My Lords, I, too, thank the noble Lord, Lord Colwyn, for initiating this very important debate. I would sum up my answer to his question about the state of health of the NHS in one sentence: it is undergoing some convulsions but its life is not in danger. The NHS has made considerable progress while the Labour Government have been in charge of it. If one looks at certain obvious statistics one sees that since 1997 we have gained 50 per cent more consultants, 35 per cent more clinical support staff, 35 per cent more hospital doctors and 34 per cent more GPs. But those are bare statistics. In a very important way there has been a profound cultural change in how the NHS has been constituted in the past few years. Patients feel that they are valued and at the centre of attention and they know their rights, and medical staff are aware that they are accountable to patients and to other bodies for what they do. Many of us who have been around for quite a while have been feeling these profound changes in the NHS. So while I compliment the Government on all that they have done, I want to highlight four or five important issues that worry me a little.
First, the results of the expenditure of resources do not seem commensurate with the amount spent. For example, GPs have been given very generous contracts—and I spend all my time among friends and relations who are GPs. On average, they earn about £100,000 to £125,000 a year, a figure which we professors simply envy. I do not begrudge them at all, but I think that in return for that one could expect that the range of services would be wider, the premises more efficient and the services offered to patients administratively more competent. I do not see those changes. And it seems the same with NHS trusts. They have been given a considerable amount of money and freedom to run their affairs but their administrative and management capacity, especially in matters financial, has not kept pace with the amount of responsibility they have been given. I do not know how much attention is being paid to ensuring that the people in charge are suitably trained.
Secondly, there are two conflicting considerations on the reorganisation of hospitals which are not easy to balance. It is right that the latest medical technology should be concentrated in a few centres, for obvious professional as well as financial reasons. It is also important that there should be supra-regional accident and emergency departments concentrated in certain places, and, pari passu with that, some should be downgraded. While that is necessary, it is also important to bear in mind that it conflicts with patients' preferences and needs. Patients do not feel safe without access to an accident and emergency department that they can reach within a reasonable time. They also prefer to have babies in local maternity units. It causes anxiety to downgrade such facilities to a single midwife-led unit. We therefore have to find ways of balancing the need to concentrate medical and professional resources in certain regional centres with the need to provide local centres. The Government seem to think that smarter communication might solve the problem but I do not think that it is as simple as that. These two considerations have to be reconciled in the light of local circumstances. In taking such decisions, a great deal of attention should be paid to the views of patients, the public and doctors. They should be involved in taking decisions of this kind.
My third concern has to do with the independent sector treatment centres. I am not against the private finance initiative but I have some grave anxieties. In this case, they are poorly integrated into the NHS and do not train doctors in the same way as hospitals. There is too much reliance on foreign—in some cases, overseas—staff. We do not seem always to get value for money. These independent centres also enter into long-term contracts which are not easy to change. I would suggest that, although they are necessary to deal with the backlog, our overall strategy should be to concentrate on expanding NHS facilities rather than relying on centres of this kind.
Fourthly, as the noble Lord, Lord Crisp, said, rationing in one form or another is insuperable. But we must bear in mind that there is an unholy alliance of drug companies, populist media and some groups of politicians who seem to want to make sure, sometimes against the advice of NICE, that certain drugs that might not be recommended because they create a certain amount of popular scare should be widely available. NICE took a very firm stand on, for example, the flu drug Relenza and faced down Glaxo, which had threatened to leave the country. Decisions on rationing are inevitable. Rather than the Government leaving these decisions entirely to NICE, it is very important to involve medical staff who could explain why certain decisions have been taken.
Finally, noble Lords will expect me to say something about the important issue of the ethnic minorities. Their representation on NHS trusts falls far below their number in the country at large and their presence in the profession. How many chief executives are drawn from ethnic minorities? How many people from ethnic minorities are on NHS trust, foundation trust and PCT boards? I would like to know how many members of the NHS Appointments Commission are drawn from the ethnic minorities.
In many areas we are beginning to find that there are redundancies and the contracts of doctors and nurses are being terminated. People who have been in training for some time are being told that they may not be able to get jobs commensurate with their qualifications. Some of my close consultant friends tell me that the burden of redundancy is likely to fall disproportionately on ethnic minorities. I should like to be reassured by the Minister that that is not the case and that, should it happen, there will be enough provision to ensure that such decisions are countermanded.
I have full faith in the Minister and the Secretary of State for Health but suggest that the style of administration and the mode of decision-making they have inherited during the past 10 to 15 years need to be radically changed. The NHS is a Labour creation and something to which the party has been strongly committed. It would be a great pity if people felt that they could not trust the Government or the party with the safeguarding of the NHS.