Opinion: How democratic are doctor politicians?

A group of 240 doctors recently threatened to stand against leading members of the government in the next election, in protest at the NHS Bill (Now the Health and Social Care Act). They are ‘shocked at the failure of the democratic process and the facilitating role played by the Liberal Democrats in the passage of this bill’. They follow the example of Richard Taylor MP, a consultant physician who won his Wyre Forest seat from a junior health minister in 2001, campaigning against the closure of the A&E Department at Kidderminster Hospital.

My immediate reaction to this news was essentially that it’s a free country, and anyone can stand for parliament if they like. I’ve seen very little comment about this, however, and I have begun to wonder about the legitimacy of such a campaign.

There were two possible scenarios when this initiative was first announced on 19th March. The first was that the government would bow to the pressure from this group of healthcare professionals and drop the bill. That was always unlikely, and that moment has now passed. The second scenario, which could still come about, is that this group stands 240 candidates in the general election, and wins a number of seats. It seems to me that both scenarios, for different reasons, are a potential threat to democracy.

In the first case, an unelected group would have imposed their will on parliament, forcing the government to alter its legislative plans. Surely, no matter how much one might dislike the NHS Bill, this is not acceptable? The doctors argue that ‘the will of the citizens of this country’ has been over-ridden by the coalition government. Has it? The two major elements of the reforms – the dissolution of the Primary Care Trusts and the handing over of their commissioning powers to GP consortia, and the opening up of healthcare provision to ‘any willing provider’ – were both in the Conservative manifesto. As we know, the Conservatives won more votes and more seats than any other party, and went on to form the coalition government with the Lib Dems, with both reforms finding their way into the coalition agreement.

We don’t know yet whether these doctors still plan to launch their ‘revenge’ strategy. But suppose they do. How would that fit with the way democracy works in this country? We can assume that they will have strong views on the NHS; but there has been no mention yet of their other policies (on free schools, for instance, or how they might stimulate economic growth, or whether they would replace Trident). Even if a small group were to be elected, they could exert considerable influence, given the likelihood of another hung parliament. An NHS campaign would have considerable popular appeal – but would a group of MPs elected solely on the back of such a campaign have genuine legitimacy?

Richard Taylor’s political activities were mostly confined to health issues. Other policies he pursued included support for Section 28, the renationalisation of the British railway system, and the availability of cannabis as a controlled drug. He also opposed the Iraq war. It seems reasonable to suppose that all the new ‘NHS’ MPs would also embrace an eclectic variety of views. I’m not convinced that would be good for transparency and clarity in our political system.

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62 Comments

  • Bald Reynard 26th Mar '12 - 3:39pm

    Good on the Doctors for thinking about standing against pro-NHS Bill Ministers & MP’s. At least we know their views on the future of the NHS – which is more than we did with the Tories and those Lib Dems (most of the Party !) supporting the Bill (ie nothing about -top-down’ NHS reform in either Party General Election Manifesto) !

  • “In the first case, an unelected group would have imposed their will on parliament, forcing the government to alter its legislative plans. ”

    Another interpretation would be that MP’s (few of whom have any in depth knowledge of the NHS or healthcare) have listened to experts, including the Royal Colleges and amended their plans accordingly. Would we have said that it was anti democratic had the previous government listened over Iraq ???

    “As we know, the Conservatives won more votes and more seats than any other party, and went on to form the coalition government with the Lib Dems, with both reforms finding their way into the coalition agreement.”

    Incorrect the coalition agreement does not mention scrapping PCT’s rather strengthening them more in line with the Lib Dem manifesto.

    “It seems reasonable to suppose that all the new ‘NHS’ MPs would also embrace an eclectic variety of views. I’m not convinced that would be good for transparency and clarity in our political system.”

    As opposed to breaking promises made during an election campaign, something Labour (no top up fees), Tories (no tax rises ’92) and the Lib Dems (Tuition fees) have all been guilty of. Nobody will make people vote for them, and there is no rule saying you need to be a member of a political party with a full manifesto in order to stand.

    Where therefore is the risk to democracy ?

  • Also let’s remember that, when it suited, in 1997 both Labour and the Lib Dems withdrew their candidates from Tatton to allow a protest Candidate to benefit from their supporters votes…

  • Richard Dean 26th Mar '12 - 3:52pm

    There’s nothing wrong with doctors or any other pressure group to stand for election. Of course it would be a disaster if they were all elected, for the NHS and well as for the country. But they have a democratic right to do it.

    They’d change the NHS according to their own priorities, which are NOT the priorities of everyone in the NHS and are unlikely to be the priorities of the users of the NHS. They would essentially form a coalition government which would have to address a whole lot of other issues which they would make a huge mess of.

    But anyway, they won’t get elected. I put may faith in the electorate who are a lot more sensible than politicians and doctors seem to imagine!

  • Are you saying that single-issue and independent candidates shouldn’t run for Parliament, that it should all be left up to political parties (even though, as we’ve learnt repeatedly, they can and will freely and easily abandon their manifesto commitments)?

