Today is Third Reading in the Lords of the Health and Social Care Bill. That this is one of the longest, most complex and contentious piece of legislation of this Parliamentary session barely needs restating. That it is unloved in many quarters is a statement of the obvious. And of course you only have to read the many articles and threads on Lib Dem Voice about the Bill to know that views still vary widely on whether it is necessary to address the fundamental challenges faced by the NHS.
Having been a member of the Lib Dem team in the Lords – working alongside far more experienced colleagues than I – I do know that the Bill has improved out of all recognition from the Bill we received from the Commons. Of course it does not bear the hallmarks of a Bill that has come from a Lib Dem stable – because it didn’t – but that is the nature of coalition government. And whilst I fully recognise that some in the party would rather part 3 of the Bill dealing with competition didn’t exist, I think it’s necessary. Firstly because restricted competition can and does help to introduce new ideas and approaches to healthcare, provided they are balanced by equally strong duties in relation to collaboration and the effective joining up of services both within the NHS and beyond. And perhaps most importantly, because the Bill significantly tightens up the loopholes on unrestricted competition introduced by Labour in their 2006 Act so that promoting the best interests of patients is now of equal priority.
My view that the outset has been that the Bill should ultimately be judged by the health outcomes it produces – essentially how it improves people’s lives, particularly the most vulnerable. Because so much of the debate over the last year has been quite a sterile one about structures, I think we have often lost sight of this fundamental point. One specific issue I don’t think has received enough airspace is the focus on reducing health inequalities. Or to put it another way doing something real about unequal life chances. Nowhere is this more starkly illustrated than in the quite shocking statistics about life expectancy. In London – where I live and work –life expectancy for men ranges from 71 years in one ward in Haringey (the Borough where I live) to 88 years in one ward in Kensington and Chelsea. A huge difference of 17 years. An oft-quoted statistic, but one that really rams the point home, is that if you travelled the seven tube stops on the Jubilee line between Westminster and Canning Town, male mortality worsens by seven years. That’s one year for each stop on the way. It’s also why for me, the fact that this legislation contains a landmark legal duty – on the face of the Bill itself – for the Secretary of State to tackle health inequalities, is so important.
As the Bill has progressed
through the Lords, these duties have been substantially strengthened at every level in the new structure so that reducing health inequalities now runs through the whole fabric of the health system in a way we’ve never seen before. In short, in addition to a new duty on the National Commissioning Board and on Clinical Commissioning Groups to report progress year on year in reducing health inequalities, at Third Reading today, and in direct response to pressure from Lib Dem peers, Ministers are bringing forward further amendments so that CCGS will be required to set out in their commissioning plans how this duty is going to be discharged and progress in doing so will be a key factor in how its performance is assessed each year by the Board. And we all know that what gets measured gets done. So now, duties on commissioners to promote equality of access and reduce inequalities cannot be over-ridden by any duties to promote choice and competition.
Coupled with the beefing up of duties to ensure universal provision of health services to ALL members of the community – irrespective of whether they are currently on GP lists or not – easy accessibility of services will be vital to reducing health inequalities. This means improving the current situation in which too many vulnerable people, including the homeless and other transient groups, turn up inappropriately in A&E because they have nowhere else to go. This is neither good for them or other people needing to use A&E. New duties to join up services between health, social care and other local services such as housing and homeless support will also have a crucial role to play here. The role of Health and Wellbeing Board in promoting joint commissioning should enable more integrated services, for example for older people and people with learning disabilities. Finally the much stronger focus on public health – and I greatly its return to local authorities – will be key as tackling issues like obesity, smoking, drug and alcohol abuse and sexual health which make a real difference in reducing health inequalities.
This all adds up to a much stronger package than we’ve had before. Whilst the proof of the pudding will always be in the eating, for me this very welcome shining of the spotlight on health inequalities has the potential to be a game changer for the most vulnerable and further the cause of social justice.
A final word. Given all the acrimony the Bill has generated, there is much work to be done to re-build bridges – and indeed trust – both with the health professions and within the Party. For the sake of those people we came into politics to serve, that work should start today.
* Claire Tyler, Baroness Tyler of Enfield, has been in the House of Lords since 2011, taking an active role in the areas of health and social care, welfare reform, social mobility, well-being, children and family policy, machinery of government and the voluntary sector. She is the Liberal Democrat member of the Lords Select Committee on Social Mobility, and co-chair of the APPG on Social Mobility
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12 Comments
So that’s a No then to dropping, pausing or taking any notice of Conference, which specifically refused to support the Lib Dem Peers expressing positive support for the Bill?. (When it was eventually asked)
Everyone fully recognises the great amount of work the Peers have put in in amending a fundamentally flawed and unnecessary Bill. Nothing that it genuinely sought to do to improve Health Care across the Health and Social divide (which was very little), could not have been done by secondary legislation or amending existing acts 2006 & 2009. The Labour Party after all, did it themselves, when they amended their own acts to strengthen the cap on private revenues, which Shirley at one point, was claiming did not exist.
I was truly impressed and pleased that the Peers have managed to get included in the responsibilities of the Secretary of State a specific duty to tackle health inequalities. But even now you come back at everyone with yet more last minute amendments that will “improve the bill”. I worry just how robust these “improvements” will be. This is after all Primary legislation and if nothing else, sets a direction of travel in Health and Social Care about which I for one, remain highly skeptical. Shortly to become an act it seems, if I catch the tone of your piece correctly.
