Jos Bell reports from the House of Lords on the latest debates on the health and social care bill, asking where next for the Lib Dems?
Jos Bell reports from the House of Lords on the latest debates on the health and social care bill, asking where next for the Lib Dems?
Campaigners to save the NHS from the avaricious jaws of the David Cameron, Andrew Lansley and their slavering friends started the week with several key hopes. Deep down, after all the months of heartfelt campaigning we all felt we would give the Lib Dems Lords one last benefit of one last doubt.
We knew there had been significant behind-the-scenes negotiations and this was the week we really felt that there was hope for a breakthrough.
The key amendments relating to competition and the ambiguous and unsafe role of Monitor – even acknowledged as such by its own chair – were on the agenda. Likewise the vote on the privatised CAP allowance.
Also those relating to ensuring patients have a voice within the ludicrously complex infrastructure that is LaLa Land; ‘nothing about me without me’, did I hear you cry?
Surely Shirley, The Right Hon Baroness Williams of Crosby, after promoting herself so fully to the media as a key opposer of the bill, was finally going to live up to her self publicity?
Daughter of Vera Brittain, whose Testament of Youth was the cry for the lost generation of the First World War – when healthcare was stitched together with hand knitted socks, crepe bandages and chloroform – she had promised so much.
As it was, the baton was passed to The Lord Clement-Jones of Clapham on Tuesday, hitherto a somewhat invisible member of the yellow team, now designated their Usain What I’m Sayin’ Bolt.
It did not even start well, offering an amendment which had been pulled together across the Opposition party divide as his very own and admonishing Baroness Thornton to ‘sit and listen’ to some of her own thoughts – he then offered up what seemed to be sensible argument to offset the worst threats of competition. Other nobles offered support.
However, when The Earl Howe opposed in his customarily courteous yet oblique manner, all those watching in anticipation of a sensible outcome were dumfounded when Lord C-J immediately withdrew without a blink of regret. Clearly this was a stitch up.
Baroness Thornton, Labour shadow health minister – with something like 15 years’ experience in the upper House – was visibly thrown by the magnitude of his action, before her customary GSOH quickly came to the rescue:
“Well my Lords – when a gentleman withdraws what is a girl to do?!”
C-J sat with his arms firmly folded while all around him stared pointedly ahead as the welcome release of laughter filled the Chamber.
The damage, however, was done. The vote was insisted upon of course, but true to previous form, the Lib Dems voted en masse against their own amendment, putting a huge nail into the coffin bearing our now wilting NHS. Their game of course is to appear to oppose the bill but then hope no one notice which way they actually vote. Duplicity thy name is 49% Shirley.
This was closely followed by similar actions relating to the amendment to improve Monitor which Lord Marks (of Henley-on-Thames, Liberal Democrat) had moved and also hardy and dedicated Crossbencher Baroness Finlay of Llandaff’s sensible proposal to address the “functions with a view to preventing anti-collaborative behaviour” – meaning doctors are expected not to work in an integrated way, but to compete, meaning sick people will be used as pawns rather than treated as patients. (Having personally found myself on the receiving end of such a scenario in a previous life I can testify that this can make for a disastrous outcome.)
On Thursday we had more of this shoddy, shabby behaviour – even accompanied by uncustomary shouting. Baroness Northover (of Cissbury, Liberal Democrat) ploughed through her own statement relating to all the very last minute changes in Healthwatch which so disadvantage patient rights.
Protocol dictates that as a noble reaches the end of a paragraph then interventions are allowed. It is also protocol that only one question per intervention is allowed. Knowing that Toby Harris, Baron Harris of Haringey (Labour), had a series of searching questions she ensured he was only allowed to voice one of them.
“Order! Order! Order !” they chanted – Lord Warner (Labour) sprang up and down like an indignant puffin, Lord Hunt (of King’s Heath, Labour, shadow Cabinet Office minister) furiously banging the despatch box to speak, followed by Baronesses Jay (of Paddington, Labour) and Scotland (of Asthal, Labour) with great elegance – all to no avail.
As Patricia Scotland said:
“I know that I have only been in this House only a short time – since 1997 – but I have never observed such extraordinary scenes.”
This raft of government amendments had been released only three days previously with the briefing meeting deliberately arranged at a time to clash with other immovable parts of the Lords calendar.
Even changes to ensure that the needs of children and the elderly were not allowed by Earl Howe, by now slouched louchely on his couch with the glint of victory in his eye. If a man’s ties are anything to go by his perpetual garb of rusty brown neckwear indicates his inner soul likely bears a definite affinity with the current NHS unhealthy bowel ads.