    What about UKIP and the Greens? Both parties have their roots in single-issue movements that still over-ride the other policies they’ve adopted; and in the case of the Greens the threat of them winning seats in 1987 lead to all three parties adopting environmentalist policies. Was that bad for our political system?

  • Chris Riley 26th Mar '12 - 4:01pm

    Could posters remind me of the names of the Lib Dem candidates who stood against doctor candidate Richard Taylor in Wyre Forest in 2001 and 2005?

  • Andrew Suffield 26th Mar '12 - 4:11pm

    But anyway, they won’t get elected

    I don’t agree with your reasoning, but I do agree with your conclusion. This is a media storm that will, at the next GE, post a few paper candidates most of which lose their deposits. The total number of these candidates who get elected is likely to be either one or zero.

    My reasoning behind this conclusion is that it takes more than an opinion on a single issue to win an election, and indeed it takes substantially more than any amount of opinions you like. What it takes is money and a substantial team of supporters who are willing to work on the campaign for months if not years. Except for rare cases, single issue candidates do not have that, because people in the UK are largely apathetic about politics and very few care about the NHS bill that much.

    (Yes, you can round up a crowd of protesters for an afternoon. If you asked that crowd which of them were willing to go out alone delivering leaflets in the rain every few weeks for the next year, they’d all just shuffle and look at their shoes. Protesting is easy and fun; campaigning is a lot like hard work)

    They follow the example of Richard Taylor MP, a consultant physician who won his Wyre Forest seat from a junior health minister in 2001, campaigning against the closure of the A&E Department at Kidderminster Hospital.

    I note that he did not, in fact, manage to get the A&E Department re-opened. I hope the people who voted for him were satisfied with what they got.

  • Andrew Suffield 26th Mar '12 - 4:12pm

    Could posters remind me of the names of the Lib Dem candidates who stood against doctor candidate Richard Taylor in Wyre Forest in 2001 and 2005?

    Wikipedia can

  • Andrew Suffield, I think what Chris Riley is trying to say is that the Lib Dems have been happy in the past to stand aside and let a doctor stand as a candidate, so what has changed?

  • They are perfectly entitled to stand and it’s up to the voters to decide whether or not to support them – BUT – I am sure none of them would be elected. For Richard Taylor, there was a local service under threat and that will motivate people to vote; this would be trying to get people to vote for the health service generally, plus I’d imagine that actually by 2015 all the doom-mongering will have come to nothing.

  • Geoffrey Payne 26th Mar '12 - 4:53pm

    Of course they are entitled to stand. Whether they get elected or not depends on whether the reforms work or not. As things stand they will get more support from Labour voters who want to protect the NHS than anyone else which will achieve the opposite of what they want. If the reforms fail then they might win over Tory and Lib Dem voters as well.

  • Grammar Police 26th Mar '12 - 4:56pm

    I think Geoff is right; ironically they may actually make it easier for Tories to win, as they will simply take votes away from Labour and Lib Dem candidates. It’s the classic 3rd party supporters’ dilemma. Vote for the lesser two evils or vote for the one you want but risk letting your least favoured candidate win.

  • Thanks for all the comments. A few points:

    The coalition agreement says: “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.” PCTs would relegated to looking after ‘residual’ services.

    Re Tatton: there were varying views at the time about whether we should stand candidates, and presumably still are. I think it’s worth thinking about these things.

    ‘There’s nothing wrong with doctors or any other pressure group to stand for election. Of course it would be a disaster …’ If it would be a disaster, I’d argue that it’s worth debating whether or not it’s a good idea.

    ‘They’d change the NHS according to their own priorities …’ Hence my query about how this would work in terms of our democracy.

    ‘Are you saying …?’ I’m not saying anything. I’m wondering.

    I don’t believe the Lib Dems adopted environmental policies because of the threat from the Greens.

    Simon Shaw – thanks for that link. I hadn’t seen that article.

  • Malcolm Todd 26th Mar '12 - 6:04pm

    “I don’t believe the Lib Dems adopted environmental policies because of the threat from the Greens.”

    You’re right, but I’m darn certain Labour and the Tories did (specifically in response to the Greens’ shock “success” in the 1989 Euro-elections) and that made rather more difference.

  • @Sid Cumberland: “I don’t believe the Lib Dems adopted environmental policies because of the threat from the Greens.”

    Well, no, the Lib Dems didn’t exist in 1987. But compare the policies on the environment in the alliance’s manifesto in 1987, with 1983. And do the same for Labour. Before the mid-80s, all three parties had lip-service policies on pollution and conservation, but that was it. After the rise of the Green Party between 1985 and 1987, Labour and the alliance both adopted more robuts positions, committing to creating a new department for environmental protection and taking action against the greenhouse effect and climate change, and the Tories started arguing that their policies were already doing this.

