Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists

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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32 Responses to “Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists”

  1. Richard Blogger

    My blog here http://j.mp/fwJlW1 got name checked on @leftfootfwd http://j.mp/gyJ0w7 I'm still sceptical 😉

  2. Dr Evan Harris

    Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me at @leftfootfwd

  3. Mark Ryan-Daly

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  4. Kelly

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  5. gimpy

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  6. JP Spencer

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  7. Steven Lambert

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  8. Duncan Stott

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  9. Rebecca Taylor

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  10. Jan Bennett

    RT @richardblogger: My blog here http://j.mp/fwJlW1 got name checked on @leftfootfwd http://j.mp/gyJ0w7 I'm still sceptical 😉

  11. Don Harrison

    RT @DrEvanHarris: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I by @prateekbuch & me …

  12. John Lever

    RT @leftfootfwd: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I write @prateekbuch an …

  13. Alan Marshall

    RT @leftfootfwd Govt. must go beyond cosmetic changes 2 health bill warn Lib Dem activists: http://bit.ly/eDq19I

  14. Chris

    RT @leftfootfwd: Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I write @prateekbuch an …

  15. Richard Blogger

    Perhaps my scepticism is really naivety. I expected the white paper consultation (which highlighted many of the issues the Lib Dems were concerned about in their Spring conference) would lead to a change in the Bill. It didn’t, most of the criticisms expressed during the consultation process were summarily dismissed in the government’s response. Further, as concern was increasing before the end of last year (and just before the Bill was published) a Lib Dem, Danny Alexander, reviewed the Bill and signed it off. Alexander was satisfied with the Bill, surely we should take that to mean that he thought it agreed with the Coalition Agreement and key Lib Dem policy?

    The debate for the second reading of the Bill had Lib Dem MP after Lib Dem MP speaking in support of the Bill (notably, Andrew George was against and John Leech expressed concerns, but still voted for the Bill). Were those Lib Dem MPs speaking for the bill aware of what was in it? Two months later the Lib Dem grassroots gave those MPs the message that they were clearly out of touch.

    Then the Bill moved to the Committee stage, which, rather naively, I thought would scrutinise the Bill and make amendments. The Bill committee contained John Pugh and Mike Hancock, both Lib Dem MPs (the latter, a chair of the committee) as well as Paul Burstow (Lib Dem Minister of State). Yet the only amendments made to the Bill were by the government, and we were told that they were simply “tidying up” and “clarifications”. In the midst of the Committee’s work the Lib Dem Spring conference declared that they wanted important changes made to the Bill, yet the Minister of State (in a good position to make Coalition government changes that would alleviate Lib Dem fears) made no such changes.

    Perhaps I do not understand how coalition government works, perhaps I do not understand how the parliamentary system works, but I have not seen any Lib Dem influence on this bill as it has gone through Parliament. Indeed, I have seen Lib Dem MPs in the second reading debate fully support the Bill.

    Now we hear that Lib Dems are against the Bill in its current form. Why weren’t they against it in the second reading? Why weren’t they willing to make amendments in the Committee stage? This is why I am sceptical.

  16. Mr. Sensible

    The proposals in their current form are in a total state.

  17. Jos Bell

    For anyone who doubts the worth of the NHS being free at the point of need for all who need it, I advise you to read this telling report from an 89 year old retired doctor who vividly remembers the pre NHS days….. http://tinyurl.com/5sfppf Also note those who were excluded from ‘the panel …the most needy & the most vulnerable’. Sound familiar? Let us stop this vile Bill before history is repeated – not out of ignorance now, but out of deliberate cruelty.

    Essentially if anyone believes that a mere tinkering with the Lansley Bill will suffice – just remember loose jawed Letwin letting slip that it has been specifically designed to demolish the NHS within 5 years. We need to preserve the NHS and build on our proven success, protecting it from profiteers and take overs – to do anything less will show that we have wasted our knowledge and brutally rejected the evidence. Please do not let ‘the pause’ be used up by nothing more than feigned listening – let us state our case loud and clear to make sure the ‘listeners’ actually hear us.

