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Lord Desai: I, too, am very privileged to have been able to add my name to the amendments. I have been thinking about de-politicising the National Health Service for a long time. Recently, there was a notice in many newspapers about a supermarket chain withdrawing a certain kind of food that it sold because it was not quite right. If that had happened in the NHS, there would have been a riot in the press. The Secretary of State for Health would have to come to Parliament and propose another target, another programme or another committee. The whole thing would have got completely out of proportion because the Secretary of State is supposed to be answerable for the slightest problem in the NHS. That is not the way it should be run.

Apart from the Chinese Army, the NHS is the largest public sector enterprise run by a single person. It is the last monument of Stalinism in the world, and it illustrates all the problems. We continue to hear that staff are demoralised—and during the past 38 years I have been in this country, I have heard nothing else—because they do not feel that they own the service in which they work. The service is supposed to be the most popular we have, but it is the most criticised we have. Everyone agrees that whether one gives too much or too little money, the staff are demoralised.

To put it simply, the present system is not viable. The proposal put forward in this set of amendments is, first, that we should de-politicise the NHS. While maintaining serious and proper parliamentary accountability, we ought to de-couple the office of the Secretary of State for Health from the day-to-day running of the NHS and the strategic decision taking.

I was sorry to see that Dr Liam Fox, shadow Secretary of State for Health has picked up my idea. I am not responsible if some of my ideas and those of other people are picked up by the Opposition. I can say only that anyone who picks up my ideas does nothing good for his own career! That is life. Health is important. The way in which we have structured decisions in health has brought about the crisis in the NHS. The fault does not lie with the input; it does not lie with the professional services; and not even with the patients. The fault lies with the way in which the system is administratively run.

Instead of there being proper devolution of power and responsibility, even as we set up primary health centres, every arrow points back to the Secretary of State for Health. As the noble Lord, Lord Alderdice, mentioned, every little problem points back to him. Anyone can stop the Prime Minister or Secretary of State for Health in the street and blame him for the delay in their mother's operation. Although the Prime Minister knows nothing about that person or the

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mother or the operation and there is nothing he can do to speed up the operation because it is not his problem, we somehow have that notion in our system.

Aneurin Bevan's proposition that every time there is a problem with a bed pan under a bed in the NHS the Secretary of State for Health should feel its tremors is the most absurd notion of how to run an organisation. No organisation can be run like that. It is time we decided that 55 years, or whatever, is long enough for the bad model and that we ought to improve it.

The interesting point about the proposal put forward in the amendments is that the model for setting up an independent agency is neither revolutionary nor new. It was used for nationalised industries. It is the Morrisonian model and the one that Willie Robson, former professor at the London School of Economics, proposed a long time ago. Unfortunately, the NHS did not fall into the category of "nationalised industry" and it was therefore taken to be more centralised.

Perhaps also the politics of those days, with strong opposition from the medical profession, led to centralisation, but we no longer have that strong opposition. The medical profession is committed to the NHS. We are all committed to the NHS, so that political difference no longer exists. We can now relax and experiment and say, "Yes, Parliament will have scrutiny. Yes, the Secretary of State for Health will have an oversight. However, let professionals and people committed to the NHS run it". I am not sure that like the noble Lord, Lord Alderdice, I would go as far as letting a health service professional be chairman of the committee. I prefer politicians and radical former Ministers such as my noble friend Lord Hunt of Kings Heath, whose chances I will do no good by naming him.

It is important, however, to think seriously about dovetailing responsibility. I am not sure how my noble friend on the Front Bench will respond. He will probably pour cold water over our ideas because this is not a good season for doing anything. There never is a good season for doing anything with the National Health Service. However, I hope that the idea enters his bloodstream and comes out in a transformed way. Some kind of de-politicisation of the NHS is most urgent, especially now that we no longer have the excuse that the NHS is not working because it is starved of funds. It is no longer starved of funds—that is not the issue. The issue is quite clear. Given sufficient funds, there are still problems—problems with morale and other complaints. If they exist, it is connected with the way in which the NHS is organised.

I welcome this set of amendments and I am happy to put my name to them.

Lord Walton of Detchant: Until I was compulsorily retired from clinical practice in the NHS 11 years ago on the grounds of age, I spent my entire professional career working in the NHS and in academic medicine and I am one of its most fervent supporters. In my professional lifetime, I have seen more than 20 different reorganisations or reforms of the NHS under

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governments of all political complexions. I confess that in recent years I have been disturbed by the increasing degree of regulation to which the health service has been subject. There has been an obsession with targets, statistics and so forth to an extent that many healthcare professionals have been diverted from their primary role of caring for patients in order to collect information to satisfy the Department of Health.

Furthermore, when I first read the report from the King's Fund its idea struck me as unattractive. It suggested that there might be established a new quango within the NHS—and quangos are sometimes to be deplored. Indeed, the idea is not completely new. I well recall that almost 40 years ago there was a highly publicised radio debate between my predecessor as Dean of Medicine at Newcastle University—the late Dr Henry Miller who was subsequently vice-chancellor of the university—and Mr Enoch Powell, then a Minister for Health but not Secretary of State. Henry Miller suggested the establishment of an independent foundation at arm's length from the Department of Health to run the NHS and to handle its finances. Ultimately, his argument was effectively demolished by Enoch Powell for all the wrong reasons. He said that it would destroy the absolute primacy of the Department of Health, which was at the heart of government as a part of government and so the idea foundered.

But the more I read the King's Fund report, the more I listened today to the noble Baroness, Lady Cumberlege, and others, and the more I read these amendments, the more attractive they became. After all, the Government's idea behind introducing foundation hospitals is to devolve the decision-making machinery to a local level and to take away those hospitals from the direct control of the Department of Health. I believe very firmly that that idea has such merit that it deserves a fair wind, and I hope the Government will take it on board. I support the amendments.

4 p.m.

Lord Peyton of Yeovil: I support very much the noble Lord, Lord Walton, whom I have known for many years and who has almost unrivalled experience of the whole field that we are discussing. As we have already been reminded this afternoon, this is the fifth or sixth bite that the Government have had at a fairly substantial cherry. Over the long period that I have been a politician, I have wondered whether governments have any appreciation at all of the labour and pain caused by constant reorganisation. It ends with people being totally demoralised and having not the slightest idea what is expected of them.

In a very distinguished and able speech, which has been widely and deservedly supported, my noble friend commented on just how much damage party politics have done to the health service. In the amendment she calls for some degree of separation from the Secretary of State. However, one thing that I did not understand in her excellent speech was why she preserved the power of the Secretary of State in so many important fields. The Secretary of State will have

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the power to appoint the chairman, deputy chairman and 10 other members; he will approve the appointment of the chief executive; he will be able to prescribe by regulations the constitution of the English agency; and he will have the power to amend by regulation the functions of the agency. What more powers can the Secretary of State possibly have? He can have as many people in the agency as he wants, and those who owe their position to his patronage are likely to be concerned about what the Secretary of State wants.

I do not want to make a very long speech. However, when my noble friend comes to reply to the debate on the amendment, I ask her to explain as clearly as she can for those who, like me, applaud much of what she said how anyone persuaded her to leave such huge powers in the clammy and unskilled hands of the Secretary of State. The only reason I can see for doing so is to satisfy the desire on the part of the Government Front Bench to perpetuate the long tradition of the bungling amateur.

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