  • I agree that populist anti-politics is distasteful, especially on a single-issue platform. For representative democracy to work, you need to know about your MP’s values and how that will inform their vote on a range of issues.

    The problem is, the Lib Dems have lived off this kind of anti-political populism for a long time. What could I tell you about my local Lib Dem councillor’s values? Nothing. I know they are against potholes. But are they right-wing or are they left-wing? Would they have been one of the 22 who voted for the hunting ban in the last Parliament, or the 22 who voted against? Would they go into coalition with the Tories or with Labour?

    The only thing I really know for sure is that they will probably have very different values to other Lib Dem candidates in other parts of the country.

    Any Lib Dem MPs undone by these populist, single-issue doctors will be suffering no more than they have visited on Conservative and Labour MPs over decades.

  • I very much hope that these doctors get as many seats as possible in order to bring this “top-down NHS reorganisation” to an abrupt halt. The people of this country were not asked if they wanted the ‘biggest NHS reorganisation since 1948′. As far as democracy is concerned, this health bill was a stain on the Conservative s and on the LibDems. It was ill-concieved, and democratically illegitimate –in my opinion. And Yes, I voted LibDem. The Coalition never had the votes or the democratic ‘wind behind it’ to justified this enormous upheaval.

  • The doctors are right, the OP is wrong.

    As far as I’m concerned there was a great failure in democracy in the bill being passed in the first place. Perhaps the so-called reforms were in the Conservative manifesto, but Cameron did campaign on the far more visible plaform of “no top down reorganisations”. Even if voters did generally read manifestos (they don’t) I doubt there were many people voting for Cameron on the basis of the Tory manifesto position over his very visible and very vocal stance on rejecting reorganisations. Put bluntly, I think it extremely disingenuous to suggest that people actually voted for these changes (particularly in mentioning the coalition agreement which is largely irrelevant to this question). Moreover, polling since the election has consistently shown distinct opposition to the Bill, with less than 20% of people supporting it and the 140,000 signature e-petition against the Bill speaks for itself .

    Even within the Lib Dem party democracy has failed in the context of the Bill. The Williams’ motion denied LD conference the chance to debate dropping the bill itself and the result of the Williams’ motion debate was an active withdrawal of support from the Bill via an amendment. This active withdrawal was blatantly ignored by parliamentarians.

    Passing the Bill was anti-democratic. The public was against it (shown in polling and our country’s sop to direct democracy – the e-petitions). The doctors are completely 100% right.

    Furthermore, I find your logic on “an unelected group … impos[ing] their will on parliament” distinctly dubious – it implies that any form of lobbying or campaigning against the position of an elected official is inherently anti-democratic. This is ridiculous. If, say, a group of concerned residents successfully lobbied a local council to halt a controversial policy (let’s say allowing a development to go ahead) is that anti-democratic? After all, the councillors are elected and the concerned residents aren’t.

    If lobbying is open and transparent and nothing illegal (e.g. bribery or threats) or immoral (e.g. changing legislation to make things more favourable for a big business in exchange for investment in the UK) goes on then it can be a natural part of the democratic process. Denying it is anti-democratic.

    As an aside, if professional bodies and the experts in the field are so firmly opposed to a piece of legislation then it is a great big flashing red light telling you to drop it for the sake of the legislation being any good, if nothing else. Even the GPs, the people who would benefit from these changes, oppose them – what does that say about the quality of legislation?

    With regards to your objecting to them because they are campaigning on a single issue – that is completely absurd. How many people vote Green or UKIP for reasons other than environmentalism or euroscepticism? 95% of Northern Irish politics basically is about a single issue and most independents are elected on a basically single-issue platform. Now, it is true that single-issue politics are not generally desirable, outside that issue you’re voting for an unknown, but they are certainly not anti-democratic. There are many things about the current system that are anti-democratic but that independents sometimes get elected on single issues is not one of them.

    To conclude, the NHS bill is anti-democratic. Hideously so. The doctors’ response to it is actually democracy in action and I wish them the best of luck. Sadly, they’ll need it!

  • Richard Dean 26th Mar '12 - 7:38pm

    Of course the HSC bill was democratic. It was voted on by the MPs who the electorate elected – the electorate who freely chose to give them the power to decide.

  • Also, although in principle I tend to prefer the LDs to Labour or the Conservatives (well, certainly did anyway, I’ve been less than impressed recently) I do have to agree with clempalme. LDs do campaign for very different things in different parts of the country and it is hypocritical for LDs of all people to complain of this GPs’ grouping doing the same when it comes to 2015 (presumably each individual GP PPC would have positions on other issues!).

    This wouldn’t be a problem if LDs were a party of independents (i.e. there may be some core party policy but on most issues every vote is a free vote) but given the LDs are not like this the party really doesn’t have a good reason to be up on the high horse about this. A purely social or economic liberal party would, but that’s not what the LDs are either.

