Grassroots pressure stepped up over NHS plans

With yesterday’s holding announcement from Andrew Lansley – yes, the health plans might be changed but no, there are no details as yet – the future of the health White Paper is very much up for grabs. It’s not quite as simple as Liberal Democrats versus Conservatives, as although there are not many Conservatives who share the principled objections to parts of the plans from the Liberal Democrats, there are many who share concerns over the practical workings of the detail and fear the political impact.

In a smart move, which reinforces how the Social Liberal Forum is becoming one of the party’s key pressure groups, the SLF is hosting an online petition from the movers of the Sheffield Conference health amendment. The petition calls for the NHS plans to be changed in order to:

a) ensure the Health Secretary has a duty to provide a fully comprehensive and free health service, with no gaps and no new charges
b) provide more local democratic accountability for the health service
c) curb the market obsession of the proposed reforms to prevent quality being relegated behind price and prevent the cherry-picking of profitable services by the private sector undermining and fragmenting existing provision
d) slow down the pace of change so that the NHS, facing its toughest settlement for decades, does not implode from the stress of another massive reorganisation

Former MP and one of the main campaigners on this issue, Evan Harris, has said to The Observer:

This list of amendments is the minimum needed to satisfy the requirements of Lib Dem policy as set out in the coalition agreement and the recent conference motion, and this will be an essential guide to Lib Dem MPs, the leadership of the party, and indeed the Conservatives of what needs to change.

The Liberal Democrats do not expect their MPs to vote down the bill, but will not accept our parliamentarians being whipped to vote against any of the necessary amendments needed to provide democratic accountability of GP-led commissioning, guarantee the comprehensive nature of the NHS and rein in the original plans for an NHS market.

A widely-supported petition is likely to make the prospect of whipping MPs to vote against a conference decision on a topic that wasn’t in the coalition agreement even more unlikely.

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  • Old Codger Chris 5th Apr '11 - 12:48pm

    I don’t see why (a) and (b) need to be mutually contradictory.

    If the government really does pause and listen, the end result might be reasonably OK after all. It’s not as if the present arrangements with PCTs are wonderful.

  • OCC: agreed – I don’t see that adding democratic oversight will necessarily make things worse. It might provide a bit of a safeguard against some classes of problems, even if it’s no panacea.

  • It seems like some people prefer to keep power centralised rather than follow the liberal tradition of localism and decentralisation.

    The amendments at A and B would force the health secretary to ensure that comprehensive provision is made while also allowing local democracy to make certain that it is provided in the best way for the local community.

    a win – win situation if you are both a liberal and a democrat who believes in the provision of healthcare for all based on need rather than ability to pay.

  • John Fraser 5th Apr '11 - 1:23pm

    The question is Mark , what is the next step if Clegg sticks with Cameron and just makes small concessions. He could probibly bring enough right wing Lib dems with him to gain the barest of majorities, but would have treated conference with total contempt.

    Under such circumstances would you be prepared to campaign for Nick Clegg to go.?

  • Dan F: We’ve seen issues with PCTs refusing to provide services like gender dysphoria treatment; while a local board should be able to bring in new or appropriate ways of service provision, some central oversight is probably also necessary to ensure that groups of patients aren’t being excluded.

  • Keith Browning 5th Apr '11 - 1:59pm

    Would any of this ‘review and consultation process’ be happening if the Lib Dems had not voted against the reforms at the spring conference. Another victory for common sense but how many of the general public will give the LDs the credit. A better PR job needs to be done to demonstrate the influence of the party within the coalition.

  • toryboysnevergrowup 5th Apr '11 - 2:11pm

    No one in their right mind would announce a detailed reorganisation of a major corporation without several months of detailed planning beforehand – let alone that of the largest employer in Europe just days after the General Election (see also similarly political inspired announcements on the Audit Commission and other quangos). Rather more than a “pause” is required before the new plans are brought forward.

    I cannot but fear that many of the outsourcing companies, such as the one owned by Lord Ashcroft (or now his relatives) are behind most of the reorganisation moves at present.

  • Who was it that decided PCTs were doing such a terrible job? I thought the coalition agreement agreed that there would be no more top down reorganisations of the NHS which was supported by GPs, Hospital Physicians and Surgeons.

    As a patient, I’d have been pretty happy with that because change always seemed to be afoot and it just created a knot in the stomach (being moved all around London further away from friends and family for treatment and surgery). It was precisely this type of change that took money out of the service too.

    It’s great that we’re able to exert some pressure over the health reforms, however, where are we thinking about the patients – the often very sick, vulnerable human beings underneath it all? Localism is all well and good but what’s it going to mean to patients?