A key refrain from the Lib Dems this week was their ‘fury’ at the sight of the nasty names people are using to describe them on Twitter. Shirley, bedecked in a bright yellow jacket as if to ensure we have no doubt as to her allegiances, attempted to transfer the blame for the whole horrid mess onto the Opposition.
Lord C-J in what must be one of the rudest addresses of recent times in the Chamber, chastised Baroness Thornton for her use of Twitter and addressed her as if a recalcitrant child, saying he would refuse to deal with her any further until she desisted. Double standards my Lord are visible even in the dense text that is Hansard.
The government may horribly be succeeding in controlling the mainstream news output, but must understand that social networking sites are a different matter.
Andrew George MP (Liberal Democrat, St Ives), speaking at the Central Hall Rally for the NHS had stuck to a similar theme – predictably heckled by almost everyone in Central Hall when he maintained the Liberal Democrat Lords were responsible for making large scale changes to the bill – he left the stage saying the party would only engage if people stopped being so critical.
So there we have it – the final sell-out of the NHS is the result of the influence of a party who behave badly and then take umbrage when the rest of us point it out.
Petulance is not a constructive political attribute. Combine this with the testosterone ideologically-driven Tories then the combination is indeed toxic. George suggested to the rally that we offer them all a way to bow out of the bill with dignity. How that could be achieved, especially at this late stage. is a guessing game which we reluctantly have to leave to their Gateshead spring conference – where the motion according to Shirley is yet another fabrication of their true role in all of this.
There are, however, some in the Lib Dems urging the party to kill the bill – after months of silence Dr Evan Harris has finally re-emerged to express the inside truth, writing in The Guardian:
“I urge Lib Dems to call for the plug to be pulled on this legislation – for the sake of the NHS.”
Couple that with the news that thanks to the fortitude of former health secretary John Healey, baked by the Shadow team, the government have lost their appeal to contain their Transitional Risk Register, and it is fair to say the weekend will be ‘lively’.
Unless they can hijack their own agenda, the party have 30 minutes to turn this around. Hopefully in this instance they will once again vote against themselves… Anyone for Cluedo?
See also:
• Lord Owen: If coalition continue to appeal Risk Register, Bill must be paused – Shamik Das, March 9th 2012
• “Shoulder to shoulder in support of the NHS”, thousands rally to Save Our NHS – Jos Bell, March 8th 2012
• Nick Clegg’s letter to Lib Dem MPs and peers is just furious spin concealing NHS privatisation – Labour health team internal analysis, February 27th 2012
• Lib Dem MP tells Lords: How the NHS bill needs to be changed – Andrew George MP, September 21st 2011
• Baroness Williams: Coalition “bewitched by a flawed US system” – Shamik Das, September 3rd 2011
• Issues of great concern remain for Lib Dems on NHS reform – Dr Prateek Buch, June 15th 2011
• Baroness Williams hits out at NHS reforms – Shamik Das, February 28th 2011
76 Responses to “Lib Dems’ NHS bill dilemma: A party that votes against itself is a party in trouble”
Lukey Stanger
RT "@LordTobySays: Description of LibDem hypocrisy and Govt manoeuvres in Lords to push through ＃NHSBill http://t.co/KOl4sgn9"
Jos Bell
@JohnrashtonJohn can someone please ask why it is that the LD Lords constantly vote against their own amendments ? http://t.co/F1TLe7NL
Gez Winstanley
As per the Dept of Health, Factsheet A2.
1. The NHS needs to modernise to meet the challenges it faces now and in the future:
2. Rising demand and treatment costs.
So we’re going to replace one of the most efficient healthcare systems in the world (ranked first out of the systems of Germany, the Netherlands, the US, Australia, New Zealand, and Canada by the Commonwealth Fund in 2010) with a market based system on the basis of no evidence at all. Just blind faith in markets. Don’t worry that the highly market based US health system is the least efficient in the world. Don’t worry that markets would have collapsed the world’s financial systems without massive government interventions in 2008. And don’t worry that the overwhelming majority of healthcare professionals think the reforms won’t work. It’ll be fine, just trust your lives and well-being to our dogma. Have faith!
3. Need for improvement.
The NHS isn’t perfect. OK, nothing is. And yes, as judged by a King’s Fund report in 2010 the NHS was already making steady improvements in terms of all its major indicators. But the new system will be better. Don’t worry. Refer to the answer above. The new system will be better because we say so.
