Committee (7th Day)

Part of Health and Social Care Bill – in the House of Lords at 3:30 pm on 22 November 2011.

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Photo of Baroness Williams of Crosby Baroness Williams of Crosby Liberal Democrat 3:30, 22 November 2011

My Lords, I will comment further on Amendment 98. One of the great qualities of the amendment is that it would oblige all of us to confront directly the huge strain between the rising demand-4 per cent a year over recent years-for National Health Service services, and the limitations on resources to which the noble Lord, Lord Harris of Haringey, has eloquently referred. It is vital that if we are going to carry the public with us in making the changes, which will be required regardless of whether the NHS survives or not, to service configurations, to the way in which ancillary professions are used, and to the whole range of community activity and help, we have to get the whole of the public and Parliament to understand how acute the pressures on resources are and how very necessary the need for change is.

It is therefore vital that we take due responsibility as Parliament and as a whole nation for the changes that will be required. All of us in this House recognise that service configuration is going to be the key way in which we deliver quality services with straitened resources. However, we should not pretend to ourselves that service configuration will be anything but extremely difficult. It will be politically difficult in particular, for the reasons which the noble Lord, Lord Harris of Haringey, pointed out. Any time you configure a service in a way that, for example, results in the closure of hospitals or other medical centres, you will encounter huge public resistance, because the public like, as is very much evident, exactly what they have. It is very sad that we have to explain, regardless of how we vote on this amendment or any other amendment, that there is this straitened position between resources and demand.

That is why Parliament, too, must accept its responsibility and not press for changes that simply cannot be afforded. Unless we have an amendment like Amendment 98, which is fundamentally part of the whole parliamentary structure within which the NHS or any other form of health service has to operate, we will not start on the crucial business of persuading and training the public as well as the medical profession and ourselves about the absolute necessity of fundamental change, regardless of the actual management structure that we happen to have at the time. I personally believe the NHS has a remarkable management structure. There are others who believe that it does not, but the one thing one can say is that the crucial issue is not so much management structure as how one actually handles the massive process of change that now confronts us.