My Lords, I, too, applaud the noble Lord, Lord Turnberg, for initiating this debate. I am sorry that I was not aware of it until rather late in the day, hence my having been slotted into the gap. I must apologise to the House for that. I want to raise two questions which have perhaps received less attention than others. Before doing so, however, I want to set out two examples of the direct implications for services of organisational change. The first concerns the major rationalisation of the acute sector, particularly in London, which was inherited by this Government. The aim of that rationalisation was to reduce the considerable excess supply of hospital beds, particularly in London, in order to make the absolutely essential savings to enable the NHS to balance its books and to improve radically its productivity. These major changes have been put on hold awaiting the completion of the development of the GP consortia arrangements. The failure to make those rationally-argued changes in a timely manner will have direct implications for the funding of front-line services.
My second example is local. I am not in any way suggesting criticism of the organisation or individuals concerned, but the commissioning changes are already inevitably distracting managers from their day-to-day essential decisions, again with severe adverse consequences. A particular trust with which I am associated, and I declare an interest, has to cut its budget by 4 per cent each year for three years-by £10 million a year. To achieve that, two very significant rationalisations were evaluated and planned, but the PCT's approval is essential before we can go ahead. If those vital savings are delayed-and they are being delayed, as we will not have the PCT decision in time-then we will have to turn away from those well planned changes. The risk is that we will have to make quick cuts on front-line services. Those are my concerns about organisational change and its direct impact on front-line services.
I have two questions. The first concerns the planned removal of the power of the National Institute for Health and Clinical Excellence to determine whether a specific-