  • @Richard Dean

    Don’t be silly. Even if we make the (wrong) assumption that everyone who voted Conservative was voting for this (hardly anyone reads manifestos and Cameron’s campaigning was for no-top down reorganisations – the opposite of what the HSC Bill is) then that’s not a majority of votes or seats in itself. Conservatives + Lib Dems makes a majority but this was not Lib Dem health policy and a vote for the Lib Dems was therefore not a vote for these NHS changes. Even in theory. There was not even a previous indication that this would be a policy that the LDs would support were they to go into coalition with the Tories.

    That the system allowed this to happen does not suddenly make the outcome inherently democratic. The system is not faultless, as Lib Dems of all people should know given their tireless (and welcome) campaigning for electoral reform. I don’t think there is any way in which you can say that the majority of the public were on board for these changes to the NHS, and in my view that is undemocratic.

    Simply stating that the system let is happen is not a valid reply to that, and you know that.

  • The first discussion I ever followed on LibDem Voice was a furious argument between LibDems and a group of doctors in Bedford which wanted us to stand down at the following general election so that one of their number could be elected to oppose something or other. Presumably by the time of the election it had happened, or not happened, because no such candidate appeared. Similarly, by 2015 the NHS will not have collapsed; the Royal Colleges will have found ways of making the new systems work to the advantage of their members; some of the legislation will have worked as it was intended to do, some of it won’t, and some of it will have had unforeseen consequences which will have to be rectified in the next NHS Bill. So, a bit like any Act of Parliament really. There won’t be 240 doctors standing at the general election, and even if there were none of them would save their deposit.

  • DunKhan – I agree entirely about manifestos – but that was, of course, part of my question. Re lobbying/campaigning – again, my question is about how far you can go. Obviously some lobbying/campaigning is legitimate – but are there limits? Does threatening to stand hundreds of doctors in a general election constitute a valid mode of action in this context? I don’t object to single-issue campaigning – I’m just raising the question (again) of how good that would be for democracy.

    Re your point about Lib Dems campaigning for different things in different places, I think you’ll find that’s all MPs of all parties.

  • Richard Dean 26th Mar '12 - 8:27pm

    Dunkan. In our democratic way, we elect MPs to decide things for us, including deciding on what things they should decide on. That is one of the ways that the people have chosen to rule, and it is one of the reasons that MPs don’t need a specific mandate to make specific decisions. We the people have freely given them that power.

    We also have ways of changing things, one being to elect different politicians next time. That is what our democracy is. And we are free to change what we decide our democracy should be and how it should work, or not to change, and we make that choice democratically, of course, as all LibSems will remember!

  • @Sid Cumberland
    Sorry but you were a bit selective in your quote of the coalition agreement. Those “residual” services are currently being outsourced, transferred to Local Authorities or turned into Enterprise / Community Partnerships. Dedicated professionals such as Health Visitors are being told they only keep their NHS Pension rights for a limited period. The coalition agreement promised a better locally accountable PCT. It never promised to scrap them…

    “We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise. ”

    “The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.”

  • I already have a GP as my MP. Any other GP would be preferable frankly.

  • Bald Reynard 26th Mar '12 - 8:49pm

    DunKhan

    I agree with all you’ve said. The MAJORITY of the Party (not all, thank goodness – there are still some with principles) who voted this Bill through, should be ashamed. I would like the Doctors to stand against ALL MP’s who voted in favour – and perhaps one or two might win !

  • Richard DeanMar 26 – 7:38 pm…………..Of course the HSC bill was democratic. It was voted on by the MPs who the electorate elected – the electorate who freely chose to give them the power to decide………….

    So let’s stop blaming Blair for the Iraq war and, if ‘push comes to shove’, moaning about supporting any action against Iran.

  • Richard Dean 26th Mar '12 - 9:23pm

    Jason,

    It is your democratic right to disagree with anything. I am simply pointing out that the HSC Act was arrived at by a democratic process. The statement that it was not is erroneous.

    Yes, let’s stop blaming Blair. He was elected by the people, and so the people share some of the responsibility for the consequences of their choice. I suggest that people who blame Blairshould stop being silly (DunKhan’s word) and instead recognize their own part in it.

    You also have a democratic right to complain about plans or actions against Iran. Isn’t it wonderful! You probably don’t have quite the same rights in Iran, or Syria, or plenty of other places

  • Good on the doctors for standing up for their views and being prepared to put them before the electorate. It would be good to see some of them get elected. We could do with a few MPs who actually know what they are talking about when it comes to important issues such as healthcare.

  • Richard Dean 27th Mar '12 - 12:36am

    Ed. Healthcare is a lot more than caring for people’s health. Doctors may know about how to do that, but do they know how to manage healthcare? How to persuade a population to pay for it? How to negotiate with the various healthworkers’ unions with their differing views and priorities ? How to arrange the logistics of an ambulance service, or a hospital? How to avoid over-paying pharmaceutical companies? How to keep financial records? Yes, it’s good to get doctors involved, but medical knowledge is not the only thing that’s needed to create and run a healthcare system!

