Senior Tories voice growing concern over NHS reforms, calling for ‘unnecessary and unpopular’ Bill to be scrapped

The Health and Social Care Bill has long been criticised by doctors, nurses, many Liberal Democrats and the Labour Party. To the list of those concerned about the impact of Andrew Lansley’s reforms can be added senior Tory figures including Tim Montgomerie, editor of ConservativeHome blog, and several members of the Cabinet.

According Tim’s editorial this morning, following on from a Times article earlier in the week (£), Conservative Cabinet Ministers are sufficiently concerned over how the reforms were being handled to press for the contentious components to be dropped and for only those elements that retain cross-party agreement to be enacted.

The Independent and the Guardian are also reporting disquiet over the Bill at the highest level in the Tory party – the latter also reports that Lib Dems are seeking to secure debate over whether the Bill should be scrapped at Spring conference.

The central argument is that the complicated reforms currently before the House of Lords bear little or no relevance on the financial and demographic challenges that the NHS will face in coming years, and that many of the changes needed to meet those challenges can be put in place regardless of the Bill. Many Liberal Democrats with close knowledge of the NHS have long held this position, seeking to have the Bill scrapped unless significant amendments were secured. It now appears that senior Tories agree that only those elements of the Bill that all parties can agree on should be passed into law, the rest being ditched.

Officially the government remains committed to passing the Bill as it stands, substantial amendments from the House of Lords notwithstanding. Under the surface there are clearly very deep concerns over the political ramifications and those for the health service itself.

The pressure on the Health Secretary and Prime Minister to rethink their position is now undeniable – I would add just this much, that with so many changes to services already underway, they should withdraw the bulk of the Bill and allow the NHS to focus on delivering a first class service at a time of severe budgetary constraint as set out in the Coalition Agreement. There’s little doubt this would be a better outcome than pressing ahead with legislation that now virtually nobody thinks is needed.

* Prateek Buch is Director of the Social Liberal Forum and serves on the Liberal Democrat Federal Policy Committee

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30 Comments

  • The most effective solution to this mess lies closer to home – Nick should withdraw Lib Dem support for the bill in both houses. A little short term pain would lead to an easy long term win for us.

  • Agree, Greg, as already posted on another thread.

  • Now is the time for Clegg to act, show leadership and bring the party together – if this isn’t a red line issue I don’t know if there ever will be one.

    If he doesn’t and the bill goes ahead he is saddled with explaining why the Lib Dems supported a measure that even senior Conservatives have grave misgivings about (you don’t get an article like that on ConservativeHome without those senior figures giving the green light).

    If he doesn’t and the bill gets dropped he will be left to explain why the Lib Dems under his leadership supported a measure all along that eventually is exposed as worthless.

    The only thing to do is act now and announce the Lib Dem party cannot possibly support the bill as it is presently written.

  • The sad fact will be that it will be Lib Dem members and Peers, and now grass roots Tory concerns that will sink this Bill that remains supported by Lib Dem MP’s. That’s if they don’t push on regardless.

  • “If he doesn’t and the bill goes ahead he is saddled with explaining why the Lib Dems supported a measure that even senior Conservatives have grave misgivings about (you don’t get an article like that on ConservativeHome without those senior figures giving the green light).”

    And why they supported it in the first place. despite the fact that it wasn’t in the coalition agreement they’d just negotiated, and in fact ran counter to that agreement.

  • @Andrew Tennant

    Yes what you say is what an economics text book would say would happen.

    But let’s look at what actually happens. We currently have a fully nationalised health service, which should lead to massive inefficiencies according to most economic thinking. And yet study after study shows it to be the most efficient healthcare system in the world for a comparable country.

    The new structure wouldn’t lead to choice driving down price, it would lead to spare capacity and cherry picking plus massive conflicts of interest for medical staff. Say the NHS offers MRI scans for £500 a time and a private provider offers them for £400 a time in a new purpose built luxury suite you’d say “great”. However what happens to the NHS facility? It still exists, the fixed costs are still there so the public purse ends up spending £400 for the scan and £200 for the wasted NHS facilities. A higher total cost for the same health outcome.

  • @Andrew Tennant
    “allow GPs”

    If you’re actually concerned about allowing GPs and patients what they want then you should be firmly against the bill.