You mention proofs and puddings in your article. Yes, we will all have to see what the actual effects of this Legislation will actually be, when the dust settles and we can all see what we have actually got. Hopefully, without too much involvement from our legal friends.
You are correct in mentioning that there are several bridges to rebuild after this. No one will be more glad than me, if I have to eat humble pie, having been wrong over this. Several portions. At present, sadly, I don’t think that very likely.
The commitment to tackle health inequalities is welcome and long-overdue – unfortunately it is quite likely that many of the reforms mooted will in fact make it more difficult to tackle the very inequalities that the Bill aims to reduce. No time to go into details as to why, perhaps in a separate post…
In addition, I want to make something very clear. A very large, possibly overwhelming proportion of the difference in life expectancy (and morbidity-free life expectancy, or how long people live free of debilitating ill-health) is attributable to the social determinants of health. That is to say, as Prof Sir Michael Marmot’s groundbreaking work has shown, much of the difference “Jubilee line effect” Baroness Tyler describes is in fact down to socio-economic factors and the psycho-social stress caused by disparities in early-years experience, education, income, stable employment and others. It is emphatically not the case that the provision of medial services, and the extent to which that differs in different parts of the UK, drives the differences in life expectancy – the differences are driven by social determinants.
The reason I flag this up is that the bitter, drawn-out and frankly sterile debate over these health reforms have cost the country a real opportunity to debate how we can implement real reforms, in areas outside of healthcare systems, that would truly tackle the gradients in life expectancy. Reforms including a much higher focus on preventive medicine, on healthier lifestyles (especially for the less well-off) and really fair labour market. I intend to discuss these social determinants, and how a capabilities-driven liberal democrat approach to them can help, at the SLF conference in June: http://socialliberal.net/about/slf-conference-2012/
We have lost credibility on health and healthcare, and thus the once-in-a-generation opportunity to really transform how people achieve good health. That’s the most depressing aspect of this fiasco…
What Prateek said + Sheep Led by Donkeys
.Claire Tyler………………………A final word. Given all the acrimony the Bill has generated, there is much work to be done to re-build bridges – and indeed trust – both with the health professions and within the Party. For the sake of those people we came into politics to serve, that work should start today……………
So, to paraphrase, “We have ignored you, the health professionals, you, the LibDem members and you, the electorate”.”We have pushed through a bill which was specifically ruled out pre-election (no top down reorganisation)”.” Having done all this, we’d like you to trust us and believe us when we say that we are here, in politics, to serve you”….
The Lib Dems have done a wonderful job in improving this Bill, but even now, as drafted, It is not good enough. I also note from various other comments that Shirley’s understanding of the effect of competition law is not correct.
Given all such misunderstandings, does it not make sense to delay the Bill till atleast after the Transitary Risk register is published. It may through more light on many of these uncertainties. What is the hurry?
Claire
I am sure we can all count on you to do the right and honorable thing and oppose this bill, in line with democratic LibDem conference motions over the last few years opposing the Bill. The LibDem party was elected on a platform to fight for education, green issues, cvil liberties, hard work with UK business and other progressive ideals, it’s time to get to work to implement this agenda and cease the non-mandated agenda of hyper liberalization supported by only the most extreme Liberalization purponents of this party.
The comment by Prateek Buch states the case very well:
” It is emphatically not the case that the provision of medial services, and the extent to which that differs in different parts of the UK, drives the differences in life expectancy – the differences are driven by social determinants.”
If the work to rebuild bridges starts today – this is where it should begin.
Your concern is unsurprising and in many ways valid. Here’s the but: it is an ugly truth of UK legislation that every bill is like this. Laws are like sausages, you are unlikely to enjoy seeing how they are made. This is one of the reasons why constitutional reform is such a big deal to the LDs. (Unfortunately, a lot of people are now crying that it’s not populist enough)
Agreed. Damnit. Still angry about that.
Baroness Tyler, if you and your LibDem colleagues vote down this Bill, then the bridges can indeed be re-built. Why is it that only after the Lib Dems and the Conservatives have forced through this very, very unpopular and unwanted piece of legislation, that we can apparently, all call a ‘truce’ and then be friends again? Why not throw the whole thing out and then make genuine peace between the political parties and the public? If this Bill becomes law, I predict political and social acrimony for years, and the LibDems will be on the receiving end of much ill-will. But you are choosing to back this legislation with your ‘eyes wide open’. There are no excuses.
Baroness Tyler’s piece seems to be a very long apology for supporting this Bill. If this is the case why not simply vote against it. Likewise, Baroness Williams said in the Lords on the 13th March [Hansard] “…… I do not like the Bill very much …..” So why not vote against it?
If evidence were ever needed of the disconnect between the political classes and the public then this bill illustrates it perfectly.
Nobody wants it, nobody really understands it, not even the health minister can explain it clearly, yet the sheep like politicians wave it through ignoring even their own party members,
This is a huge shake up of one of the world’s most efficient health systems which is untested, unnecessary and unwanted.
It will also kill the Lib Dems as a political party. I certainly can’t see a situation where I’d ever vote LD again after voting for you in 2 out of 3 general elections.
Surely a major improvement in health and the quality of life would come from people taking responsibility to eat a sensible diet and exercise moderately? If a person cannot take resonsibility for eating sensibly and exercising moderately ,what can they take responsibility for? Chinese and Indian civilisations have understood the relationship between health and the appropriate diet and exercise for thousands of years.