My Lords, the noble Lord, Lord Lipsey, set us off on the right question for this debate—whether the legislative process in relation to this Bill has worked. We on these Benches are convinced that, at this stage, it has not. We have in front of us one central question to answer: do the proposals add up to a National Health Service delivering a truly national health service with all that is good about local knowledge, involvement, participation, flair and imagination? Is what is proposed fit for its purpose? At the end of a very long and detailed Committee stage, we have come to the conclusion that it is not. The noble Earl, Lord Howe, pinpointed the one factor that belies that—the way in which the Secretary of State runs through this legislation from beginning to end as the final arbiter.
The noble Lord, Lord Desai, in a characteristically rambunctious speech and the noble Lord, Lord Turnberg, and others, have talked about the dead hand of regulation on the NHS. This proposal will not change that at all, but it could be changed very effectively and quickly. The best thing that could happen to the NHS is a bonfire of targets, but we do not need this legislation to do that. In fact, it makes it worse. The Bill is the worst of management-speak and targets.
The noble Lord, Lord Hunt, was near the mark, but wrong. He described the Committee stage as long on detail and where there were many answers. That is true, but there were many key issues on which there were either no answers or the wrong answers. Those of us who care about a National Health Service that works well locally have considerable concerns about the equity—as the noble Baroness, Lady Finlay, mentioned—and ethics of setting healthcare targets, and about the need to safeguard those with specialist needs and those who are the expensive patients in this new world of tariffs and diagnostic treatment centres. We did not receive convincing answers on these matters, which are the key issues we have to decide.
I have not yet met a healthcare worker who has not said that what they want is to provide healthcare, which is what they should do. We should be requiring local hospitals to focus completely on that. It is not their job to give the Electoral Reform Society a run for its money on questions of governance. Ultimately, we have failed very badly in the proposals in this amendment.
Many of the early hospitals in this country were charities. In my working life I advise charities on governance structures and constitutions. I would not advise a charity to accept these proposals and hope that they would be fit for any purpose, still for less for running a hospital service on which, as the noble Lord, Lord Lipsey, said, people's lives depend.
In voting against these amendments today I believe that we give ourselves and another place one more chance to do our job properly. It is for us to sort out a system of clear membership, decision-making and accountability. It is for us to do our job properly so that health workers can do theirs without hindrance.