Lib Dems *will* deliver significant changes to NHS reforms

Andrew Lansley’s misguided NHS reforms that the Health and Social Care Bill look set to be recommitted to Parliament, writes Dr Prateek Buch of the Social Liberal Forum.

Much to the chagrin, no doubt, of the Conservative 1922 Committee, those “yellow bastards” – also known as their coalition partners the Liberal Democrats – look to have delivered such significant alterations to Andrew Lansley’s misguided NHS reforms that the Health and Social Care Bill looks set to be recommitted to Parliament.

Nick Clegg gave a strong speech to UCH yesterday that once again echoed the substantial changes his party called for in Sheffield, indicating afterwards that the resultant legislation would differ sufficiently from the original to require renewed parliamentary scrutiny.

Yesterday’s developments may result in the first such recomittal for a decade.

Also yesterday, it was revealed that shadow health secretary John Healey, who tabled a motion requesting the bill be re-sent to Committee, plans to publish Labour’s specific objections to the bill, joining the Lib Dems in doing so.

Given the significant changes to the bill Clegg gave a preview of, there will undoubtedly be speculation relating to Andrew Lansley’s future as well – but the fallout from the changes look like going further than that, with backbench Tory MPs setting out their ‘red lines’ which they insist on retaining.

Sending the bill back for more scrutiny is of course a welcome move as it rightly gives parliament and the medical profession further time to get the reforms right. Should all of the required changes be made – strengthening democratic accountability; retaining commissioning as a transparent and public function; ensuring competition isn’t expanded at the cost of patient care; and softening the pace of change – the bill itself will emerge much improved.

But what about the NHS in the meantime; what happens to the sweeping changes already taking place across the country?

Clegg insisted in his speech:

“We aren’t going to just sweep away tiers of NHS management overnight.”

Yet I’ve met several Primary Care Trust staff who have recently been laid off with the expectation of being hired soon by emerging GP-led consortia. My father, a GP in inner city Salford, is one of hundreds of primary care physicians eagerly awaiting the resolution of the political wrangling over the reforms.

The uncertainty created by a prolonged process – necessary though that is – will surely add to the opportunity cost of implementing the Bill’s reforms.

Some of the changes Clegg set out yesterday are in direct conflict with the Tories’ leaked red lines – not least their apparent insistence on a rigid timetable for introducing GP commissioning across the country without exception, and the role of Monitor as a competition watchdog in a healthcare market.

If these really are red lines for the Tories, it shows their dogmatic adherence to the marketisation of the NHS, and puts into strong relief the battles yet to be won before the reforms are acceptable.

We may well look back at Clegg’s speech yesterday, calling yet again for substantial changes to the bill, as a turning point – not just for the reforms but for the coalition. What matters from here on in is that the personnel running the NHS, the doctors and nurses delivering world class care, are given clear guidance as to where the process goes from here.

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