4. There are unjustified variations in the quality of care across the country.
Which we’re going to improve by taking the Secretary of State further out of the picture and handing over control to consortia, private healthcare providers and self managing hospitals, all able to do their own thing, including increase their number of private patients to 49%, and all encouraged to compete with each other. That’s bound to increase consistency in quality of care, isn’t it?
5. The experience of care for too many patients is fragmented between different parts of the health service and between the NHS and social care. Good examples of integrated services do exist, but there are huge opportunities to make services more integrated for the benefit of patients. While progress has been made, more still needs to.
So we’re going to hope that the complex and ever changing mix of bodies we mentioned above, all now open to commercial pressures and some of which will be profit making, to stop competing for a moment and co-operate to provide integrated services. Yes, we’ve really got all our fingers and toes crossed on that one!
6. The NHS also needs to be more responsive to the patients it serves. Too often, patients are expected to fit around services. Decisions about their care are taken at several removes from those who know them the best – the professionals who care for them. Public measures of performance bear little relation to what really matters to patients: how well the NHS is delivering their care.
Forget that most of those professionals think the reforms will be bad for their patients. And don’t worry abut the reforms shifting the focus from a duty of care to money making. Or about conflicts of interest in the new commercialised system, when some of the people commissioning services also have a direct stake in the enterprises from which those services are being procured. Or that many time pressed GPs will still have to hire in consultants and private health care companies to do their procurement for them. This isn’t a free for all for private health care providers, their salespeople and their lawyers; it isn’t a recipe for chaos and institutionalised corruption. The patient will still be central!
7. For too long there has been a vacuum in NHS accountability. With no measures to hold PCTs and trusts locally to account, the notion that the Secretary of State is responsible for all clinical decision‐making in the NHS results in a less responsive and accountable service and a poor deal for patients. Clearer accountability is essential.
Of course, you may well believe that the above heady mix of consortia, independent hospitals and private healthcare providers, in a state of constant mutual competition and even litigation, is going to be less accountable to the general public, especially those meanies who won’t stump up the extra cash to go private. So we’ve thrown in an odd arms-length quango or two. We all know how effective those are at ensuring government accountability, or at least credible deniability. And we all know how effective quangos are at regulating markets (remember the FSA and the banks? Or how the energy supplying companies were forced to stop making excessive profits and brought to heel?) and don’t think that our “bonfire of the quangos” when we came into office means that we don’t really believe in such bodies…now we’re converts!
8. State of the public finances. Recent years have seen improvements in services alongside growing budgets. However, we cannot afford to keep doing the same things in the same ways. Too much of the NHS budget is consumed by layers of bureaucracy that would be better spent on patient care. We need better value for money for what the NHS spends.
And of course, once we’ve spent 2 billion on reforms themselves, we’ve got every faith (faith being a belief held with no requirement for evidence) that our system will really offer efficiencies beyond those of the one of the world-leading healthcare system in terms of efficiency. Now here you really have to admire our self belief that we’ll save money, given that the new system will erode altruistic motivations and strengthen the profit motive, open the doors ever wider to private healthcare providers using every opportunity to make money and often need to find extra cash to fund shareholders profits. And admittedly we’re having to re-hire many of those old health service “bureaucrats” to operate the new consortia. After we’ve paid them their redundancies packages, of course!
Now you can see the absolutely perfect fit between our solutions and the problems we’ve identified. Trust us! Don’t worry about Lord Owen’s hysterical claims that the reforms are a “constitutional outrage”, or that Mr Cameron bare-face lied to you all at the election, when he promised no “top down reform” of the NHS, while simultaneously planning the biggest “top down” reform in its history. The lack of a mandate is a mere nicety. It’s only the lives and well-being of you and your loved ones and stake. When it all goes pear shaped we can just sack Andrew Lansley. And hope that you fall for that and don’t consign us to political oblivion at the next election (more fingers and toes crossed on that one!) And, if you’re worried still you can go just be one of the 49% who goes private. Can’t you???
Inspired by Factsheet A2, which provides details regarding the case for change behind the proposals within the Health and Social Care Bill. You can see the original here:
http://www.dh.gov.uk/health/files/2012/02/A2-Case-for-change.pdf
Other sources:
http://www.telegraph.co.uk/health/9106880/Read-this-and-prepare-to-fight-for-your-NHS.html
http://www.kingsfund.org.uk/publications/a_highperforming_nh.html
http://www.bma.org.uk/images/srm2011briefingpaperhealthoutcomes_tcm41-204676.pdf
BevR
@DrEoinClarke http://t.co/F1TLe7NL LDs and the NHS #NHSBill
Jos Bell
@BendyGirl @doc_jest http://t.co/F1TLe7NL #NHSBill