Amendment 3 (Baroness Williams)
2)‘The Secretary of State must for that purpose provide or secure the provision of services according to this Act.’
Amendment 4 (Lord Mackay of Clashfern)
2 For that purpose, the Secretary of State –
a) Retains ultimate responsibility to Parliament for the provision of the health service in England, and
b) Must exercise the intervention and other functions of the Secretary of State in relation to that health service so as to secure that services are provided in accordance with this Act.
Shirley Williams withdrew her amendment and allowed Lord Mackay's to go forward instead. I wasn't particularly happy about this, because it seemed to me that Amendment 3 was a) shorter and b) clearer. There was also an argument about whether 'ultimate responsibility' had a meaning in legal terms. Shirley Williams said that the reason she withdrew her amendment was because if it was voted on at that point and rejected, the house could not return to it, so maybe the Lords are going to play with Amendment 4 and if they can't make it work, go back to Amendment 3. But I'm still uneasy about it.
After that, I decided to read the bill in its present form. To my surprise I found this;
“1 Secretary of State’s duty to promote comprehensive health service
(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of illness.
(2) For that purpose, the Secretary of State must exercise the functions conferred by this Act so as to secure that services are provided in accordance with this Act.'
Now, this is different to what we were all objecting about. The weasel phrase 'act with a view' has disappeared and although the phrase 'provide or secure' has also gone and replaced with 'so as to secure that services are provided' this isn't half bad. So when did this happen? And is that now going to be replaced with Lord Mackay's amendment?
If anyone can help with this, let me know. In the meantime, here's Shirley William's opening speech in full. I'm still doubtful about this. I keep getting a picture of a nice washed woolley sheep on a string, leading all the other sheep into the slaughter pen. I really hope I'm wrong.
Baroness Williams of Crosby: I apologise for the slight delay in rising to my feet—my understanding was that the Minister was proposing to start the debate by making a statement. I apologise for delaying the House. Let me say right away that I do not resile in any way from the amendment which the noble Baronesses, Lady Jay and Lady Thornton, the noble Lord, Lord Patel, and I have put down. We believe that it is important to have an absolutely solid basis by which the whole of the House and the public can understand exactly the accountabilities and responsibilities of the Secretary of State. It is therefore of great importance that this House, in this crucial Committee sitting, is able to reach a clear understanding of what those responsibilities and accountabilities are.
I very much hope that that will be possible as there are still legal questions about the particular meaning of both the amendment put forward by the noble and learned Lord, Lord Mackay of Clashfern, and the amendment put forward in the names of the noble Baroness, Lady Jay, myself and others. There are still difficulties and differences of opinion between legal voices about exactly what the forethought of those amendments is and just how clearly they lay out the responsibilities and accountability of the Secretary of State. Some Members of this House will recognise that one difficulty is that the Secretary of State is extremely anxious to avoid any further micromanagement of the health services because he believes that it would reduce professional discretion. I think that many of us sympathise with that argument.
The difficulty is that many of us also believe that the Secretary of State should have clear accountability for the very large sums involved in financing the NHS at present. We also have regard to the fact that there are certain crucial responsibilities revolving around things such as national emergencies for which we believe the public would expect the Secretary of State to be the person responsible. So on constitutional grounds, and on grounds of financial accountability and clear responsibility in certain areas of national concern, we are anxious to see that the Secretary of State retains those responsibilities. However, the possibility of drafting legislation which comprises both the issue of having no micromanagement and the issue of the crucial ultimate responsibilities of the Secretary of State has proved somewhat elusive. In that situation, I hope very much that the Government will consider pressing ahead with trying to draft acceptable legislation for Report stage, when I hope there can be broad agreement about what the responsibilities are. I cannot answer for my noble friend the Minister, of course, but I hope that he will give consideration to that request.
Perhaps I may quickly add three other considerations. The first, which I have mentioned already, is the area of legal ambiguity. I think that all Members of this House will have heard clashes of opinion about the precise meaning of the amendment before us. I regret that, and I hope the legal profession will forgive me for saying that when there is more than one lawyer in a room there is very often more than one opinion. That is exactly the situation in which we find ourselves. Secondly, many of us feel—I would certainly speak for myself and my party, and this point was raised by the noble Baroness, Lady Jay—that it is absolutely critical to look at Clauses 4 and 10 together with Clause 1, rather than trying to take them separately. They are intimately interrelated. Many of us recognise that to make a change in Clause 1 without taking on board the implications of Clauses 4 and 10 would leave us in a world of deep twilight uncertainty.
The third issue is perhaps a bigger one; perhaps it constitutes a vision that I profoundly hold. I think we all recognise that the NHS is deeply cherished in this country. It is something to which people cling, as they find themselves facing financial hardship, as one of the few certainties and areas of trust that they can rely on. However, we also know without any doubt of the essential need for change in the NHS—my noble friend the Minister and others have made this absolutely clear—if we are to be able to finance an aging population, and not least, although we often neglect this, the very welcome survival of far more people with chronic sicknesses than used to be the case even 20 years ago, all of which lays heavy responsibilities on the health service. Because of that, I for one feel strongly that the greatest prize that this House could give to the future of health services in this country would be to reach a broad political consensus on the issue, so that the NHS and other health services, as they go forward, find that they are based on a solid rock of acceptance and consensus that will carry us through many of the ups and downs that we are bound to face in the next few years.
Therefore, I ask the Minister of State whether he will consider asking those of us who have put down amendments—I am one of them—to withdraw them in light of the need for further discussion. That would allow us to bring forward, I hope, a very broadly agreed proposal at Report stage in this House, when we have also considered the issues around the autonomy clause.
Finally, I add one more thing, for which I hope I will be forgiven. I know that those who have been in the House for a long time are fully aware of this, but it may be helpful for those relatively new Peers who are not fully aware of it. If an issue is brought up in Committee and then voted on and voted down, it cannot come back again on Report or at any other stage of the proceedings on the Bill. That would be disastrous. It would mean that if any vote were carried, we could not then go back to trying to get broader and stronger agreement on Report. It would simply mean that the whole issue disappeared. This is far too important an issue to be allowed to disappear. Therefore, I plead with those who I fully understand passionately support my amendment or that of the noble and learned Lord, Lord Mackay of Clashfern, to allow their passions to be put to one side, temporarily at least, while we contemplate the absolute necessity of debating this more fully, trying to draw a consensus from it and accepting that we can go back to these matters on Report, when a vote would be appropriate, right and timely.
Make of that what you will. And for those who followed the link on the amendments, here's what happened to them. There's some important stuff in here, but I'll cover more of it in another post.
Amendment 3 withdrawn.
Amendments 4 moved.
Amendments 4A (to Amendment 4) not moved.
Amendments 5 and 6 moved.
Amendment 7 withdrawn.
Amendments 8 to 8A not moved.
Amendment 8B had been withdrawn from the Marshalled List.
Amendment 9 withdrawn.
Amendments 10 to 11A not moved.
Amendment 11 withdrawn.
Amendment 11A not moved.
