Nick Clegg has not demanded the role of competition in Lansley's health bill to be changed, only the appearence that there is a "dogmatic obsession with it".

Nick Clegg’s amendments to the health reforms, in particular in connection with the injection of external competition that could see the NHS become more like the electricity or gas markets, could be little more than presentational according to a leaked paper.

The BMA is clear on the need to remove the competition clause from the Health and Social Care bill. It says:

“The pressure to apply competition rules could divert providers and commissioners from their key task of designing and maintaining high-quality patient care. There is a risk that it will become difficult or impossible for commissioners and providers to operate in the best interests of patients…

“Local health services and patient care may become fragmented and/or destabilised if arrangements between local providers and commissioners that have worked well in the past are deemed anticompetitive by Monitor. Existing NHS services could be at risk of closure, despite being popular with patients and delivering high quality care

“The partnership model of care provided by GPs and hospitals doctors could be disrupted and replaced by the inevitable instability… The BMA is committed to an NHS that cares for patients through co-operation, not competition. Monitor’s key task must be to maintain access to high quality patient care, rather than promoting competition.

“Only by removing the duty on Monitor to promote competition can it be ensured that commissioners and providers are given the freedom to operate in the best interests of their patients.”

As it currently stands, Clause 60 of the bill endows Monitor with similar powers to the energy regulators. The organisation’s chief executive Dr David Bennett has spoken of his enthusiasm for a Thatcherite-style reform of the NHS, and bringing healthcare in the UK in line with the water and electricity markets.

However, the deputy prime minister has not asked for the role of competition in the bill to be changed in a recent set of demands, only the appearance that that there is a “dogmatic obsession with it”.

The Independent reports today:

“In a paper sent to the Prime Minister and seen by The Independent, Mr Clegg demanded four radical changes to the NHS and Social Care Bill during the “pause” the Government has called as it tries to allay fears about the reforms.”

These changes are:

• Ensuring GPs only get involved in commissioning decisions once they are ready and willing;

• The removal of any suggestion that we are pursuing a dogmatic obsession with competition [rather than] the best healthcare system in the world;

• Preventing the cherry-picking of services by private providers to make sure NHS providers are not needlessly pushed into financial trouble and NHS research and training can thrive;

• Enhancing governance and local accountability so decisions are transparent to all.

This careful wording, which appears to reduce action on competition to a PR exercise, has been welcomed by 2020 Health Chief Executive and and 2010 Conservative candidate Julia Manning. The head of the think tank, which has deep links to andrew Lansley, the Conservative Party and private healthcare interests as reported on Left Foot Forward said:

“On the whole, we agree with you Nick. And we understand that you need to look tough on the NHS.”

Clegg had previously been reported as wanting to block the empowerment of Monitor as a utility style regulator, that Lib Dem Dr Evan Harris has described as: “this mass marketisation of the health service”. Nothing short of the removal, or alteration beyond recognition of Clause 60 will satisfy medical professionals, Lib Dem grassroots and all worried about external competition in the NHS.

However, it may be that Clegg is soft on this key battleground within the coalition, without which his ‘muscular liberalism’ on health may amount to little more than ‘playfighting’.

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