My Lords, I welcomed the decision to set up the committee in order to take a mature, carefully considered, all-round view of the NHS, more than simply the need for stable and predictable funding. I share the Government’s response to the report: it is thorough and thoughtful within the limits of time and it raises most of the right questions.
I have played no significant part in health matters in the House except on stroke, which I shall mention later. But for many years, as a Member of Parliament, I dealt daily with the health problems of my constituents. In the 1960s my simple campaigning slogan was “Jobs, homes, schools and pensions” Then, in about the mid-1970s, I switched to “Jobs, homes, schools and health”. Since then, the NHS—the national religion, as the committee calls it—has been full of pain as well as pleasure.
It may be pretentious to refer to a book, The Politics of Change, which I wrote 30 years ago but in a chapter entitled “Is Public Expenditure Enough?”, I mentioned needs and means in health. It was not, I said, until 1976 that any attempt was made to establish rational and systematic priorities. Barbara Castle, then Secretary of State for Social Services, said:
“Demand will always outstrip our capacity … Choice is never easy but choose we must”.
That was also broadly the message of the Cabinet Office central policy review committee at that time, as the noble Baroness, Lady Blackstone, may recall.
However, all too often over the years since then, politicians on both sides have ducked priorities and choice and delayed awkward decisions. That was the case with preventative medicine, and Aneurin Bevin himself said that,
“the victories won by preventative medicine are much the most important for mankind”.
When death, disablement, injury and social distress could be avoided, even with a net saving of public expenditure over time, it seems extraordinary that a double bonus was ignored. I strongly support recommendation 30.
When I was Secretary of State for Transport in the late 1970s it was clear that a single, simple step of making seat belts compulsory could save 1,000 lives a year, prevent some permanent disablement and achieve substantial savings within the NHS. However, progress was slow because the Official Opposition and the Back Benches on both sides of the House claimed that seat belts were an unacceptable restriction of personal freedom. When I managed to get my seat belts on the Cabinet agenda, the Prime Minister was clearly half-hearted. Then, when I won in Cabinet, it took six months before I reached my Second Reading in the Commons. In carrying the Bill by 244 votes to 147, it was opposed by the Deputy Leader of the Labour Party and its Government’s Chief Whip.
I welcome the report’s call for more substantial and sustained action to achieve parity of esteem between mental and physical health. I endorse everything in the report about obesity and the failure by successive Governments to lead a robust campaign.
The report mentions stroke. It was in 1993 that the Lancet showed for the first time that stroke units saved lives and reduced disability. However, it took 14 years before the national stroke strategy was published. The Government in response to the report quotes the chief executive of the Stroke Association on what has been achieved by the reconfiguration of stroke services centralised in a fewer number of hospitals. I entirely share this view and applaud the London Hyper Acute Unit. As a victim of stroke, I am able to acknowledge the major strides in dealing with this illness over the past 15 years. The Government must maintain that momentum. It is good news that the new National Medical Director is now working toward a fully worked-out plan and the National Stroke Audit is being recommissioned. I ask the Minister only to say today, or in writing, what has happened to the reorganisation of acute stroke care in Greater Manchester and whether—or when—the changes in acute stroke services will be extended to elsewhere in the country.
Appropriate to a Select Committee, the report is wholly cross-party in tone. Quite apart from the closing paragraphs of the report, I greatly welcome that, but there is much more to be done to reconcile the spirit and purpose of the Bill and the willingness of Members of Parliament, local politicians and activists to accept change. They must work alongside CCGs and other NHS organisations to set priorities and make choices.