    Patients are generally happy with the way things are although with all the job cuts due to hit soon, wards could become even more dangerous than they are now.

    I wrote to Vince a while ago about the NHS cuts and he just replied saying they were Labour cuts nothing to do with the coalition, they just inherited them!

  • @Andrew Tennant

    Why on earth would you want a free market in healthcare, it prioritises shareholders over patients! Healthcare is ultimately a loss making business, no matter how much you invest the patient inevitably dies. The only way to make it profitable would be to provide treatment to patients who are going to be well enough afterwards to pay back the expense (or pay it upfront).

    What’s wrong with seeing healthcare as the state’s responsibility to its citizens?

  • @g – given you are so much against private businesses being involved in healthcare you presumably want to make GPs civil servants and nationalise the drug companies?

  • @SMcG GPs being civil servants would be an improvement on things as they are, for a start you’d be able to reduce excessive pay. As for drug companies, they are a different part of healthcare compared to service providers and the consequences of a free markets refusal to investigate non-profitable treatments doesn’t effect the rich developed world. Not so good if you’ve got HIV, malaria or other diseases in the developing world though.

    @Andrew Tennant

    You’re living in a dream world where services become cheaper with no loss of quality or working conditions. The status quo costs us more because healthcare works, people live longer. Constant improvement is unsustainable in the long term unless new technologies reduce costs under any system of healthcare. What the free marketeers have to do is show that a free market offers a better cost/benefit ratio than the present. You could look at the healthcare figures from the USA and EU to compare different methods from a complete free market to mandatory insurance to the NHS. You’ll find that the latter two cluster around the same points, whereas the free market of the USA is shockingly expensive and poor quality for all but the rich.

  • @Andrew Tennant

    Right, I’m calling your bluff on the the claim “France, Germany, Holland, all of Scandinavia, Australia, Canada & Singapore all have far more marketised healthcare systems than we do, and all of them outperform our centrist NHS on many measures.”.

    Citation for this, please.

  • @Andrew Tennant

    I think you’re ignoring the evidence.

    Tell me, how happy are customers with our rail service, the privatised utilities, etc, etc, etc, etc, etc.

    I think you should take what you read by Friedman and other Mont Pelerinists with a tini tiny pinch of salt.

    We are =19th in the world for spending on health by %GDP (we spend 7.5). The US, that freemarket mecca you dearly yearn for, are 1st with 13.9. Consequently, France and Germany spend 9.4 and 10.8 respectively (=4 and 3rd).

    The US healthcare system is renowned for being really bad unless you’re rich. Poor people or even just people with insurance that’s too low because their companies are cheap can’t get adequate treatment for cancers let alone hip replacements.

    We, the Liberal Democrats, promised to protect the most vulnerable in society. Subjecting them to a Friedman/Mont Pelerinist freemarket experiment is not protecting them.

    Consequently, are you actually a LibDem or are you allied to another party altogether?

  • @Andrew Tennant

    “Nations such as France, Germany, Holland, all of Scandinavia, Australia, Canada & Singapore all have far more marketised healthcare systems than we do, and all of them outperform our centrist NHS on many measures.”

    Yep, would you mind providing these ‘measures’? Oh, and because you’re so concerned about cost, Germany 10.8, France and Canada 9.4, Iceland 9.2, Australia 9.1, Sweden 8.8, Denmark 8.6. Yes, I’m sure you get my gist, they cost more than ours does as we only spend 7.5% of GDP and are due to beat France in terms of overall performance in the next few months.

  • @Andrew Tennant

    Can you point to the exact figures that make your case rather than doing the online equivalent of throwing 1000 pages of paper in my face and telling me to find it myself?

  • @Andrew Tennant

    “I have specifically said that replicating the US model is not desirable; I note that you do not distinguish between health GDP spending by each state and by their businesses and citizens.”

    I missed this post as was posting, however, I think I might have also mentioned France and Germany too but you’ve chosen to ignore these. Sorry, is it that they don’t fit your theory?

    The only reason I asked about your party allegiance is that I normally get bogged down in these Mont Pelerinist discussions with supporters of the Conservative Party.

    Anyway, back to the point, did you have any feedback on previous privatisations? As you’ve avoided the subject so neatly you could always talk about the success of Metronet. Or how about the Banks that nationalised their losses whilst keeping their profits and avoided paying taxes at the same time as paying huge bonuses to the gamblers who made such losses.

  • Perhaps Andrew the reason why you dont publish the statistics that support your argument is the fact that they dont exist?

  • @ Andrew Tennant

    “I think you need to accept that I come here for light relief and not to do whatever work you, on a whim, demand me to.

    Find it yourself.”