  • @Peebee

    “Now is the time for Clegg to act, show leadership and bring the party together – if this isn’t a red line issue I don’t know if there ever will be one.”

    Absolutely. However, I fear in effect there are no red line issues for the Lib Dems which have any importance for the general public (or at least none that the Tories disagree with). To an extent it comes from Nick being a nice man.

  • @Andrew Tennant

    “That a private provider offers a service doesn’t compel anyone to buy it if it’s more expensive or poor value for money. Providers can and will only make a profit if they can compete with and exceed the quality of existing provision – in other words, profit can only be made where costs do not rise but the service is better. If their services are inferior then they’ll not get paid – it’s their motivation and risk.

    A stronger health service for the same expenditure – why is anyone but an absolute ideologue against that?”

    I think the families and victims of Winterbourne View would disagree with you there.

    These people where charged and paid for by the tax payer for this Private company to look after and provide care for seriously vulnerable and disabled people.

    I think we are all aware of the despicable level of care and abuse that took place in this place at huge expenses to the tax payers.

    So No Andrew ” Providers can and will only make a profit if they can compete with and exceed the quality of existing provision – in other words, profit can only be made where costs do not rise but the service is better”
    is just a load of old waffle and clap trap

  • @Andrew Tennant

    Well again I have to disagree, it is my opinion that when any other health services get contracted out to private providers, we see a huge increase and sub-standard and often criminal levels of care provided.

    I believe that “patients” deserve to be treated by the NHS and for the NHS to be wholly accountable for failures and negligence.

    This is what our Taxes and National Insurances pay for.

    Not for corporate pharmaceutical companies that already have their dirty fingers in to many pies and for private health care providers, charging extortionate fees to the tax payer for sub quality care.

  • Andrew Suffield 10th Feb '12 - 10:59am

    And yet study after study shows it to be the most efficient healthcare system in the world for a comparable country.

    Aside from the minor detail that those studies found very few “comparable countries”, and this is something of an “after discarding all contradictory data points…”, my main objection to this argument is that it just says “why should we try to be better than anybody else?”

    There are many objective weaknesses in the NHS, even in comparison to other countries. We are spectacularly poor at spending money on preventative healthcare, for example. The fundamentally illiberal system of “if you don’t like the healthcare you get then you can stay sick” is something that needs to be addressed. (Very little of the current bill is concerned with this subject, but it’s going to be a shame to lose that)

    Say the NHS offers MRI scans for £500 a time and a private provider offers them for £400 a time in a new purpose built luxury suite you’d say “great”. However what happens to the NHS facility? It still exists, the fixed costs are still there so the public purse ends up spending £400 for the scan and £200 for the wasted NHS facilities. A higher total cost for the same health outcome.

    This is a textbook example of the sunk costs fallacy, and it fails to consider the larger picture.

    A private provider has proved that it is possible to provide scans for £400. You are proposing that the NHS facility should stay open at £500. This is clearly a misconception: that facility is now a sunk cost. There are two immediate options: either the NHS facility should change their practices to the newly developed ones and start providing scans at (£400 – profit margin), or it should close and be replaced by one that runs more efficiently as soon as funding for this is available.

    But that’s just the immediate reaction. In the bigger picture, here’s what happens:

    Never again will we approve plans to construct an NHS scanning facility that costs £500. All future facilities will be built on the £400 model. When every facility has been upgraded, the NHS scanning budget can be reduced by 20% across the country, saving millions each year.

    This is what we mean when we talk about “innovation”. The NHS has proved quite bad at it. (Pure-private healthcare systems have also proved bad at it, because they don’t have a public healthcare system to repeat their successes and force profit margins down)

  • Andrew

    Substitute ‘Railways’ for ‘Health Service’ in your arguments and rewind….

    Starve a functioning but needing help organisation of investment, install a private sector approach where money is made on the back of customers, where directors are paid obscene bonuses for poor performance and the legal eagles rub their hands in sheer delight. Oh and to cap it all end up with the highest cost per mile routes in all of Western Europe.

    Are you surprised a lot of people are sceptical about the market’s capability to deliver?

