It’s at this time that the Liberal Democrat grassroots pressure for changes must be heard the loudest, to prevent the government from making cosmetic or wrong-headed amendments to the NHS legislation and try to pass them off as significant improvements to the policy.
By Dr. Prateek Buch, a research scientist and an executive member of the Social Liberal Forum, and former MP Dr. Evan Harris, vice chair of Liberal Democrat Federal Policy Committee
At last month’s Liberal Democrat spring conference, the party’s views on Andrew Lansley’s health reforms could not have been made clearer; the Health and Social Care Bill is unacceptable to Liberal Democrats in its current form, and the membership is now insisting on significant amendments to bring the policy back in line with last year’s coalition agreement and with Lib Dem principles.
Following the overwhelming show of support for substantial changes to the bill, several leading Liberal Democrats have composed a number of specific provisions which need to be inserted into the bill or guaranteed. Lib Dem MPs will need to make clear to the Conservatives that these are the changes required. The amendments that we expect to see delivered would reaffirm the role of the secretary of state to provide or secure a comprehensive NHS; ensure proper democratic accountability and/or scrutiny of commissioning bodies; restrain the proposed deeper marketisation of services; and ensure that any changes are brought about at a pace that the NHS can handle.
Various reports indicate that the government has agreed to delay, take control of and significantly alter the bill to fend off increasingly damaging criticisms. In addition the house of commons select committee on health published its recommendations which, in many areas, echo the Liberal Democrats’ call for changes. Andrew Lansley has thus been forced to admit the need to make concessions; though Nick Clegg went even further this morning on BBC breakfast by saying that major changes would be made.
It’s at this time that the grassroots pressure for changes must be heard the loudest, to prevent the government from making cosmetic or wrong-headed amendments to the legislation and try to pass them off as significant improvements to the policy.
There was some scepticism amongst Labour bloggers about the value of internal party democracy as defined by the Lib Dems’ debate on health reforms; perhaps the changes about to be made to the bill will encourage Labour to reinvigorate their own internal democracy.
There are some things which were not Liberal Democrat policy that can not be prevented because they were included in the coalition agreement as part of the deal. These include a national commissioning board. There are other provisions which are made more difficult to stop because of the way they were introduced or even embedded under the Labour government.
For example, a greater role for GP commissioning (which Labour’s manifesto also called for), a continued role for the private sector in provision, foundation trusts having the greater freedom of the market place and all trusts being forced to move to foundation trust status.
It is no excuse for the coalition government to point out that some of the other unacceptable suggestions originated under Labour. They were wrong then too! For instance, the attempt to out-source to the private sector Oxfordshire Primary Care Trust’s commissioning function in 2008 by Patricia Hewitt. Or the proposal to allow price competition on tariff services found in the December 2009 NHS Operating Framework. Or the way that primary care trusts were forced to privatise a specific proportion of their provision and forced to transfer activity from the NHS to ISTCs who were then paid regardless of activity – wasting £22 million in London alone.
It is astonishing that the Conservative party has not understood that while the Labour party could get away with undermining the NHS if it wanted to, because of the trust earned gradually but not consistently over decades, the Tories simply can not. That is politics 101 and it is an irony of the situation that Labour and Lib Dems are combining to save the Tories from retoxifying their brand to the full extent that Andrew Lansley and the Tory right seem to wish to.
The essential amendments we have published are necessary if the NHS is to be retained as a comprehensive, egalitarian, world-class institution. There is ample evidence to suggest that Lansley’s proposals threaten the cohesion and cooperation at the heart of the NHS, and it’s only by retaining these core values at the heart of the system that any reform will be acceptable for Lib Dems and the country at large.
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