Published: 15/07/2004, Volume II4, No. 5914 Page 15
Reform of the House of Lords may seem a trifle remote from the everyday cares of NHS managers.Yet if they had any spare time to thumb through Hansard they would be pleasantly surprised by the informed nature of many of the debates on the NHS. Not surprising, perhaps, given the number of peers who have worked in or are users of the service. Lord Winston and ex-royal college presidents Baron Turnberg and Baron Patel are a pretty good starting line-up.
There is no shortage of questions and debates about the NHS.
Remarkably, many supportive comments are made about NHS managers. Far from joining in the bureaucratic bashing so beloved of many politicians, a surprising number of Lords members think that it is under-managed.
I have been reflecting on the quality of the second chamber having accepted the heavily poisoned chalice of chairing a group of Labour peers looking into what the functions and powers of the Lords should be.
We were set up to find answers after the government was recently forced to withdraw its proposals for getting rid of the remaining hereditary peers.
This is par for the course. Ever since the 1911 Parliament Act, one attempt after another to reform the membership has failed.MPs have always feared that a fully reformed Lords would attack and undermine the pre-eminence of the Commons.
So, going back to basics and asking exactly what you want a second chamber for has a lot of attractions. If you're sure about its role and purpose, then you are in a much better position to sort out what kind of membership you want - be it elected, appointed or something in between.
Over the years, the Lords has balanced its lack of democratic legitimacy by exercising constraint over the use of its powers.
Conventions have guided its behaviour. This includes not voting against the government on a manifesto commitment or on secondary legislation and ensuring that the government is entitled to its business without unreasonable delay.
But since the removal of most hereditary peers in 1999 the Lords has become much more assertive - voting down secondary legislation, threatening to filibuster and generally testing the boundaries of the conventions.
The result is confusion over its de facto powers and a tense relationship with the Commons.
This is unsustainable in the longer term and there is a very strong argument for bringing much greater certainty as to what the appropriate powers of the Lords should be.
At the same time, there is much that the Lords could do to modernise its working methods. Though it has a deserved reputation for the way it scrutinises legislation, it could do so much better if it scrapped some of its more archaic procedures.
Should it be elected? That is a question for another day. But for an NHS increasingly ready to engage in the political process, a confident and reformed house might listen to it even more in the future.
Lord Hunt is chair of the National Patient Safety Agency and a former junior health minister