For a year a group of Liberal Democrats who know something about the NHS and the delivery of healthcare have been working to modify Lansley’s Health Bill with the aim of preventing irreversible damage to the NHS.
Until last week our draft motion still offered the hope of amending the Bill. When we saw Nick’s letter we realised that there was no point.
On preventing competition by price the letter is doubly misleading. David Nicholson warned about this in January 2011 and the Government conceded the point in February. However, even now competition on price has not been completely prevented. Government Peers admitted this week that the EU and UK competition law still applies to the NHS. Competition law only recognises two sorts of competition one wholly on price, and the other partly on price. There is already case-law on this matter. Imagine a small group of GPs taking on the financial might of a multinational health provider. The lawyers will make mincemeat of them.
Even the new amendments promised in the letter have not been delivered. Nick said we would remove the reviews by the competition commission. Government amendment 185 does nothing of the sort. It simply changes the words that describe the reviews. He said we would keep Monitor as the regulator of Foundation Trusts. Then Lib Dem and conservative peers defeated an amendment proposing exactly that. Even if they had delivered on that promise it would have be no help. Monitor cannot protect the NHS from competition law.
Nick said we had safeguards against ‘cherry picking’. All we have is words. We have not and cannot prevent ‘cherry picking’. So many of the things we claim to have delivered like ‘making the UK a world leader in medical research’ are just words. Telling commissioning groups buying in a fragmented market that they must remember education and training is like telling someone who’s boat you have torpedoed that they should try to keep their feet dry.
Nick says that “Public health will finally be returned to its rightful place in local government. Integration between health and social care will become the norm rather than the exception.” So how does moving public health from ‘A to ‘B’ guarantee integration between ‘A’ and ‘B’? And why do the experts in public health all tell us that the Bill will increase costs and increase inequalities?
From 1946 to 2006 every NHS Act has required the secretary of state to secure or provide healthcare. This Bill will remove that. In June we were assured that the clause on the duties of the Secretary of State would be reinstated word for word. It turned out that someone had their fingers crossed behind their back, or they were refering to a different clause at the time. In the Autumn Lansley boasted that his Bill had come through the commons unscathed. Last week Number 10 said that the additional changes being requested by Nick and Shirley were insignificant. And we didn’t even manage to deliver those.
So, fellow Liberal Democrats, we decided that Lansley’s Health Bill is not amendable. The time has come for a clear open honest debate. No middle line fudge. No more amendments that could be reinterpreted, misunderstood or half-delivered. Are you for or against the Health and social Care Bill? Conference should now decide.
*Charles West is a GP and chair of Shrewsbury Liberal Democrats