Opinion: Hackney debates NHS

You would expect that the electoral disaster faced by the Lib Dems last Thursday, with hundreds of councillors losing their seats and the referendum on fairer Votes comprehensively lost, would have overshadowed the weekend’s political activity. Not so in Hackney, where the local party and friends gathered in the sunshine to discuss the apposite question, “what is happening to our NHS?” First to address the issues around the government’s proposed reforms was health Minister Paul Burstow, and in fairness he did begin by paying tribute to the hard-working activists who had to deal with exacting national political circumstances – he also emphasised the few bright spots amidst all the gloom (Eastleigh amongst others) and spoke of the lessons we can learn from those areas where our vote did hold up. Paul then moved on to discuss the question du jour – with the party expecting significant revisions to Andrew Lansley’s NHS reforms, how will Lib Dems in government deliver the improvements to the Bill demanded by conference? On one thing Paul was very clear – the reforms as they stand will have to be altered before Lib Dems will consider supporting them – and he set out some clear areas where changes are vital to secure the Bill’s passage through parliament. Highest on Paul’s agenda for amendments was the pace of change – he reassured us that where GPs felt unwilling or underprepared to take on the role of commissioners, they wouldn’t be forced to do so under the strict timetable set out by the current legislation – change would not be brought about in a disruptive manner, a sentiment that echoed Nick Clegg’s assertion earlier in the day that “we shouldn’t be forcing the pace according to artificial deadlines in a calendar,” that “no bill is better than a bad one, and I want to get this right”. Indeed on commissioning Paul went further during the Q & A that followed, indicating that a central plank of the amendments sought by conference – the retention of commissioning as a public function not to be outsourced for profit – would be part of the revised Bill. Should this be the case it would significantly ease many concerns around the potential conflicts of interest that would arise if commissioning became a for-profit activity, and I hope to see commissioning retained as a transparent public function.

Paul also emphasised, and he was right to do so, the positive proposals in the Bill which are to be welcomed; for instance, the integration of health and social care that should help end the often shambolic treatment of elderly and vulnerable in society. In my spiel I also flagged some positives that the Bill includes – such as devolving responsibility and funding for improving public health to local authorities, and ending the shameful Labour practice of paying independent sector healthcare providers for procedures regardless of whether they are carried out or not. But beyond these clear improvements to the NHS, I also raised some significant concerns about the central tenets of the Bill – practice-based commissioning, any willing provider and increased choice and competition amongst providers – that I hope will be acknowledged when the amended Bill emerges.

On GP commissioning, I argued that there was little evidence of its being more effective, not least as the reforms hadn’t been rolled out in controlled pilots where we could assess the outcomes fairly. I also added that thousands of GPs signing up to the programme was hardly evidence of their enthusiasm – I should of course have quoted Dr Laurence Buckman, chairman of the BMA’s GPs committee “Just because someone gets into a lifeboat doesn’t mean they support the sinking of the ship.” I went on to argue that if any willing provider is to be allowed to treat NHS patients, the cherry-picking of clinically simple cases is an inevitable consequence; even if said providers won’t be allowed to compete on price, as appears likely, for-profit providers will choose easier, more lucrative procedures, leaving public providers to pick up the more complex ones – as well as having the sole responsibility to conduct crucial training and medical education functions, something that is seldom raised but is central to a well-run health service. I also questioned whether increasing choice for patients was a valid end in itself, not least if the most vulnerable in society (those whose first language isn’t English, who aren’t savvy or sharp-elbowed or those with severe health problems) do not have their capacity to exercise said choice enhanced. On this latter point Paul agreed with me that measures need to be put in place to avoid patient choice becoming an agenda for the capture of the best services by the affluent.

Indeed overall I’d say Paul struck a measured tone, backing many (but tellingly not all) the reforms in principle and confidently making it clear that Lib Dems would be improving the Bill to reflect our Conference motion. My final point – before an absorbing question session with detailed discussion around issues such as local accountability and the role of the private sector – was that even if the Bill were to be completely re-written to include our changes, we would still be some way off an optimal NHS, as the Bill explicitly fails to address some of the most pressing challenges facing the service. The continued use of the wasteful PFI scheme to upgrade infrastructure; the inadequate standards of care in some hospitals; the rising cost of prescription drugs against a background of shrinking hospital budgets; the direction of travel towards an NHS that is essentially a brand stamped onto publicly regulated, privately provided services – these are the challenges clinicians and patients face and will remain unanswered even if all Lib Dem concessions are incorporated into the current Bill. Far from being a low note to end on, however, this shows that there’s an excellent chance for us as a serious party of government to formulate a health policy that liberates people to live their lives more healthily.

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