Baroness Liz Barker writes… The Health and Social Care Bill in the Lords

I have spent my entire working life in the field of health and social care. For many years I worked for Age Concern and for all my time in the Lords I have been a member of the Health and Social Care team. I am, and always will be, a passionate supporter of an NHS which is free at the point of need and open to all regardless of their ability to pay.

Although the Health and Social Care Bill only came to the Lords this week I have been working on it for several months along with Liberal Democrat colleagues, including Nick Clegg, Norman Lamb and John Pugh, Shirley Williams and Dr Evan Harris. We have already achieved significant changes to the original legislation and will continue to press for more.

Having looked at the original legislation, the report of the Future Forum and the revised Bill which came from the Commons, I came to the view that the Bill contains a number of proposals, such as Health and Well Being Boards and transfer of Public Health to Local Authorities, which will reduce health inequalities. However, there are aspects of the Bill which require much more scrutiny. In my view, it will take a lot of hard work by members of the House of Lords, who have a wide range of experience and skills, to turn this into a secure legal foundation for the development of the NHS.

I managed to read the first 100 e-mails which I received on the subject of the Health and Social Care Bill (and I regret that as I do not have staff I cannot reply individually to them and the many others). Having done so, I am convinced that it is the duty of the House of Lords to be mindful of the real concerns expressed by many people as we proceed to think about this legislation in detail. That is why I voted to let the Bill go to Committee on the floor of the House and it is why I, along with colleagues, will continue to raise questions and issues with the Government.

Rumour has it that, having failed to command significant support from the Crossbenches, Labour are preparing to filibuster this Bill like they did on the Parliamentary Voting System and Constituencies Bill. The NHS is too important to be used like a political football and failure to give this Bill thorough and fair scrutiny would be condemned by the public, who have already shown an unprecedented level of interest in this legislation. I hope they will continue to follow the proceedings of the House closely and be alert to any signs of gamesmanship.

You can read my contribution to the second reading of the Health and Social Care Bill here, and you can access the Wanless Report, which I refer to in my speech, here.

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This entry was posted in Op-eds.


  • “Democrat Liberal”… “colleagues in the Commons, including Nick Clegg, Norman Lamb and John Pugh, Shirley Williams and Dr Evan Harris”.


  • The destruction of the NHS is another neo-con ideal driven by senior Tories connected to Atlantic Bridge. They have been planning this for years and the Lib Dems have enabled the toxic policies. A speech by Fox to Atlantic Bridge in 2003 asked: “How Much Health Care Can We Afford?”

    Members of the Galen Institute, a thinktank which promotes “freemarket ideas in health”, attended its conferences while the failed bank Lehman Brothers, sponsored at least one event, as did the powerful neocon thinktank the Heritage Foundation. (Guardian)
    Osborne, Hague, Grayling and Gove all members of the ‘Advisory Board’.

    Many in this country may be led to believe that UK policies have been driven by outside forces and personal gain instead of for the good of the country. Treason?

  • david thorpe 17th Oct '11 - 5:03pm

    @ anne
    the lib dems had these refoms as polciy, we didnt faciliatte anythingw e drove it forwrad.
    The increase in the NHS budget, and the increse in clinical staff wemployed in the NHS since the coalition came to power would also indicate that far fromw eakening the NHS we are sterengtehening it.
    The original lansley proposals did propose a free mnarket in healthcare, the ammeneded ones, ammended thanks to the Lib Dems explicitly prevent that, but then I doubt you are fmailiar with the proposals so you wouldnt know how we have prevented it, so I suggest rather than looking at the gaurdian talking about people who have no impact on helath policy attending talks, I suggest you learn about the content of the bill then ocmnes back to us

  • David Thorpe

    The 400 public health experts who wrote to the Daily Telegraph oppose this bill. 70% of the Royal College of GPs members oppose this bill. The British Medical Association opposes this bill. The Royal College of Nursing opposes this bill. The Medical Practitioners’ Union opposes this bill.

    I assume you would also tell all of them that they (lacking your expertise) have got this wrong too.

  • Nigel – to quote the Secretary of the BMA:
    “There is something personal in medicine, something in the doctor-patient relationship which is essential to good medicine. Break into that, make the Doctor not your Doctor, your friend, your advocate and you will have done something to medicine that it will be impossible to repair.”

  • davifd thorpe 17th Oct '11 - 8:55pm

    ” nigel
    the bma opposed the creation of the NHS in the first place…NYE BEvan famously hadsaid he had to ‘stuff their mouths woith gold’ to buy them off.
    The BMA are experts but they are also a vested interest, the lib dems were created as a oparty to opposed vested interests wherever they occur, in the city as vince cable has beeing doing
    or among the semi state sector…….

  • these reforms were not in either the Lib Dem’s or the Tories manifesto .; the Lib dems must vote against these reforms or face total annihilation at the next GE

  • Charles West’s Motion, which calls for the Bill to be thrown out if the House of Lords cannot rectify its fundamental deficiencies, was finally debated at the East Midlands Regional Conference last Saturday. It was passed by an overwhelming majority – with just one opposed and one abstention in a crowded hall.

