The idea that the health secretary 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 (pictured) 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 a 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".
Do you think the House of Lords would be "cruel" if it were to delay the bill further? Your comments (terms and conditions apply):
"I feel it would be 'cruel' to allow the bill to be passed without proper scrutiny and debate" – Susan Smith, Sussex
"Let's be quite honest about the NHS – for the preceeding 10 years it was badly micro-managed, burdened with mindless and useless bureaucracy that spawned layer upon layer of costly management and given an internal market system that succeeded to reward activity in secondary care without any responsibility for its cost. Anything would be better than that so let's not delude ourselves that it was all sweetness and light before. At least this lot in government are not making undeliverable promises to the public that only serve to raise unrealistic expectations" – Alan Moore, Cheshire
"No I do not agree that to delay the bill further would be cruel. I think the House of Lords should do what parliament has not done and start listening what the people of this country want. The people who voted this condem government into power were not privvy to this bill as it was in neither parties' manifestos. What they do not want is a return to those with
the money to pay for private treatment being given even more preferential treatment than they have now. More private beds in a health service that already has long enough waiting lists for those who cannot pay. This part of the white paper in particular has never been debated sufficiently in parliament. Other countries who in the past have envied us our NHS must think we have truly lost our minds if we let this bill go through" – Sheila Hepworth, Yorks