  • @Andrew Suffield

    First time trying to use quotes so hope this works…

    But that assumes that both organisations can measure costs in the same way. If I am running a large training hospital right in a city centre and have to account for the facility costs, staff costs, contribute towards training budgets etc then I can in no way compete with a private provider based in a cheap part of town, who only employs staff trained on public money.

    But again that is assuming the cost has been driven down by innovation rather than simply lowering costs or rather transferring these costs through the system onto other parts of the system. For example if sending the MRI’s offsite adds 20 minutes of paperwork onto the process for an NHS doctor then the cost saving is negligible.

  • Well clearly that didn’t work!

  • Sarah Ednay 10th Feb '12 - 1:56pm

    Sad day when Tories are concerned about the damage they are doing to the NHS and Clegg and the rest of the party are supporting the Madness.
    Please dont let this be another Tuition fees issue when we refrain from protecting our supporters to keep the Coallition together.

  • Here’s what will actually happen if this bill goes through:

    Private healthcare companies will hire lots of PR people and dodgy “consultants” to persuade GP commissioners that their services are ‘better’, while at the same time delivering the bare minimum service to cut costs and maximise profits.

    Many GPs, who are trained to be doctors and not administrators, will either not have enough time to make good commissioning decisions (since they already have a full-time job) or will be fooled by private health companies or (in a minority of cases) corrupted by backhanders/junkets.

    There will eventually be a string of clinical disasters as private health companies push their cost-cutting too far. The NHS and the government will try to cover them up, deny they are happening, and try to write them off as teething troubles, just as Labour and Connecting For Health did with NPfIT.

    By the time the problem becomes too big to deny, the bosses of those companies will already have cashed out with huge bonuses and will be able to evade prosecution while the government has to pick up the pieces.

    The problem is with perverse incentives. Market solutions work fine when it’s easy to compare products – but comparing health outcomes is difficult and time-consuming. What will happen is that the private MRI facility will do the scan at £400, then another provider will come along doing the scan at £350 but botching the interpretation of the scans or mixing up patients results. The lag time in detecting that, delayed by cover-ups and attacks on whistle-blowers, will mean that lots of GPs will have ordered the £350 scan in good faith. The ultimate cost will then be much greater as lots of people suffer from serious, protracted illnesses that could have been avoided.

  • Dave Eastham 10th Feb '12 - 2:20pm

    As I said on another thread, this bill neither satisfies the original Lib Dem aspirations for a democratically accountable health service, integration between health and social care or indeed the 2010 Lib Dem manifesto. It is not in the coalition agreement (despite attempts to squeeze wording in that document into this particular bill’s straight-jacket). The original white paper was clearly a blueprint (no pun intended) for a full marketisation of the NHS (not that if truth be told that was not what the Labour party was largely up to anyway). Apart from the actual costs of implementation this, bill inevitably increases structural transaction costs (bureaucracy) whilst claiming to free NHS staff from it.. Now, after attempts to amend it, it is now a proverbial dog’s breakfast and is now even more not fit for purpose. Now really is the time to pull the plug. It is not as though existing legislation does not allow readjustment of Service provision. After all, Paul Burstow has been making a whole series of welcome announcements of initiatives which don’t require the Bill to be enacted. Primary legislation was never required. Except if you are intending to fully “marketise” the NHS (“Privatisation” is such an emotionally loaded word these days). The NHS is not perfect but neither is it stuck in 1948, or “broken” (Battered at present it may be) and those who keep asserting it thus are simply wrong. As has been suggested the best thing in the next few days would be for Nick to withdraw support for the bill. If he really did not read the original White Paper as has been reported but simply trusted what he was told and has now found out the hard way. Then I am sure he is big enough to take it. To force this through would be a travesty. Withdraw support PLDP. Please.

  • @Ben

    You should post that analysis to every single Lib Dem MP – its quite the most succint understanding of what actually happens in a ‘free’ market situation. I have sadly seen it all too often.

  • Daniel Henry 10th Feb '12 - 3:39pm

    What we need is our backbenchers to join up with Tory backbenchers to form a cross party rebellion. A cross party approach is needed to deal with this in a way that doesn’t split the coalition.