  • Yes, medical knowledge is not the only thing required to run a healthcare system. However, I would trust someone with medical qualifications to run a healthcare system over a person without medical knowledge anytime. I question why I should trust a politician who was formerly a PR man (the PM) or a banker (DPM) to make decisions about my healthcare system rather than someone who has spent decades working in medicine. The LibDems obviously felt the same about Doctor Taylor in Wyre Forest. That’s why they refused to run against him.

  • Well the government seem to think the doctors know how to do some of those things Richard. Isn’t that supposed to be the point of the bill?

  • Richard Dean 27th Mar '12 - 1:01am

    @Aaron – Good point! :-)

  • Richard DeanMar 26 – 9:23 pm……………………………………..You also have a democratic right to complain about plans or actions against Iran. Isn’t it wonderful! You probably don’t have quite the same rights in Iran, or Syria, or plenty of other places………………..
    A yes, democracy……
    And it’s through that there Magna Carta,
    As were signed by the Barons of old,
    That in England today we can do what we like,
    So long as we do what we’re told.
    ( Marriott Edga)r

  • Well, after the leaked draft risk register reported in the Guardian today these doctors will probably have a good chance when the NHS goes belly up Remember that they are targeting marginal seats and the electorate will take their revenge. i wonder how many private health company people went to dinner?

  • Toby MacDonnell 27th Mar '12 - 9:57am

    Critics of the Health and Social Care Bill who centre on its lack of democratic accountability seem to have idealised democracy to an unhealthy extent. Democracy is a part of any modern functioning state: it is the most powerful incentive to good government of any check and balance. But the point of having a legitimate system of government in this country is so that one side can win over the other without resorting to violence, as in a civil war. The point of elections is that we consent to be ruled by the majority in exchange for having a chance to be the majority: while there are obvious ways to improve the accountability of Parliament through democratic means (STV, Lords Reform) critics of a bill cannot and should not call into question the legality or legitimacy of Parliament if they wish to remain in a lawful country.

    Questions like “Did anyone read the Tory mannifesto before they voted?” are irrelivent. The responsibility of deciding who to vote for rests with the voter and their methods are their own: claiming that the Tories can’t pass the bills they want to pass because the majority of the country doesn’t agree is a feeble challenge because it inhabits a reality where 1) people don’t know what they want and 2) people should be trusted to know what they want.

    Claiming that parties which control a majority of parliament should not rule is to argue against a parliamentory majority and in favour of a popular majority, but the point of parliamentory majorities is to seperate government from the popularist instinct: government needs to be powerful enough to do the things which need doing, not the things which are popular. It is precisely because of the imprecise nature of the popular will that we operate under a system of representative government and not a system of direct democracy.

    By all means criticise the bill on practical terms: perhaps GPs don’t have the time or skill to commission healthcare. Perhaps outsourcing does produce national divergence in quality. But what it does not do is undermine democracy, as we do not live in one and ought not to wish to live in one outside of an anarchist utopia.

    As far as I can see, Sid’s arguements that these Doctors threaten democracy are an overstated concern that a Doctor Party might inadvertantly shift the balance of power without having prepared for such an eventuality, reducing the predictability of the system. It’s a legitimate concern, but it’s not a threat to democracy or to our system of government: only to the established political advantage.

    DunKhan’s objection to the Bill is founded on the idealisation of the rule of the “people” and a misconception surrounding the importance of Parliamentory sovergienty for the safeguard of law as a whole, as I have outlined above.

    There is no democracy to be threatened, and thank goodness for that. We should spend less time constitutionally naval-gazing and fight for what we believe in on its own merits rather than defer to an unqualified and unquantifiable concept like the “people’s will”.

  • @Anne
    Here’s Simon’s link from above, in case you missed it: http://conservativehome.blogs.com/platform/2012/03/lord-ashcroft-anti-nhs-bill-candidates-would-boost-the-conservative-party.html
    (According to this, the electorate will NOT take their revenge.)

    Re the leaked report: the one I’ve seen is nearly 18 months old; the bill has changed significantly since then.

  • @Toby MacDonnell
    Thanks for your reply. Not many responders seem to have spotted that my concerns were not specifically to do with the NHS Bill or the doctors, but with the (often misunderstood) principles which underlie our democratic processes. The way you have framed your answer leads me to re-frame my question: would the advent of a single-issue party with a lot of candidates and huge public appeal threaten our current ramshackle system to the extent that it should be deemed illegitimate? You suggest that my concern is overstated; I’d say it was a bit of a caricature, to provoke discussion.

  • patricia roche 27th Mar '12 - 10:32am

    In a democracy anyone is entitled to stand. If the NHS changes are not as catastrophic as they seem to be, there will be no problem. If they are, the people who are responsible for those changes are toast anyway. It may be in the ‘national interest’ to do all manner of things in a coalition. Churchill did this and look what happened to the election results after the war.

