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. 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.

  2. 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

  3. 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).

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  5. 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.

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