as ours, one size does not fit all.
As one health policy commentator said, ‘If there were a nuclear war, the two things to survive would be cockroaches, and the regional tier of the NHS’ (This was Rudolf Klein, I think.)
The third point is that the Bill itself is not yet perfect. We have an opportunity to strengthen provisions for social care and mental health. In principle, the major challenge facing health and social care is improving the strength and resilience of uits workforce. We have so often been promised 5-15 years workforce plans, and as they come near to delivery, those plans get muzzled. Jeremy Hunt’s proposed Commons amendment would have sorted out a requirement on Government to do this, and I hope we do similar.
Another key area is the proposals on the powers of the Secretary Of State, and care is needed to ensure this does not centralise decisions that should be made locally. Early in my career in the NHS, I went to a large public meeting about proposals for shutting a small maternity unit. Hearing the expert opinion, a voice from the back of the room asked "so how many babies would be needed here to make the unit viable?" The medical expect offered a number, and the heckler replied “OK, give us 18 months”. And that local area hit its numerical productivity target.
That is not a decision that should be made in Whitehall. Citing the Nye Bevan quote about the “sound of a dropped bedpan on a ward should resonate in the corridors of Whitehall”: not even Bevan suggested that each hospital should write to the Secretary Of State asking if they could move the cupboard in which bedpans were stored.
This Bill is pragmatic modest, evolutionary; and it builds on changes that NHS staff have been making over this past decade. [Closes by citing lengthy Nye Bevan quote on legislating.]