  • Maybe a better question would be how the democratic process stands up in the face of the draft risk register published today.

    The coalition agreement, which clearly foresaw a continuing role for PCT’s, was barely 4 months old and the draft risk register appears to show that they were going to be disbanded. Surely this means that the internal democracy of the Lib Dems has been circumvented, and that the public at large will lose faith in any type of coalition, which would be a blow for anyone who believes in a more plural type of politics. The Tories always planned their dismantling, the offer of elected members appears to be merely a (false) sweetener to Lib Dems as it brought the Tory plans closer to the Lib Dem manifesto.

    Democracy suffers when people vote on a misrepresentation. The question is were the health plans misrepresented in the coalition agreement????

    I oppose the Bill, and I do some from a position of some knowledge due to my position. I would however probably not vote for a Doctor on this single issue unless they laid out their intentions on a broad spectrum of issues and they were more in line with my views than any other candidate.

  • Richard Dean 27th Mar '12 - 11:07am

    Some of the reaction to the draft risk register suggests the government were right not to publish! A risk is a risk, not a certainty, and people identify risks precisely in order to prevent them happening,

    For instance, it is good to recognize that there might be a long term reduction in the NHS’s ability to handle emergencies. Just about any change whatsoever would create this risk, including no change at all, but it’s not a certainty – far from it. Having identified the risk, it is now possible to develop measures to monitor and control it, so that if this begins to happen, action can be taken to stop it.

  • Bald Reynard 27th Mar '12 - 11:39am

    16 Lib Dems MP’s voted for the Early Day Motion calling for the NHS Reform Risk Register to be published(Annette Brooke was first alphabetically – but I would be happy to list them all, if LDV Bloggers felt it helpful) – if ALL of them (instead of just the ‘Famous 5′ !) voted against the Bill, it’s passage to Act would have been far more uncertain. Obviously (thanks to the ‘leak’), we only know the details of the Draft Register (published in September 2010) – but my bet is, the Final Risk Register didn’t differ dramatically – certainly in it’s main findings.

    Richard Dean
    You’re correct – the Government were right (in their eyes !) NOT to publish – it could easily have ‘scuppered’ the Bill. What is the most significant fact though here, is that the Government opposed the findings of the Tribunal set up to investigate the importance of the Register – AND OPPOSED the Appeals Panel who found in favour of the Tribunal’s requirement to publish.

  • @Richard Dean
    Accepting that a risk is not a certainty there are ways of judging this. As in most risk assessments they seem to have used likelihood Vs Severity (or impact in this case).

    The problem is that in most organisations, a risk assessment is used by people deciding a course of action. In this case the course of action was decided by people without knowledge of the risk. In industry were those deciding a course of action to do so without consulting available risk assessments, and then something happened they would be liable. This document should have been available throughout the debating period and used to shape amendments to mitigate the risks.

    All good risk assessments are living documents and this one could have been updated following amendments to show their likely impact.

    However, my main concern on seeing this assessment is that it appears to show we were all lied to when the coalition agreement talked about PCT’s becoming patients champions and being more accountable. In fact it appears they were always for the chop. Where is the democracy in that? What else in the agreement is never intended to be actioned ??

    As for keeping this hidden, didn’t Lib Dems used to stand for open government, explanations relating to decision making etc….

  • Richard Dean 27th Mar '12 - 11:59am

    @Steve. All the risks so far published seem to be very predictable. Any parliamentary representative should have been able to recognize most of them and take that into account if necessary in tabling amendments. Even so, I would certainly have liked to have seen the risk register long ago, not as a stand-alone document but rather as one that compared risks of different strategies and put risks into context. But , if it had been published, there would have been people claiming that some of the risks were being hidden and others being assessed wrongly. You can’t win!

    In my industry, involvement in risk assessment s the key, not so much risk registration, On some building sites, risk assessments are done twice a week, by the people who work there, partly because the site changes as construction is done, and partly because the workers working one day might be completely different people to the ones working the previous day. By doing the assessment themselves, people become aware of the risks, and are able to plan their actions so as to work safely.

  • Repeat after me:

    ‘War Is Peace’
    ‘Freedom is Slavery’
    ‘Ignorance is Strength’
    ‘Democracy is tyranny’
    ‘Liberals are tyrants’

  • Amusing that Sid Cumberland mentions the conservative manifesto whilst failing to mention that in that manifesto we were told there would be ‘no top down reorganisation of the NHS’.

    Also amusing to note his belief that ‘democracy’ doesn’t consist in people voting who they want to vote for but rather for the ‘right’ people.

    Double-plus ungood thinking right there.

  • @Toby MacDonnell

    So you are effectively saying you don’t believe a government or MPs should behave honestly and openly when seeking election and that a government’s legitimacy is not drawn from the public?

    Do you consider yourself a liberal, because I don’t… although perhaps your views are prevalent at the top of this party.

