NHS: Front-line and Specialised Services

Baroness Thornton Excerpts

Thursday 13th January 2011 Lords Chamber

[Baroness Thornton]

My Lords, I congratulate my noble friend Lord Turnberg on this debate. Indeed, of all the speakers who have contributed today I particularly welcome the noble Baroness, Lady Jolly, to our debates and our deliberations for the future. I also need to congratulate all the speakers who have contributed today, because we have had a really excellent debate. We probably needed about two or three hours longer than we have had; maybe we need to do that.

I want to raise two matters, one strategic and one specific. Since June we have debated or had Questions on, among other things, cancer, diabetes, chronic pain, Parkinson’s disease, epilepsy, social care, COPD, neurological conditions, dementia and many others. I cannot recall a single debate or Starred Question where the issue of how services would be either safeguarded or delivered under the proposed reforms of the NHS was not raised in one way or another. The Conservative-led Government have been telling us this comforting notion that your family doctor will commission the services that you need—and who better to do so? I am on the record as saying that I support that in principle. However, Conservative MP Sarah Wollaston rather let the cat out of the bag when she wrote in the Guardian on 4 January:

“I know many GPs who are keen to tackle the redesign of care and even the issue of failing colleagues, but I know none that are interested in EU competition law. If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap”.

I think that that means that private commissioners may turn to private providers at the expense of NHS providers because of the intimidation, or their interpretation, of EU competition law. Will the Minister confirm the role that EU competition law will play in the forthcoming reforms? For example, will GP commissioners be able to choose NHS providers where they offer the best quality and comprehensive service even if they are not the cheapest, without fear of legal challenge from private enterprise cherry-picking the most lucrative contracts? The Minister will know that I have long been a supporter of choice and diversity within the NHS, but the question of how we achieve that might lead to a fundamental dividing line opening up between us.

The EU competition rules being used as a regulator for NHS services through Monitor provide us with a huge problem. The problem, if I might put it in shorthand, is that health-providing companies owned by shareholders and hedge funds are not independent providers; they are accountable to owners who want to see a profit. So patients and organisations that promote the interests of long-term conditions, for example, are correct to be asking how health services owned and run by these people will have their long-term interests at heart. These are the questions that we will need to answer when we look at the NHS Bill that is promised next week.

What role does the Minister envisage for the market, for competition and for the private sector as a result of these proposed reforms? Does he believe that collaboration or competition is the best way to run our health service? I promise noble Lords that the noble Baroness, Lady Finlay, and I have not collaborated in asking that question. These are very big issues to which, as I have said, I suspect we need to return for longer and deeper consideration.

I conclude by raising a specific issue—in many ways, a perfect example of the anxieties that are being raised in all quarters. This concerns GP commissioning and the future of cancer expertise in the new system, and I thank both Cancer Research UK and Macmillan Cancer Support for drawing this to my attention. Before I go on, I add my congratulations to the noble Lords, Lord Crisp and Lord Kakkar, who asked questions that drilled down into the detail that we are going to have to address, as indeed did my noble friend Lord Winston.

As the Minister will know, the cancer networks have been an absolutely integral and important tool in improving outcomes for cancer patients. The Government have said in the new cancer strategy, Improving Outcomes: A Strategy for Cancer, published yesterday, that cancer networks will continue to be funded during the transition period to GP commissioning. How will GP consortia make use of the expertise currently available in cancer networks to help in the effective commissioning of high-quality and seamless cancer services? How will the Government ensure that the functions currently provided by networks are not lost and standards compromised under the new commissioning regime? Will the Government ensure that cancer networks are funded throughout the transition period until 2014? Will that funding include funding that cancer networks receive from PCTs at the moment as well as directly from the Department of Health? How will GP consortia be incentivised to ensure that the critical functions of cancer networks are still carried out as they commission cancer services?

I am happy if the Minister wants to write to me about those questions; it is unfair to expect him to answer them in detail at this moment. But they are very important, and I look forward to his remarks.