Liberal Democrats vote to oppose NHS privatisation, but it’s more than just Lansley’s health bill
Something about the Conservative tradition has been lost as time has passed, namely in that Edmund Burke was not simply against the French Revolution per se. Instead Burke was positively for the Monarchical tradition that preceded him, pleading at revolutionaries to explain why they were going to put into jeopardy a system of governance that had the benefit of tradition, for a new experimental system, benefits of which were not entirely known.
The knee-jerk opinion that Burke was simply a thorn in the side of revolutionary change has normally been the preserve of liberals, but the Conservative phobia of experimentation with evidently useful, treasured and existing elements of society has clearly been overturned by Andrew Lansley, the UK health minister, and his new health bill. So much so in fact that Liberal peer Shirley Williams declared her opposition to what she called the “untried and disruptive reorganisation” of the NHS, back in February.
Yesterday, during the Liberal Democrat Spring conference in Sheffield, party members (still able to change policy) voted for an “extensive and radical re-write of the government’s NHS bill”.
Williams, along with former MP Evan Harris, “tabled calling for proper accountability and safeguards against privatisation” which has thankfully paid off, and not without support from party leader Nick Clegg who accepted the “rebel” amendments.
What this will do in the short term is create deep ruptures within the coalition. The Liberal Democrats, and Nick Clegg – who has vowed not to let the “profit motive drive a coach and horses through the NHS” – have sent a message to the health minister saying that they do not support the inclusion of “any willing provider” in the NHS. But as Paul said recently on this blog, proposing amendments to the health bill may not stop the coach and horses so soon. The backdoor attack on the NHS:
has been in the form of the abolition (in 2013) of Primary Care Trusts, and the establishment of three waves of GP commissioning consortia, already covering 35 million people in England.
This has created the space in which most GP consortia, who have nothing like the capacity to commission their own secondary care services, will buy in what the commissioning PCTs used to provide.
This time it won’t be the PCTs who provide it, but private sector health management firms like Capita, Dr Foster and the US giants like McKinsey, who are already working with 25 consortia.
Sure, some ex-PCT staff will get jobs in these management firms, as their technical understanding of secondary care contract development and monitoring will be needed, but little will remain of the PCT’s public-health oriented, public service ethos.
Though many of us are unsure what will happen if the coalition collapses, we hope Lib Dem rebels pull something out the bag to shake things up for good. Many people I know were hoping for the floor to fall in over tuition fees, but to no avail. Hopefully enough courage from the Tories’ orange bedfellows will be plucked to tear apart this horrible political mess once and for all.
Perhaps even the British Medical Association will pass a vote of no confidence to really bollocks things up for Lousy Lansley. But amid all celebrations that the majority of Lib Dems have dealt an important split in the coalition, we must still remember that the pressure by the Tories to pursue round-the-back privatisation to the NHS extends further than this new bill.
(H/T Alex for information on the BMA)
Carl
Richard Blogger has already written the perfect rejoinder to this piece of intelligent but ultimately wishful thinking. At http://torylies.blogspot.com/2011/03/lib-dems-live-up-to-their-reputation.html Richard says:
“We have even heard from Dr Sarah Wollaston – a Conservative MP! – that she was told that the only amendments that would be accepted during the Committee stage would be those from the Government. For any other amendments – even those from Dr Wollaston – the government would whip its MPs on the Committee to vote down the amendment. So does Dr Harris really think that his motion will have any effect at all?
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.”
This won’t break the coalition apart for the simple reason that the LibDems in Westminster have nowhere to go. If they had, they’d have tried harder earlier. Richard is right that this is simply face-saving stuff. Any resistance will have to be from outside (see part 2 of my piece when it’s done).
Just a basic correction: Lansley is the *English* Secretary of State for Health, not the “UK health minister”. Health is devolved, but what happens in England will inevitably affect the other nations in the Union (not least because the GP contract is a UK-wide contract, and if Lansley changes it – as he says he will – to include a responsibility for commissioning, then GPs in the other nations will get that too, although what they’ll do with it is unclear).
I think that over the next few days Clegg and his fellow collaborator Lib Dem ministers will claim that the Health Bill is substantially Liberal, and to a large extent he will be right. The problem will be that neither him, nor his inner core of Orange Bookers told the electorate (nor his candidates, nor party members) what their intentions really were at the last election. The same is true of the Tories. Lansley is simply delivering what he has always wanted to deliver and there has been plenty of information in previous Tory health policy documents to indicate what the policy would be. Again, Lansley did not tell the public (nor his party members, nor PPCs) and worse, the Press hasn’t particularly been in a mood to ask him the right questions. (Can some TV journalists ask Lansley, Cameron or Clegg the direct question: “Do you honestly think that the public voted at the last election fully knowing what you where planning for the NHS?”)