    I think that was you just losing your own argument. Been good to discuss these things with you and hope you might see that freemarkets aren’t everything Friedman and the Chicago school claim they are.

  • @Andrew Tennant

    I’ll forgive your debating tactic of insulting me instead of providing supporting evidence because I have the figures you need:
    From here:,3343,en_2649_34631_2085200_1_1_1_1,00.html

    First number is %GDP spent on healthcare in 2008, second is life expectancy (a relatively crude measure, but one simple enough for you to understand), and the third number is the ratio between the two, lower is better.

    France 11.2% 81 0.138
    Germany 10.5% 80.2 0.131
    Holland 9.9% 80.2 0.123
    Australia 8.5% 81.5 0.104
    Canada 10.4% 80.7 0.128
    Norway 8.5% 80.6 0.105
    Finland 8.4% 79.9
    Spain 9.0% 81.2

    by comparison the UK is 8.7% 79.7 0.109

    As you can see the UK performs reasonably well when we compare %GDP spend on healthcare vs life expectancy. It performs better than some on the list, and worse than others but they all cluster around similar values. Here’s the USA 16% 77.9 0.205

    Would you be prepared to revise your previous opinion in light of the evidence?

  • @ Andrew Tennant

    “On the banks, those we have nationalised we should be able to re-float at a profit; those we haven’t will pay back their liabilities through loan interest and taxes.”

    But the banks appear to be avoiding paying their taxes and George Osborne has made it even easier.

    Any feedback on utilities, railservices, hospital cleaning and all the other disasters.

    On the subject of BA, oh yes where do I start, what a fine example of monopolising routes and reducing staff pay and conditions. Yes, I know the same old institutional shareholders are reasonably happy but have you actually flown much on BA? I have you see – my company, an institutional shareholder, had an account with BA and many of us found them not very good (and that was in Business!)

  • Keith Browning 5th Apr '11 - 5:27pm

    Frank – ‘mine is bigger than yours’

    Andrew – ‘no it isn’t’

    Frank – ‘yes it is’

    Andrew – ‘no it isn’t’

    Frank – ‘well show me’

    Andrew – ‘not with other people looking’

    Frank – ‘lets go behind the bike sheds then and compare our statistics!!!’.

  • @Smg Make GPs civil servants and nationalise the drug companies. Top policy, you Lib Dems really are forward thinkers. I’m in !

  • “Today I’m in Pakistan. Tomorrow I’m in the NHS and all will become clear then.” Cameron will be visiting a hospital with Nick Clegg. Source: Guardian.

    Great to hear the dodgy car salesmen are doing another roadshow wonder if they’ll have any weapons to sell!!!!!!

    Oh god, I hope it’s nowhere near where I will be, hmmmmmm, I hope they’ll protect palliative patients.

  • British Rail under Bob Reid I was recognised as being one of the most efficent. he introduced the sectorisation concept, disposed of the regions and seemed to make what little cash they had stretch very far indeed.

  • In the absence of @Andrew Tennant, does anyone else think the OECD figures justify a change in the structure and function of the NHS?

    If it aint broke…

  • Andrew, you seem to completely ignore that healthcare is so diverse and requires co-operation and collaboration between a vast range of services and skills, and between different areas. Then there’s the research and constant improvement that is necessary to find more and more effective ways of treating and caring for people. None of these aspects lend themselves to a market led model. Markets are great when you can tell them exactly what you want and then let them compete to find the cheapest way of providing it, or of improving on that little bit, but that is no way anywhere near as effective as a collaborative set of specialists and organisations able to work together and share information without worrying about maintaining their ‘competitive edge’. Quite simply there are public servicees which are far more important than mere money based considerations. If we were discussing who provides the chauffeur service then fine, but we aren’t.

    I think it needs a change of structure. Every health professional or worker I have spoken to has serious complaints about how departments are managed, about how fragmented the system is, and about how the care of the patient is often disregarded.

    Then there’s the fact that we treat healthcare as something isolated from the environment in which people live. We have local authorities making judgements on the provision of local amenities, parks and open sapces, sports facilities, schools, control over development and housing provision, transport measures (such as provision for cyclists), the creation of environmental policies (such as clean air zones) and none of these are tied in to a necessity to see to the general health and well being of the people who live under those local authorities jurisdiction.

    Yes I think we need some change, but no I don’t think market forces are a fix for any of the problems that need solving, and are likely to create far more of their own.

  • richard heathcote 5th Apr '11 - 7:22pm

    with regards to BT being a success, i’ve just left BT and gone to virgin media as the service offered by BT was poor. I was paying for a 20MB service and getting 1.8MB as its still on the old copper phone lines and they haven’t invested in the infrastructure to upgrade to the new Infinity service. as a comparison i’m paying less for virgin media and getting over 40MB speed on my internet. I think a lot of other services that have been privitised are the same poor service for a premium price and from the way things are going i can see nothing to suggest the NHS will be any different.

