My Lords, I speak as until recently the chair of the Church of England's Hospital Chaplaincies Council, and, as it happens, the husband of a specialist in palliative medicine and the father of a fairly newly qualified hospital doctor. I believe passionately in the National Health Service and want to see its future secure.
I share some of the concerns expressed recently by primary care trusts about what might be endangered by their demise and by my own church's response to the Government's proposals through its mission and public affairs council, and I hope these concerns are among the issues that the Minister will want to address. There is time to do little more than list them.
First, there is in the proposals a risk of losing local intelligence and grip on performance in the management of poorly performing doctors and practices. Secondly, there is a lack of clarity about future commissioning arrangements for learning disability services, mental services and services for other vulnerable groups. Thirdly, the White Paper does not consider what additional GP training might be needed to make effective patient-centred services a reality. In the absence of training and monitoring, it would be all too easy to see the provision of patient-centred services being reduced to a box-ticking exercise. Fourthly, the proposals do not make it clear which services are considered to be front-line services and which are ancillary or administrative. In seeking to cut administrative costs, both commissioners and providers may find themselves under pressure with regard to allied health professionals and chaplaincy services, yet holistic care is essential for good health outcomes; the expertise of allied health professionals and chaplains ought not to be minimised in delivering such care. Fifthly, and perhaps more fundamentally, there is a question about the ability of local authorities to take on new responsibilities in the face of 20 per cent cuts in their own budgets. Linked with this is the complexity of what is proposed, with GP consortia responsible for commissioning healthcare, local authorities receiving an enhanced role in relation to public health and health and well-being boards also having a part to play. The fact that GP consortia and local authorities are not coterminous will make the commissioning process more difficult.
Alongside these worries, I make two other points very briefly. The first is that for the new arrangements to work, there needs to be rising morale in the health service. That cannot happen while there is a culture that is dismissive of the achievements of recent years. It may well be right, for instance, for PCTs to disappear, but their work does not need to be criticised or rubbished. Unlike the experience of the noble Baroness, Lady Sharp, in Surrey in Gloucestershire where I live and work, the PCT has brought about transformation in infrastructure with new buildings, in finance with historical debts resolved, in health outcomes, for instance in the reduction of teenage pregnancies, and in engagement with clinicians and communities. We need to affirm and honour those who work in the NHS, or else the quality of the health service could trickle through our fingers as morale dips at the same time as difficulty climbs.
Finally, we need more honesty and realism. Changes are almost bound to damage front-line and specialised services. We have to save money. We have to make choices. We need to accept that not everything can be delivered. If we can start being honest about that, there can be genuine debate about priorities and proper consideration of what can and cannot be achieved. Instead, and this contributes to the collapse of morale, we keep up a pretence that cuts need not damage services and we expect those who work in the NHS to deliver the impossible, but they cannot.