Page last updated at 13:26 GMT, Friday, 14 October 2011 14:26 UK
The digested House of Lords Health Bill debate

The government's plans to reform the NHS in England continue to cause controversy.

Democracy Live has compiled this selection of highlights from the second reading of the Health and Social Care Bill.


Watch the unedited first part of the Health and Social Care Bill debate above or click on the links in the text below to go directly to each peer's speech

Health Minister Earl Howe

Opening the debate, Lord Howe sought to pre-empt criticism that the responsibility of the secretary of state for health for the NHS would be watered down by the bill.

"Managing the range of healthcare needs for our diverse population is now so complex that no one would argue that it is a task best carried out from Whitehall," he argued.

The bill sought to bring about a "fundamental shift in the balance of power" from politicians to patients and doctors, the minister asserted, which would raise standards.

"The case for change is clear and compelling, and I am personally in no doubt that the changes set out in this bill are right for our NHS and, more importantly, right for patients," he concluded.

Labour peer and former GP Lord Rea

But the government's staunchest critic in the Lords was not soothed. Labour's Lord Rea set out to persuade his colleagues that the government had no democratic mandate to introduce the reforms and back his amendment to throw them out altogether - a highly unusual move for legislation that has already been approved by MPs.

Crossbench peer Lord Owen

Former Labour cabinet minister and founder of the SDP Lord Owen, who now sits as an independent peer, did not want to block the bill but he argued that the changes in it were so significant that a special committee should be established to look at them in detail.

After the health secretary's role had changed, he wondered, who would be in charge during a pandemic? "Adversarial debates across the floor of this House" were not the right medium for making judgements of such profound importance, he averred.

Labour frontbencher Baroness Thornton

Opposition health minister, Baroness Thornton, declared: "People did not expect, did not vote for and do not want these changes."

Focusing on the structural changes to NHS administration, she claimed that the new NHS Commissioning Board would be the "biggest quango in the world" and complained that Monitor was being transformed into a "huge bureaucratic economic regulator".

"The Liberal Party was in at the birth of the NHS," she noted, pleading with Lib Dem peers not to put that "legacy... in jeopardy".

Senior Lib Dem peer Baroness Williams

Baroness Williams told peers that extremely high levels of satisfaction with the current system were being overlooked, and that there was a pervasive fear that the NHS would be "essentially market based" under the changes.

She warned of the "frightening" consequences of mixing medicine and profit, suggesting that some US doctors were reluctant to cut down on carrying out lucrative prostate cancer tests despite warnings that they might cause incontinence and impotence.

Former Conservative Health Secretary Baroness Bottomley

Lady Bottomley suggested that some campaigning material she had received prior to the debate had been wide of the mark.

It exhorted her to "ensure my grandchildren can have the same benefits that you and I have received from the NHS since 1948", she revealed.

"I do not want my grandchildren to have the same benefits; my grandchildren have high standards. Like everybody else in this House, I want my grandchildren to have a better, more responsive, more effective and cost-effective NHS. Only through this bill will we achieve that."

Surgeon and former Labour health minister Lord Darzi

Lord Darzi, who conducted his own review of the NHS three years ago, said the "right competition for the right reasons" could drive up standards by "sparking creativity and lighting the fire of innovation" among clinicians.

But he criticised the complexity of the proposed new lines of accountability in the NHS.

Historian and broadcaster Lord Hennessy

Crossbencher Lord Hennessy, a co-signatory to Lord Owen's amendment, said the day the NHS was created was the "closest we have ever come to institutionalising altruism".

A way had to be found that did not involve the health secretary "abandoning" his role as the guarantor of a comprehensive service, free at the point of delivery, he said, and the special committee envisaged by his amendment would be able to do just that.

Fertility expert and broadcaster Lord Winston

Labour's Lord Winston spelled out why he believed "the legacy of the previous government which we keep hearing about might be a bit better than has been suggested by the present government".

The changes were "unnecessary" and "irresponsible", he lamented.

Lib Dem Baroness Hussein Ece

Lady Hussein Ece agreed the legislation was not perfect.

But she added: "I think most of us would agree that the status quo is not really an option." The bill could improve patient care and accountability, she predicted, if amended appropriately during its passage through the upper chamber.

Conservative former Health Secretary Lord Fowler

Lord Fowler lambasted a "dreary" misconception: "The use of the private sector does not mean that one is privatising the service."

He also dismissed the Owen-Hennessy bid to refer the bill to a special committee, telling peers that "the normal committee processes of the House would be sufficient" scrutiny for the legislation.

Health Minister Earl Howe

Finally, Lord Howe faced the daunting task of responding to the marathon debate. Peers agreed to give the bill a second reading, and then let it proceed with normal committee-stage scrutiny without establishing the special committee envisaged by Lord Owen and Lord Hennessy.

Compiled by Democracy Live's Ed Lowther

More from BBC Democracy Live
Compare who does what across the UK and Europe
Our A-Z of words used in the business of politics
Discover what BBC Democracy Live has to offer you
Americas Africa Europe Middle East South Asia Asia Pacific