  • @Alex I’m not suggesting that improvements aren’t needed, no management system is perfect, just that the basic structure of the NHS competes well when compared to other systems.
    You are absolutely right about environment, and the UK does score poorly on measures such as alcohol and cigarette consumption, obesity and the disparity in health between rich and poor. I’m not particularly enamoured of the governments approach on these issues…

  • “As you can see the UK performs reasonably well when we compare %GDP spend on healthcare vs life expectancy.”

    You realise that this gets better if either figure changes out of proportion to the other… I imagine if we only spent £500 life expectancy would still be high enough to blow any other percentage out of the water… but you’d still have a shite healthcare system.

    % spent on healthcare vs. life expectancy is a meaningless way to judge any healthcare system.

  • Andrew Suffield 5th Apr '11 - 8:03pm

    Then there’s the research and constant improvement that is necessary to find more and more effective ways of treating and caring for people. None of these aspects lend themselves to a market led model.

    Well that certainly rules out the possibility of a statist model. The NHS, like most bureaucracies, is legendary for its inability to innovate or to adopt new ideas.

  • richard heathcote 5th Apr '11 - 10:18pm

    i dont believe the ipad was a UK development

  • So now you have to set up a petition to try to get the parliamentary party to do what it says in the constitution? What use is the constitution then? The party has been hijacked.

  • “The Liberal Democrats do not expect their MPs to vote down the bill,”


    It is neither party policy nor is it something we agreed to in the coalition agreement so where is their mandate to vote for it?

  • richard heathcote 6th Apr '11 - 7:07am

    usually private companies make profits and drive costs down by employing less people on lower wages and expect them to do more, as an example my mum was a teacher for 40 years the school she worked in used to be cleaned by the school cleaner who kept it clean kept the toilets etc spotless, i would suggest these are the customers and this was paid for by the local council. After her job was ended and the private company got the tender for cleaning the schools they basically had 1 person doing 3 local schools and it was a rush job with the schools cleanliness going downhill. as long as it was good enough for the terms of the contract that was it as a result the schools in that area are not aswell kept as they used to be and the staff and pupils have all noticed the difference.

    just because private sector can do these jobs doesnt mean they will do it to as high a standard. i suppose the 3 cleaners who lost their jobs could all be seen as getting rid of a layer of bureaucracy.

  • @Andrew Tennant

    Are you going to admit that your claim “France, Germany, Holland, all of Scandinavia, Australia, Canada & Singapore all have far more marketised healthcare systems than we do, and all of them outperform our centrist NHS on many measures.” is not supported by the evidence?

  • @Andrew Tennant

    I used the data from those link to show that with respect to life expectancy the UK does reasonably well considering GDP spend on health. You can read it up thread…

    Perhaps you could present additional data supporting your case?

  • @Andrew Tennant
    The stats are laid out quite nicely in spreadsheet format with links to all the supporting data. It’s relatively easy to go through and compare different measures. I chose life expectancy because it’s a decent measure of the general health of a population, even if it is distorted by envirnomental factors such as diet, smoking and alcohol consumption (all of which Britain has problems with), I chose %GDP spend on healthcare because it is an absolute measure of healthcare costs irrespective of healthcare systems.

    If you think comparing these values is misleading perhaps you could explain why and offer your thoughts on a better comparison?

  • Steve Hicks 6th Apr '11 - 10:53am

    Andrew George MP, the Lib Dem Health Select Committee member’s latest position on the NHS reforms can be seen here:

    Andrew George is Lib Dem MP for St Ives, which includes Penzance, Helston, St Ives, St Just and Porthleven as well as Lands End

  • David Allen 7th Apr '11 - 12:16am

    “The petition calls for ….:

    a) ensure the Health Secretary has a duty to provide a fully comprehensive and free health service, with no gaps….”

    But there are bound to be gaps. There are always gaps. There are drugs which aren’t affordable, treatments reserved for the worst cases, etc. How do we decide whether the gaps in the new system are different from the gaps in the old system?

    “b) provide more local democratic accountability…”

    OK, a few token councillors watching the private market swing into action?

    “c) curb the market obsession of the proposed reforms to prevent quality being relegated behind price….”

    So, it’s still going to be a market system but it’s not going to “obsess” about that fact? Then how will it actually work?

    “d) slow down the pace of change….”

    And that will make everything hunky-dory?

    Will Lib Dem pressure bring real changes? Or will it just get us past the local elections with less trouble, after which we will get the Lansley plan with a few meaningless sops thrown in?

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