  • @SidCumberland

    I just would like to reiterate my objection to what you term ‘democracy’. Everything you criticise as being anti-democratic is in fact the very essence of democracy. Simply doing what the prevailing government tells you isn’t being ‘democratic’… rather protests, campaigning, and challenging the government using legal channels are all essential parts of what it is to live in a genuine democracy. The essence of democracy is not the government or even in electing the government but rather the daily discourse that takes place and the channels that are there for it to take place in. Threatening the government is a good thing, it makes it accountable. At the end of the day if the public wish to vote for a single issue party or single issue campaigners than that is their right, that is part of what it means to live in a democracy: the ability itself to bestow legitimacy or take it away from the government (whether or not you think people are voting for the ‘wrong’ candidates), and the other (more major) part of democracy is that people are allowed to threaten and challenge the government, hold it to account, and put fear into it.

  • @Rob
    I’m glad you were amused. But I didn’t mention it because I didn’t have space to put everything in. You shouldn’t find your second point quite so amusing, as it isn’t in my text. I merely raised some questions which I find interesting.

  • There are already people who can’t stand for parliament; ‘You can stand as a candidate in the general election if you are 18 years old or over, and either a British citizen, a citizen of the Republic of Ireland, or a citizen of a Commonwealth country who does not require leave to enter or remain in the UK, or who has indefinite leave to remain in the UK. Certain people may not stand as candidates, such as members of the police forces, members of the armed forces, serving civil servants or judges, certain convicted prisoners or those declared to be bankrupt.’ I was wondering whether we ought to add to that list people whose only intention is to subvert the legitimate actions of a legitimately elected government.

  • @Sid Cumberland

    ” I was wondering whether we ought to add to that list people whose only intention is to subvert the legitimate actions of a legitimately elected government.”

    Sounds a bit scary really. The problem I have is that both in this post and in your article you write as if legitimacy is something bestowed upon a government merely by the fact that it is in power. So when someone says ‘this government [or one or more of its actions] are illegitimate’ you will merely respond ‘the government is legitimate because it is the government’. That would make the actions of any state or government at all perfectly legitimate, and appears to suggest (although it was probably not the intention) that ‘might makes right’.

    Throwing terms like ‘legitimate actions’ and ‘legitimately elected government’ is problematic here precisely because the doctors you are criticising specifically believe that the actions of the government are illegitimate based upon the platforms on which both parties campaigned. Who is to say who is right? You don’t seem to deal, or want to deal, with such questions as what actually constitutes legitimacy in this case, and that is probably why I got the impression (again, probably unfounded) that your attitude is somewhat elitist and ‘state knows best’ in nature. Just saying ‘this government is legitimate and so you shouldn’t challenge the legitimacy of its actions’ doesn’t make this either true or the right course of action.

  • ” I was wondering whether we ought to add to that list people whose only intention is to subvert the legitimate actions of a legitimately elected government.”

    Although I have been posting too much, I will just add another point: who exactly gets to decide which candidates are merely there to cause nuisance and challenge the actions of the elected government, and which candidates are there in good faith? What exactly is wrong with allowing the voting public making this decision (the decision as to who is a legitimate candidate or not) and choosing to vote for who they want, even if you personally deem that person unsuitable, rather than the state? If, ultimately, that person does a rubbish job as MP they can then be unelected.

    This, specifically, is what I find a little bit frightening and patronising in the views you advance in your article and your posts.

  • How on earth have you ended up convincing yourself that expressing disagreement with the government or standing against them in a free, transparent election is somehow anti-democratic? And what is this meant to mean?

    “I was wondering whether we ought to add to that list people whose only intention is to subvert the legitimate actions of a legitimately elected government.”

    They are not a terrorist group. They are people who have a different opinion to you. Do you want everyone you disagree with to be barred from seeking office?

  • Richard Dean 27th Mar '12 - 1:52pm

    Keep posting, Rob, your posts are worth reading.

  • @Rob
    The biggest problem I have here is that I can’t get all I want to say into 500 words. People write books about this sort of thing! However – I should have been more aware that relating my wondering to the NHS Bill would lead to all sorts of distractions …

    However: I’d say the government is legitimate because we voted for it. Part of my query about the legitimacy of the doctors’ threat (especially if it had had an effect without a general election) is that no one voted for them – they are a self-selected group pursuing their own agenda.

  • @Sid CUmberland

    Ok well I accept the 500 word limit point but I can’t help disagree with regards to your opposition to the doctors or what you seem to think might be an appropriate way of dealing with them. I do, however, understand your point that democracy and legitimacy breaks down when people are using democratic institutions in bad faith and in a way in which they were not intended to be used, although I think in this particular instance the doctors are not doing so. I am sorry if I was rude or abrasive in my earlier posts but I’m sure you appreciate that politics (especially on the web) tends to provoke heated discussion.

  • @Rob
    Thanks – no objection to heated discussion. However – I am not opposed to the doctors’ campaign – I evidently didn’t make it clear enough that I was asking questions, not giving answers.

