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Health Secretary's duty queried in Lords clashes

The idea that the Secretary of State for Health should have legal responsibility for the NHS "does not hold good today", said Tory Health Minister Lord Howe.

Kicking off the second reading of the Health and Social Care Bill in the House of Lords today (11 October), Lord Howe said the proposed NHS reforms are of "profound importance" for patients.

He refuted the claim the Bill promotes a top-down reorganisation, claiming that "by allowing power to be devolved from the centre to unleash innovation, this Bill proves it is the reverse of a top-down approach."

Lord Howe also moved to clarify the Health Secretary's role under the reforms.

"The Bill does not undermine the Secretary of State for Health's accountability to Parliament, neither will it undermine his or her responsibility to provide a comprehensive health service for all," he said.

"I am aware of the concerns around this area and we are ready to listen to such concerns and make any amendments necessary to put this issue beyond all doubt."

Lord Howe said he came "very close" to pass crossbench peer Lord Owen's motion to create a Select Committee to discuss such concerns but time guidelines proved a sticking point.

He claims the Select Committee route would only work if the government imposed a strict time limit on the committee.

Lord Owen could not agree to such a condition, as he "could not form a judgment on how long the House should provide on this Bill."

In urging the Lords to back his motion, Lord Owen said it is mistake to believe the Health Secretary's role can be separated from running the NHS.

"The public will find it very difficult to look to the head of the largest quango we have ever created (NHS Commissioning Board) for guidance if the country was in a position whereby it was gripped by a pandemic," said Lord Owen.

"A select committee is the only process to deal with the complexity - if we fail we are in very serious trouble."

Shadow Health Minister, Baroness Thornton, who plans to support Lord Owen's motion, said it is a "sad day for the House and Parliament as the state of disorganisation in the NHS is beyond the point of return."

"There has been a breathtaking disregard for the democratic process.

"We should not allow ourselves to be brow- beaten; it is not too late to take a fresh look [at the Bill]."

Baroness Thornton promised Lord Howe that the creation of a Select Committee would not delay the passage of the Bill. In return, however, she said the government must give the House "as much time as is needed" for scrutiny.

Surgeon and former Labour Health Minister Lord Darzi pledged his support to clinical commissioning reforms on the basis they "empower clinicians to reshape and reform services to improve quality of care for patients."

He, however, sought reassurance from ministers that all clinical professions - GPs, community services and specialists "will work together to undertake commissioning".

Despite his concerns, Lord Darzi warned it would be "cruel" if the House were to delay the Bill any further.

"The NHS has been put to sleep and we have spent too much time focusing on organisational structures and not quality," he said.

"The incision has been made and new structures are starting to take shape.

"We cannot wait around any more, this has been a bumpy journey and it would be cruel not to put the end in sight."

He also said the "frequent attacks" on NHS management must stop. While they may be good politics, he claims they make for "bad policy" and in the long run will serve to be "self defeating".

Your comments (terms and conditions apply):

"Yes. To delay the Bill would be an injustice to us all. The health of the population in the UK should be of concern to all of us. We cannot continue as taxpayers of the NHS to throw good money at a service which is not delivering effective efficient and sound evidence-based medicine that the population deserve. Presently those political point scorers within the
debate and external agitators for the Bill's demise are hoping that with the word privatization repeatedly mentioned as being the ultimate objective behind the Bill will have the desired effect - that of killing off the Bill. I have worked for many years in the NHS and support the objectives within the Bill. Changes within the NHS is long overdue. Ken Clarke stated a process in 1990 despite some very clever tactics and opposition but pressed along nevertheless with his reforms which have shown over the years to have benefited us all quite greatly and has got us where we are in health improvements over the last two decades. Ken Clarke has not been given any credit for the considerable improvements that have occurred since then. It will take another brave Health Secretary to weather the storm. The Health Secretary and the those elected to govern should show courage stick to the path set follow it through with the right safeguards in place" - V Henry, London

"No, I think they have to first get it correct, listen to all the concerns and act, or else the health service may end up in a shambles" - Hilda Singh, London

"Absolutely agree with Patricia. As well as full public scrutiny, healthcare staff should be consulted as they deliver the care on the front line and see first hand how services are affected. The Tories are intent on bulldozing their political ideologies through without consideration on how this will affect the majority. Private companies care little about the complexity of health problems and prefer everything to be treated in a tick box fashion that is compatible to their time and motion studies. Long term, complicated and expensive medical conditions are at the moment referred back to the NHS. Privatised health care does not work well for the poor - which will include the vast majority of health care providers whose conditions, salaries and pensions are diminishing to satisfy shareholder profits" - Name and address supplied

"No, this bill must be fully scrutinised and the public must be listened to. Both patients and staff in the NHS are being neglected by a political ideal which seeks to privatise everything. People cannot be stacked on shelves as tins of beans" - Patricia Amis, North Tyneside