My Lords, I, too, thank the noble Lord, Lord Turnberg, for initiating this timely short debate, and I also look forward to the maiden speech of my noble friend Lady Jolly.
As most noble Lords will know, it is not usual for me to speak on National Health Service issues. I do not have the detailed knowledge that I have of the education system, but I retain an open mind about the proposed changes. I come from Surrey where we have not had a very happy experience with PCTs. Our PCT has had perennial financial problems of one sort or another. One area with which I have some concern is the future of community hospitals. The decisions they have made have been bad and incredibly vacillating, and have taken far too long. By contrast I have had good experience with my GP practice, and most of my friends are also extremely happy with their GPs. My own practice is very innovative and go-ahead, and I am pleased at the thought that it will have more power.
Of the reforms, I welcome very much the greater local accountability. We on the Liberal Democrat Benches have long argued for bringing together the responsibilities for health and social care, and a greater role for local authorities. The creation of the health and well-being boards will bring together, within the NHS, both the social care and the related children's care and public health services. That is a very important step in helping to provide us with joined-up health services. I also welcome the focus on patients and their needs. I hope that it will not just be rhetoric. In most cases, patients defer to decisions made by their own GPs or by the consultants they see, but there is a danger that the whole system may be too dominated by professionals and the mentality that professionals know best what to do. It is, therefore, extremely important that we retain within the various boards lay membership at all levels-in the GP consortia and all the way up to the NHS commissioning board.
Lastly, I welcome the establishment of HealthWatch. I was quite involved at one point with our local community health council and I regretted very much its replacement 10 years back by what struck me as a relatively toothless link committee. I hope that HealthWatch, together with local scrutiny committees, will mean that there is a genuine watchdog for the patient in terms of quality and accountability.
I have five questions for the Minister. First, precisely what is the role and what will be the powers of the NHS commissioning board? Secondly, where within the system does NICE now fit? I am grateful for reassurances from the Minister at a meeting the other day that NICE will not be abolished, but indeed would be strengthened. However, it would be useful if those reassurances were on the record and he could tell the House how it will fit into the greater scheme of things. Thirdly, I do not understand the trail of accountability in the new system. Who will set the budget for the GP consortia and who will oversee their expenditures? What happens if they overspend? Who holds them to account? With the strategic health authorities now going, who will oversee hospital expenditures and hold them to account if they overspend? While I welcome the bringing together of local public health services with the community and children's health services, will there be enough resources to meet needs given the cuts in local authority funding? Already instances of bed-blocking are reappearing. My noble friend John Shipley raised the issue of bed-blocking in Newcastle with the Minister the other day and there are other instances. As a school governor I have experience of children's and adolescent mental health services and the lack of facilities to provide educational psychologists when they are needed to back up special educational needs provision in schools. Time and again, the NHS has failed to deliver on its responsibilities. How are we to get really effective linking-up between health and local government services?
Finally, the health and well-being boards will bring together public health and social care services, but one of the traditional problems of the NHS has been the divide between primary and secondary care. What incentives are there within the system to improve that relationship? In particular, there is the relationship between GP care and specialist care. Can the Minister tell us a little more about proposals there? I look forward to hearing the answers that the Minister will give us on those issues.