  18. Liam Carr

    Natural Break? A wobble, but not yet a U Turn. I teach Biology but I Have never taught prospective medical students about balance sheets. The changes are fundamentally flawed here’s why… http://bit.ly/fK92rs

  19. Evan Harris

    @Richard Blogger

    I linked to the wrong blog of yours.

    You wrote (in unnecessarily personal terms against me) that the Lib Dem Conference vote would not matter and has not mattered. You were wrong and I think you should admit you were wrong and apologise for the personal tone of your articles both of which affect your credibility.

    This one http://torylies.blogspot.com/2011/03/lib-dems-live-up-to-their-reputation.html said,

    “So we hear that Dr Evan Harris will propose a motion on the NHS at the Lib Dem spring conference tomorrow. What a pathetic action that is.”

    ” he is proposing this motion at a time when he knows damned well the amendments will not be made.”

    “As anyone who has read Lansley’s response to the “consultation” will tell you, his reply to any criticism was “tough, I will have my way regardless”. And this will be his response to Dr Harris.”

    “I expect the Harris motion to be passed and Lansley to say to Clegg “deal with your little local difficulty”. The Bill will pass largely unscathed and Dr Harris will be seen as having tried to amend the Bill. The only winner will be Dr Harris.”

    And this blog
    http://torylies.blogspot.com/2011/03/reaction-to-lib-dem-nhs-motion.html

    “Let’s have a look at the reaction to the Lib Dem spring conference rebel motion against the government (just joking, we all know that it will be treated as a little local difficulty).”

    “Downing Street has ruled out “significant changes” to government NHS reforms following their rejection by Liberal Democrat members.” So in other words: not much will change.

    Also you do not, as you suggest, understand parliamentary processes. Potential rebels do not generally vote against a whole bill at 2nd reading (esp where many of its contents stem from the manifesto – or in this case the Coalition Agreement) but wait for Report stage to vote for specific changes. If that fails they have the option to vote against at 3rd reading or wait for Lords amendments to come back.

    Public Bill Committee is not the place for rebellion (the last Labour Government was never defeated in Public Bill Committee in 10 years – or just once I think). The chairman of a Public Bill Committee – who is deputising for the Speaker – can’t express a view, let alone vote (except as a casting vote for the status quo). This is basic. You really should do some research before making allegations like that against Mike Hancock.

  20. Gareth Jones

    http://tinyurl.com/3fprjqf Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists

  21. Prateek Buch

    @Richard Blogger – your scepticism/naivety is understandable, but as Evan pointed out rebellion isn’t usually encountered at earlier stages – even less so in a Coalition I’d suspect.

    What matters is that through internal, democratic dialogue, the Lib Dem membership made its position on the Bill clear at Conference – and now expects its representatives in Parliament to deliver the amendments we set out.

  22. bob

    I don’t understand the natural resistance people have to this bill.

    Why is privatising the NHS instinctivly a bad thing, NO ONE is talking about changing the “free at point of use” part of our healthcare.

    Why does it matter that it is public or private run?

    Why are these people not looking at the fact that WHO ranks the UK NHS in the 20s wheras countries that have privatatly provided BUT state funded healthcare (which is basically what this bill is about) sitting in 1-5th place?

    I don’t understand the resistance to this bill other than some idillic moral crusade about protecting public sector intrests.

    What about the paitents who are recieving declining healthcare at ever increasing costs?

  23. Paul Gleeson

    Govt. must go beyond cosmetic changes to health bill warn Lib Dem activist | Left Foot Forward: http://bit.ly/evUwVL via @addthis

  24. mike cobley

    Well, BOB, the reason we are opposed to market mechanisms and the involvement of private sector in frontline services is pretty straightforward. You see, its all about core functions. The core function of the NHS is to take care of the health of the nation; the core function of a private sector health trader is to maximise profit & minimise loss, as it is for any commercial venture operating in the market. Straight away, the conflict of interest is starkly obvious. Both the historical and contemporary record is replete with examples where private sector health traders have degraded the services under their purview, or triaged their patients and clients according to ability to pay, or siphoned off financial resources in the form of bonuses, exorbitant executive pay, and shareholder dividend.