I expect that over the next few days Lansley will give some concessions on “accountability”, maybe “put councillors on GP commissioning boards” as suggested by the Lib Dem motion (which frankly will be pointless since what the hell do Lib Dem councillors know about healthcare?). Perhaps he’ll create some toothless adjunct to the boards (similar to FT council of governors at hospital trusts, frankly I was amazed that Lansley hadn’t thought about using this Blairite sop to “accountability”). He won’t want councillors on the actual consortia boards; if Lansley didn’t even want clinicians on the boards why would he want councillors? Nah, he will agree to a toothless “governing board” and the Lib Dems will get a warm glow of having achieved something.
The Lib Dem motion will have no real effect other than to allow the grass roots and senior figures like Dr Evan Harris to position themselves in the case of a future split. As I mentioned above, Clegg will be right to say that the Health Bill was in their manifesto (see here: http://sites.google.com/site/nhsfuture/Home/debunking-the-myths/myth-2 and here: http://sites.google.com/site/nhsfuture/Home/debunking-the-myths/myth-2/myth-2-lib-dem ) however, we know that he will be wrong to say that the public are behind the policy, and wrong to say that they were even aware of it.
This is why I agree with Paul’s comment above: the pressure to change the Bill (or stop it completely) will have to come from external forces. Lansley knows this, and this is why he’s emphasising “patient choice”. He says that AWP is “patient choice”. This was a powerful Blairite message and Cameron knows it. Lansley will resist much of the Lib Dem motion saying that they are against “patient choice”. He has said repeatedly that the health service unions, in particular, Unite and Unison, are against “patient choice”. (Don’t write them off, but note that “patient choice” will be the message that Lansley will use to attack them.) Finally, Lansley will say that the BMA (who he will specifically say is “the doctors’ union” since a Thatcherite attack on trades unions is alwauys popular with the Tory core vote) is against “patient choice”. He will quote “vested interests”. This is nonsense,of course (as is suggesting that a concept of “no decision about me, without me” is new). The Department of Health even said last week that the BMA were against “patient choice”.
Do you see a pattern here? If we (“the opposition” whatever that is) are to oppose Lansley, we have to attack and bring down his argument of “patient choice”. Either prove that patients do not want it (some do, many don’t care) or that it is ineffectual in delivering better healthcare (there is some evidence that shows this), or that it is more costly (IMO this would be quite a powerful argument if constructed properly).
The BMA SRM is very interesting. This meeting will let off a lot of steam, but more important is what the BMA council will decide to do afterwards. If there is a decision not to take part in AWP then Lansley will be stuffed. However, is he likely to kill the Bill? I suspect not. He’s very much a bludgeon, he believes in AWP and so he will not remove it from the Bill. Indeed, if he did, there would be no Bill. The other option, that is, replacing him with someone who could smooth (or rather, smother) the opposition, is also unlikely since in health policy circles it is generally regarded that only Lansley knows what the hell the Health Bill is all about. And remember, Cameron sent Letwin in to examine the Bill and Letwin OKed it, which means that both are fully behind it. Any climbdown on the Bill will damage Cameron badly. Can he survive that?
A final option is to halt the Bill, give Lansley time to “amend” it and reschedule it. I think that this is not an option either. The problem for us, as Paul suggested in his post on this site a few days ago, is that GP commissioning is already in place in the way Lansley wants, with PCTs fatally damaged and the private sector commissioning companies already in place. So that part of the Bill has already been enacted. Lansley will not reverse any of that. Further, Blair already put the structures in place for AWP, so that can go ahead without the Bill (the Co-operation [sic] and Competitions Panel – part of the Department of Health – are already steamrollering this policy). But from the point of view of Cameron and Lansley, they cannot delay the Bill (or put a halt on AWP, GP commissioning and bringing the private sector into NHS hospitals) because this will result in unrest in the service coinciding with the 2015 election. (Paul Corrigan – Blair’s health advisor – has written extensively about the timing of the Bill.) This is why PCTs are effectively being abolished, AWP established and GP consortia created right now. Lansley knows that NHS professionals have to make his policy work because no one can countenance the service failing. He knows that time is short and he cannot delay the bill or else the NHS will be failing at the time of the next election.
I think the P.C.Ts do a good job, Helping and supporting the public in there needs, How I know have been on meetings like, the L.T.P That is people with long term conditions. If the Health service is abolished. This could mean a cut in home nurseing visits for people who cannot get around, and other services like it so come on Liberal Democrats block this. stop David cameron, haveing his way.Dont be like a pupet, with the torys pulling the strings