Baroness Shirley Williams writes… Making sense of the Health Bill amendments

If you are trying to explain to Liberal Democrat members and interested potential voters how the Lib Dem peers changed the health bill, much the best source of information is the House of Common’s library standard note, which is non-partisan and available online at the Parliament website.

In my view, no local Lib Dem group should be without it! It describes all the more significant amendments, from Lib Dems and also from Cross-Benchers and Labour peers, in a way that most of us can understand.

It brings out the changes to the powers of the Secretary of State; the removal of the Competition Commission and other changes to competition; the responsibility for addressing health inequalities; the bringing together of health and social care, especially for older people; the provision to make sure that every resident of England is included in a Clinical Commissioning Group; and the limit on increases in private patient income for Foundation Hospitals to no more than 5%. There is also information regarding big improvements on research and medical education. It’s even quite easy to read!

* Baroness Shirley Williams is a Liberal Democrat member of the House of Lords, a founder member of the SDP and the Liberal Democrats and author of several books including her autobiography, Climbing the Bookshelves.

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  • Link didn’t work for me.

  • It is interesting reading but still leaves a number of issues for me:

    The education clause, and I think particularly of post grad Doctors, seems very loosely worded. This has been a major concern of the Royal Colleges, and I believe also has an impact on how “competitive” NHS providers will be when commissioning services. I would have liked to see the role of the Royal Colleges in defining standards and training to have been solidified.

    The 49% issue concerns me, even with the increased scrutiny if a Trust increases private income by more than 5%. I would prefer the decision not to be with the Trusts governors but the SOS in this case. Also requiring Trusts to demonstrate how non NHS income had benefited NHS patients is too open a definition. Demonstrating how no NHS patient had treatment fall outside of target waiting times due to staff or resources being used for private treatment should also have been explicit.

    The risk register issue is also massive for me. Didn’t Lib Dems used to believe in open Government ? To me it seemed as if it had been decided to lose the headlines over the final passage of this Bill in the (rightly) more favourable news related to the Budget.

    The other issue, and I believe this is a trust one, is why the Bill does not follow the coalition agreement. Why, looking the draft risk register in the Guardian, does it appear that this decision was taken so soon after the agreement was put to Lib Dem members. Was this just misinformation to get the agreement agreed, sloppy wordsmanship, or a Tory con trick. As the original Bill moved so close to the original Tory plan I would like to believe the latter.

  • Richard Dean 27th Mar '12 - 7:32pm

    Thanks, this is helpful but is very far from an easy read! And that has been a problem all along – people are not being given information in digestible form. Anyway, this does illustrate much of how the original bill had significant flaws, now corrected. Some interesting surprises – no duty of candour, and no duty to reduce bureaucracy! Why not?

  • Andrew Suffield 27th Mar '12 - 9:25pm

    The risk register issue is also massive for me. Didn’t Lib Dems used to believe in open Government ? To me it seemed as if it had been decided to lose the headlines over the final passage of this Bill in the (rightly) more favourable news related to the Budget.

    Something you should consider: most of the people who were saying it should not be published had read it. Clearly they know something you don’t – perhaps they’re right? If it was one person trying to suppress the contents, that’s suspicious. When it’s everybody from two opposing parties, and nobody’s breaking ranks, it’s worth considering that they might just be telling the truth.

    Thanks, this is helpful but is very far from an easy read! And that has been a problem all along – people are not being given information in digestible form.

    This statement has always been true of the UK legislative process. It’s not that people don’t want to give out digestible information, but rather that there was none prepared and nobody had the time or staff to do it.

    And yes, this is a significant problem.

  • Bald Reynard 27th Mar '12 - 10:09pm

    Shirley Williams, posting at 3.43pm – over 9 hours after the Guardian published the Draft Risk Register and their report on the matter – makes NO mention of it in her blog ! Why ? Did she see (final version of) the Register ? If not, she has been ‘hoodwinked’ by Clegg. If she did and still recommended a ‘Yes’ vote …… what remains of her creditability has gone (her only defence, would be if the Final version differs dramatically from the Draft – and I doubt that).

  • @Andrew Suffield. You ask…….”If it was one person trying to suppress the contents, that’s suspicious. When it’s everybody from two opposing parties, and nobody’s breaking ranks, it’s worth considering that they might just be telling the truth.:” The answer is emphatically not. Not in a free and open society. [and I honestly do not know to what “truth” you refer]. I want to know this so-called “suppressed” stuff so that I, adult that I am, can make up my own mind about the ‘risks’ to the NHS. Who do these “suppressers” think they are? It used to be the case that the LibDems (quite rightly) were at the forefront of the magnificent ‘free and open society Awkward Squad’ (my words). I am not the first to mention the LibDem pressure for publication of anything and everything relating to the Iraq war. So by the same principle publish the NHS Risk Register. I bet if the Conservatives or LibDems were in opposition right now they would be screaming for publication. I suspect that, sadly, the LibDems’ days of being that admirable ‘ Awkward Squad’ have now gone.