    Lib Dem members across the country will not understand it if our parliamentarians do not now seize the opportunity to make amends for the tuition fees debacle, and stand up for their principles. And as anyone who watched Question Time last week can confirm, the nation won’t understand either.

  • Grammar Police 18th Oct '11 - 8:15am


    The BMA opposed several aspects of the Beveridge report …

  • There have been amendments to the bill but its final outcome will be to make all hospitals self sustaining financial institutions that will not be prevented from failure by the state. If they fail they will be open to takeover by other foundation trusts or private corporations or simply close. The income they are able to derive will be from GP consortia and private sources. There will be no cap on how many private patients they are able to take. Increasingly hospital trusts will be dependent upon private income in order to sustain their existence. As waiting lists grow individuals will be increasingly incentivised to take private insurance.

    The incentive structure of this proposed system is near identical to that which presently forms our dental care provision.

    If the only method available to defeat this bill is filibustering then so be it. Within 10 years of this system the NHS will be no more than a rump service offering a safety net of services to those without private insurance. The scrutiny being offered, up until Shirley Williams raised the issue of lifting caps on private work for NHS hospitals, was merely tinkering at the edges and in many cases has simply rendered the essentially private system that will still be its product, a worse private system than if they had left the bill alone.

  • I still have grave concerns over this bill. I recognise that we have got rid of some of the worst bits, but I hope our peers will perform significant surgery on what remains. It’s reassuring to hear Liz Barker’s comments here and I hope Evan Harris will continue to have input as well…

  • Catherine,

    All of the worst aspects, those that will ultimately lead to an americanised insurance based system, are left intact. Some amendments that have been made will also make for a poor version of that. For example, how will the conflict of interest that has been created by having hospital doctors and nurses on commissioning boards improve the system?

  • @David Allen “and stand up for their principles”

    In for a penny in for a pound springs to mind, it’s not nice to say but the damage is already done and probably irreparable, what we have now is politicians that are enjoying the power & the limelight and it’s distasteful.

    As someone has previously mentioned, this policy was not part of any manifesto; all stakeholders are against it and no doubt most NHS users are against it so the honourable thing must be done, throw this bill into the gutter where it belongs.

  • Karen Wilkinson 19th Oct '11 - 2:35pm

    I was at the very well attended fringe meeting on the NHS Reform Bill, arranged at the last minute at Conference, at which Shirley Williams, Evan Harris, David Babbs of 38 Degrees and a range of medics spoke.

    The most chilling comment to my mind was that from Shirley Williams, not known for hyperbole, who said that as Lansley – already having the power to do so – had started the process of “hollowing out” the NHS’s current system, there was a fear that *should the Bill be thrown out now, the NHS would collapse*.

    With that in mind, it is clear that the work of the Lords is to mitigate where possible the more worrying effects of the Bill rather than throw it out. It is also clear that we have sharp minds and experienced hands on this case so my view is we should be cheering them on rather than yelling from the sidelines. So, I wish our Lords every success in their endeavours.

    I also gather the situation begs the question whether the Secretary of State has acted properly in this matter. My understanding is: he brought to Parliament a Bill which was not in the coalition agreement; the Bill is unnecessarily complex and covers aspects which he already had the power to achieve; because he already had the power, he has encouraged change assuming the Bill will go through Parliament.

    If this understanding is correct, I would like to know how a non-coalition agreement Bill got to Parliament – did it go through the Quad? – and, by pushing elements of reforms through before the passing of a Bill, has the Secretary of State treated Parliament with contempt and acted unconstitutionally?

  • David Allen 20th Oct '11 - 5:10pm


    Yes, Shirley Williams’ fears are understandable. Unlike many Lib Dems, Shirley would like to see real changes to (or the scrapping of) the Bill, not just tinkering and play-acting. While “collapse” is rather a dramatic word, no doubt there would be a good deal of chaos if the Bill were thrown out. At some point, an ill person would no doubt die, in circumstances which might conceivably have been made worse by the chaos. Then the finger of blame would be pointed at the politicians involved in throwing out the Bill. However, let’s not forget that a massive and longer-running blame game will quite fairly be played against us if we fail to throw out the Bill, and our health service goes downhill over the coming years. Shirley Williams knows that too. I’m not clear who else does.

    I’m not sure to what extent Lansley actively decided to “hollow out” the NHS. It might have been rather that employees in doomed PCTs have voted with their feet, and scrambled to get new jobs, rather than hanging around to go down with the ship. Could someone closer to the NHS perhaps comment on this? Is Lansley to be blamed for letting that happen?

    If, in fact, Lansley has deliberately acted to pre-empt the decision and force his plans through irrespective of what Parliament actually decides, then it certainly raises a whole host of new issues. Does the Werrity Goverment have any respect for probity and proper procedure?

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