    I disagree that Clegg should take the lead over ditching this bill. We’re relying on Tory support to get our policies through. Dropping Cameron in it like that might lose us the support we need for measures like Lords reform.

  • David Evans 10th Feb '12 - 5:20pm

    Please stop dreaming of things like Lords reform that Cameron is using to keep you hanging on. It won’t happen and you will just be strung along like a patsy.

  • Daniel Henry 10th Feb '12 - 8:11pm

    If major progress hasn’t been made on it by the end of 2012 then fair enough.

    In the meantime, let’s tackle this bill in a way that won’t split the coalition.

  • Interesting how Andrew Tennant implies its Labour against this Bill. Today’s story is about CONSERVATIVE MINISTERS privately briefing against it on an influential Conservative blog. If 3 Conservative Cabinet ministers and a number of Conservative junior ministers are worried ,there must be serious problems with it. As others have said it would be ironic if Tories brought their own Bill down while Lib Dem ministers stayed silent.

  • Stuart Mitchell 10th Feb '12 - 8:21pm

    Steve: “If you’re actually concerned about allowing GPs and patients what they want then you should be firmly against the bill.”

    Well put. One of the government’s main rationales for this bill was that doctors (and in particular GPs) know better than anybody else how the NHS should be run. Funny then that the government seems hell bent on ignoring the call from the Royal College of GPs for the bill to be scrapped entirely on the grounds that it would “cause irreparable damage to patient care and jeopardise the NHS”.

    Only a few right-wing armchair theorists making up naive GCSE-economics scenarios seem to think there is any merit in this Bill. Those on the ground (the RCGP, BMA, RCN, etc etc) see it for the disaster it is. Nice irony that the government which crowed so much about being anti-authoritarian should be so deaf to the opinions of the public and the various medical professions, blundering on with this “the government knows best” approach. I cannot recall any other time when a government determined to follow a course so contrary to public and professional opinion on an issue as important as this.

  • Andrew Suffield 11th Feb '12 - 11:37am

    What will happen is that the private MRI facility will do the scan at £400, then another provider will come along doing the scan at £350 but botching the interpretation of the scans or mixing up patients results. The lag time in detecting that, delayed by cover-ups and attacks on whistle-blowers, will mean that lots of GPs will have ordered the £350 scan in good faith.

    It’s a pretty story, but this happens just as often with state bureaucracies. It’s not a feature of markets, it’s a feature of poor regulation and oversight.

    But again that is assuming the cost has been driven down by innovation rather than simply lowering costs or rather transferring these costs through the system onto other parts of the system.

    Less assuming, and more discounting – this is another problem which happens regularly in the current NHS, where costs are shifted into somebody else’s budget and announced as “savings”. It’s a serious problem that needs addressing, but you address it through independent oversight.

    Substitute ‘Railways’ for ‘Health Service’ in your arguments and rewind….

    The privatisation of the railways was a travesty of anti-free-market politics. It has all the worst features of private and state-run organisations, siphoning off public funding while providing no consumer choice or oversight. The Tories did not create competition in the railways, they created a postcode monopoly – you can choose to travel to Manchester with one company or Newcastle with a different company, but you have no meaningful choice if you had a specific destination in mind.

    This is where Tories and Liberals diverge on market issues – the Tories want to move money to big business, and prefer “efficient” monopolies, while Liberals want people to have real choice and control in their own lives, and oppose monopoly control.

  • The purpose of entering such a market would be to identify a niche from which profit can be made. It would not be a very pure market because prices would be fixed – you can’t put prices up but you don’t need to reduce prices.

    NHS excess capacity might be the stuff that simply has to be there to handle emergencies (or private failures) but may not always be used. Private suppliers can manage the amount of business they do to maximise use of resources and do not have to provide this backstop.

    And the larger the proportion of private suppliers in the market the more likely that there will be pressure applied to change the rules of the game in their favour.

  • According to the BBC, this morning, Cameron has ‘thrown his full weight behind Andrew Lansley and the NHS bil”l.

    I know that’s normally the ‘kiss of death’ but, on the face of it, that makes it even more likely that the future of this bill will be in the hands of LibDem MPs.
    I am against the bill but, if it goes through, one thing is certain; any credit will be taken by Conservative’s and any blame will be left to the LibDems….

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