  • Peter Andrews 27th Mar '12 - 10:24pm

    I’m not particularly pro or anti the Health and Social Care Bill but I am certainly against publishing of risk registers.

    We need civil servants to be able to communicate with ministers about possible risks of bills without the civil servants being so afraid of the risk register becoming damaging when it comes out (and them getting the blame for that) that they decide not to include some risks to make it seem better for the public rather than actually flagging up all the risks to ministers. Also they are risks not certainties its not just the consequences of the risk but the likelihood of the risk which matters. So for example there might be the risk that commissioning bodies don’t function properly and essential services/products fail to get commissioned. That would have bad consequences but the risk of it is probably very very small. However I’m sure we can all imagine the scaremongering headlines that would come out of such a risk being on a risk register if it was published.

  • Bradley Colmans 27th Mar '12 - 10:34pm

    Sorry Shirley but you let the party down as well as the whole country. You made a passionate demand that Part 3 of the Bill needed to be scrapped and then you went back on and voted against your own admendments, with the ludicious attempt to somehow blame the Guardian for not telling the truth. You wrote the article in it, you cant deny that. And lets not forget the Party workers voted against you no matter how you and the likes of Clegg tried to stop it.
    The Party will rise again but not before the electorate get a chance to get rid of all the faux LibDems in charge of the moment. The only shame is the Lib Dem peers who have let down the party so much will be able to stay. If they had any shame they would stop claiming to be Lib Dems

  • Richard Dean 27th Mar '12 - 10:45pm

    The risk register looks pretty irrelevant now, of historical and vindictive interests only. Most of the risks – perhaps all – will already have been known about, and some of the processes described in the House of Lords document were clearly designed to reduce risks that peers had identified.

    For instance Lord Warner’s amendments 196ZA and 214G help to mitigate risks of localised failure to provide adequate services. Other examples include the large amount of work done to prevent the risks of conflicts of interest, and the changes to prevent the risk of damage to NHS effectiveness by inappropriate management of competition. In essence almost all the Lords’ amendments can be interpreted as measures that mitigate risks.

    Even if the risk regster contains something noone has yet thought about, noone is going to admit they didn’t, because such an admission would reflect badly on them!

  • An amended bad Bill is still a bad Bill. it is a very silly and costly waste of time and money which will probably not be fatal to the NHS, just create a lot of open wounds which will distract the NHS from what it really ought to do while wasting a small fortune.

    As for the Risk register, Peter Andrews has a pretty poor view of civil servants. The Civil servants have no interest in craeting false statistics, and nothing bad happens to them if their stats show a high risk. So why on earth would they produce false stats? Other risk registers have been published and the world did not end. This is a false argument.

  • Andrew Suffield 28th Mar '12 - 12:56am

    Other risk registers have been published and the world did not end.

    Given the reactions of the people who read this one, I would tend to assume there are some things in it which are politically unwise, and they don’t want to force civil servants to get political when they write these things.

    Perhaps the ones which were published just didn’t have much/any touchy stuff in them?

    (Note that Labour will also know what’s in it, and they wouldn’t be pushing for it to be released unless it contained something damaging)

  • Richard Dean 28th Mar '12 - 5:56am

    There is no reason at all to say that an amemnded bill is a bad one. Almost every bill has amendments. The whole point is to make improvements, and incremental ichange is a perfectly valid method of doing this. This one had much debate and many improvements, which might even make it better than the average bill!

  • @Richard Dean
    I think you may find, if read again, that Tony Dawson said and amended Bad Bill is still a Bad Bill…..

  • In the House of Lords on 13th March 2012 Baroness Williams said of the Health and Social Care Bill “…I do not like the Bill very much…..”. With respect I would ask Why then vote for it? From various comments made by LibDem MPs and Peers it seems this Bill (now Act) was and is pretty unloved, therefore how did it become law? If it was the ‘least worst option’ then it is an awful situation when a large number of our rulers end up, for whatever reason, voting into law something that they don’t like. This is an example of politicians behaving in a way that could be designed to turn voters more and more cynical.

  • Surely the risk register issue is simple and one that anyone who wants effective decision making should agree with.

    If we are asking 650 people to decide how the Health Service is going to be run in the future should we give them the most complete information to enable an informed choice ?

    If Parliament is the decision making authority, which it is, then should information be withed from it ?

    Would this happen in a business?
    Hiding information from the Board if you’re a Director would likely lead to you being disqualified.

    There will be a time when this party is in opposition again and it will be rightly mocked the first time it demands information and open Government. Whatever peoples feelings about the Bill this is hypocrisy…..

  • The idea that I’m going to say anything other than “Sorry, I really don’t know what they were thinking” when faced with a voter pressing me on the H&SC Bill, let alone raise the matter myself, is laughable.

  • Yeah, see your point Greg!

  • Richard Dean 28th Mar '12 - 10:27am

    @Steve. Thanks for the correction, apologies to Tom for any offence.. I guess it’s a Better Bill now!

  • patricia roche 28th Mar '12 - 5:21pm

    As a user of the health service perhaps you could practice on me and give me a clear and simple explanation of what was bad about the health service and how my experience will be so much better.

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