    @AndrewR
    ‘How on earth have you ended up convincing yourself…’ – I haven’t – see above.

  • “Part of my query about the legitimacy of the doctors’ threat (especially if it had had an effect without a general election) is that no one voted for them – they are a self-selected group pursuing their own agenda.”

    As is just about every interest group that lobbies their MP or Parliament. The only answer would be for MP’s to exist in a vacum and not listen to any representations. Cancel surgeries, forget engaging with a workforce or Unions, do not take public representations in any way. If we restrict those who want to change the direction of Government from standing in elections we may as well cancel them.

    Let’s not forget members of a political party are self selecting and pursue their own agenda, some even stand for Parliament !

    I would also take issue with he fact that we voted for this Government, a coalition between Lib Dems and Conservative was not on offer in May 2010. The only people who voted on this Government were those who voted on the coalition agreement.. That does not make it illegitimate (I agree it was the only sensible outcome) but it does mean that in terms of “Democratic Mandate” it is not as clear cut as a single party Government.

  • Toby MacDonnell 27th Mar '12 - 10:40pm

    Rob, I am a liberal. I am also an elitist. I do not believe in classical democracy, the rule of the Demos, or of “the people”. I think it is an abstract concept which is at once impossible to read as well as being populated by masses of underqualified individuals either without the skill or without the interest to govern. People are busy living their lives: they don’t want to make decisions about bin collection and taxation, which is why they deligate the task to our political class.

    In classical terms, an aristocracy is the rule of the few, or of the elite. Elitism exists: some people are more qualified, some people are less qualified. That’s not to say that qualification rests in qualifications, but that there are people who are suited to the job and people who are not suited to the job. That’s just a fact of life. Even in the highly educated utopia I would like to inhabit, and strive to inhabit, there will still be people who’d rather be fishing than discussing GP consortia, and fair play to them.

    Representative democracy recognises the inherient flaws in an aristrocracy, particularly the problems of aristocrats becoming entrenched in power, which is inheriently corrupting, and neglecting the people social contracts place them in charge of. Under Feudalism, the surfs traded their liberty for protection from criminals and raiders: there was a compact between the ruled and the rulers. We now live under another social contract which promotes liberty alongside freedom. In order to prevent the social contract devolving into the scandalous behaviour which triggered the French Revolution representative democracy incorperates the consent of the people as a condition of the aristocrats’ maintainance of power.

    Our parliament trades one set of aristocrats for another. When we participate in elections, we do not pick what we want to happen to the country, but express to what extent we are discontented with the ruling party and which party we would prefer: out with Paper, in with Scissors (even though I vote Rock). By trading between three clearly defined parties at the head of a perminant civil service every 4-5 years, Parliament as an institution balances strong leadership with the check of elections to incentivise good leadership. Of course I believe there is room for improvement (I favour an AV Commons and STV Lords), but I do not believe in the rule of the people because reality doesn’t work like that.

    Individuals govern themselves in their everyday lives and government does its best to expand the horizons of the citizens’ destinies: the people cannot rule, because the rest of the people don’t want them to. That’s what John Stuart Mill meant by “the tyranny of the majority”. Rob, if you’re still reading, I hope I have adiquetely explained why I am in favour (to an extent) of the status quo. I do not believe that politicians lie when they campaign: I believe they express their priorities. I do believe that government, trusted with the safety of all the people in its care, must take whatever steps it believes are nessecary to safeguard the freedoms, liberties and destinies it believes are important, provided they have the support of the majority of Parliament (MPs having liberty of concious). They were elected as much on their attitudes as their policies, after all, and just because I might not agree with it doesn’t mean they can’t do it. Our oppertunity to rule only comes if we agree to abide by the rule of whomever may win the election.

    Sid, I do not believe that anyone should be prevented from appearing on the ballot. If revolutionaries are elected to overthrow the system, then they have the legitimacy to do so. But what are they going to do with one MP? And if a hung parliament results with a substancial minority on one side, then a coallition agreement must be drawn up. The constitution grants legitimacy, but legislative priorities are down to MPs, whoever they are. By agreeing to abide by the constitution, we all agree to operate within it even when we’re changing parts of it (such as liberalising procurement within the welfare state rather than using the welfare state as a tool to garentee full employment).

    If they won a majority, then they would have to coordinate within their own party what their priorities were, and if they couldn’t form a coordinated programme for government within their own MPs their PM would find it impossible to whip them and the opposition would become a de-facto minority government as it built alliances between functional independents in the governing party for its own bills. Alternatively, the government party could split between multiple new parties (like the Liberals between Lloyd George and Lord Asquith) or the Queen could invite the leader of the Opposition to form a new government rather than let them rule from the opposition benches.

    I know your question was an exaduration of your concerns, but even when scaled down I think the constiution is flexible enough to deal with whatever electorial arithmatic is thrown at it, as so much of what happens electorially comes down to how people behave within the system rather than down to the system itself. It’s why I like it rather more than any other constiution in the world.

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