    See, where the money goes is also of vital importance to us; for you and others to turn round and sneer that all we should be bothered with is that its ‘free at the point of use’ is profoundly insulting. Here endeth the lesson.

  25. scandalousbill

    bob,

    You say:

    “Why are these people not looking at the fact that WHO ranks the UK NHS in the 20s wheras countries that have privatatly provided BUT state funded healthcare (which is basically what this bill is about) sitting in 1-5th place?”

    Is it simply a question of private versus public funding, or do the results reflect the results of a larger spend on healthcare? For example France and Germany spend a higher percentage of GDP on healthcare as opposed to the comparable spend of the UK.

    A second point to note is that country by country comparisons may not accurately reflect the differences that may occur between nations, as the article by David Beemer alludes

    “The WHO ranking was ambitious in its scope, grading each nation’s health care on five factors. Two of these were relatively uncontroversial: health level, which is roughly the average healthy lifespan of a nation’s residents; and responsiveness, which is a sort of customer-service rating encompassing factors such as the system’s speed, choice and quality of amenities. The other three measure inequality in health-care outcomes; responsiveness; and individual spending.”
    “These last three measures struck some analysts as problematic, because a country with unhealthy people could rank above a healthier one where there was a bigger gap between healthy and unhealthy people. It is certainly possible that spreading health care as evenly as possible makes a society healthier, but the rankings struck some health-care researchers as assuming that, rather than demonstrating it….”

    http://online.wsj.com/article/SB125608054324397621.html

  26. bob

    *Is it simply a question of private versus public funding, or do the results reflect the results of a larger spend on healthcare? For example France and Germany spend a higher percentage of GDP on healthcare as opposed to the comparable spend of the UK.*

    You miss the point.

    Those countries spend more, but they do not provide the healthcare, they provide the funding.

    Many other countries provide better healthcare without the state being the provider (they just provide the funding).

    I see no reason why the NHS has to be owned or run as a goverment entity as it is, and THAT is what this whole thing has been turned into (You only have to look at the top of this page “Keep our NHS PUBLIC).

  27. Is Lansley really listening? | Left Foot Forward

    […] list of those opposing these reforms continues to grow, and includes an ever increasing number of Lib Dems and Tories like Lord Tebbitt. They join a growing list of leading health […]

  28. scandalousbill

    bob,

    Many other countries provide better healthcare without the state being the provider (they just provide the funding).”

    If you check out the OECD data with regard to the proportion of private/public healthcare spend as a proportion of GDP, you will find that the UK spend mix is roughly in line with the OECD average, and that nations with a higher percentage of private healthcare are not at all entirely top performers.

    The spend figures can be found in the OECD Factbook,

    http://oberon.sourceoecd.org/vl=8219516/cl=17/nw=1/rpsv/factbook2009/10/02/01/10-02-01-g1.htm

    Compare with the rankings found in the article from Health Consumer Powerhouse.

    http://www.healthpowerhouse.com/files/UK.pdf

    The Netherlands healthcare system, ranked first, is a public healthcare system, not a private one, it is also heavily regulated by the government and payments towards insurance are collected by the government. You will note the public/private mix as per the OECD Factbook is roughly the same as the UK. So your correlation in favour of the private sector fails.

  29. Cameron "humiliates" Lansley while coalition health reforms stall | Left Foot Forward

    […] the Liberal Democrats still demanding substantial changes, and medical professional bodies looking unlikely to be convinced any time […]

  30. Daniel Pitt

    Govt. must go beyond cosmetic changes to health bill warn Lib Dem activists: http://bit.ly/eDq19I #ConDemNation

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