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.

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

  1. 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.

  2. Gareth Jones

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

  3. 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.

  4. 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?

  5. Paul Gleeson

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

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