LibLink: Richard Grayson – NHS reforms: Listen to your party, Nick, or the voters will punish you

Writing on Comment Is Free on Sunday, Professor Richard Grayson warns Liberal Democrats in government against ignoring the calls of party members to re-think elements of the planned NHS changes.

Here’s a sample of what he had to say:

If the Liberal Democrat leadership is wise (and they have said that they want to listen to the party), it will now act to the advantage of both the party and the NHS. Unless the leadership actually agrees with the reforms, why continue to support them now that they have such an opportunity to amend them significantly? The party leadership must tell the Conservatives that our MPs will not support the reforms unless there are major changes. David Cameron might even welcome the chance to backtrack.

Such an approach would not only be right for the NHS, although that must always be the most important consideration. It would also be publicly popular and might begin to transform the narrative about the role of Lib Dems in the coalition. The public could begin to see the party’s ministers as applying a brake to the worst excesses of Toryism.

This will mean changing how the leadership approaches coalition politics. Its view has been that if the public, fearing instability, becomes aware of coalition splits, they will reject this and all future coalitions out of hand. But there is just as much danger that the public equates coalitions with broken pledges, making voters hostile both to coalitions and the parties they believe have given up the most. Ask the Greens in the Republic of Ireland about what happens to such parties. In the UK, the NHS is just the issue to provoke an electoral backlash. Its place as a secular deity means the public will punish parties which undermine it. Equally, they will reward any party which defends vigorously the basic principles of the NHS.

You can read the piece in full here.

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26 Comments

  • Just as there is a duty for the leadership to listen to the activists, so too there is a duty for the activists to listen to the leadership. Much of what I’ve seen from activists at conference seems to be couched in terms that Ian Paisley would be proud of: “Never, never, never!” A little more thoughtful reflection and a little less shouting, please.

  • @Tabman

    Surely the whole point of having democratic structures internally in a party is so that pressure can (theoretically) come from the bottom up and not the top down.

    Now, I get your drift that maybe activists should be more pragmatic but surely it’s the wrong time to focus on that, given that the policy that ministers have the chance of scuppering is very ill thought out and would also be very beneficial to the Lib Dems to scupper.

  • DunKhan – “Now, I get your drift that maybe activists should be more pragmatic but surely it’s the wrong time to focus on that, given that the policy that ministers have the chance of scuppering is very ill thought out and would also be very beneficial to the Lib Dems to scupper.”

    I think more generally there is a blind spot int he party and the country about the NHS, and ANY change is characterised as “privatisation”.

    I am sure that there are elements of the proposed changes that need scrutiny and change, but the prevailing atmosphere seems to be one of no change at all (hint – just because interested parties oppose the changes does not necessarilly mean they are right).

    First and foremost as Liberals (i) we should keep an open mind about things and (ii) we should challenge vested interests on beahlf of the powerless, and I’m not seeing a lot of this in the NHS debate.

  • Leviticus18_23 17th Mar '11 - 1:27pm

    They’ll support whatever Cameron tells them to – sold out for AV.

  • Lee_Thacker 17th Mar '11 - 1:51pm

    These so-called reforms were not in either the Conservative or Liberal Democrat manifesto neither were they in the Coalition agreement.

    I am not opposed to new thinking in the NHS, but we should decide our own health policy and not be dictated to by the Tories.

    Thankfully, conference overwhelmingly supported the amendement .

    Richard Grayson is right – the party will die if we are just seen as part of the Conservative party.

  • I have been reading on this site recently very self-congratulatory posts about how the LibDems have weathered the tuition fee fiasco and broken pledges because people have stopped mentioning.

    I agree that there hasn’t been as much in the way of demos and publicity but I usually find that is normal when people have made their mind up on an issue and I believe the general public have now probably reached an immutable position on LibDem performance on the uni issue.

    But perhaps not given today’s figures released by the BBC and the continuing failure to provide details of the new scheme which should have been published 6 months ago.

    Still, what has gone before will count as nothing unless the LibDem Tory-leaning Parly leadership locate a backbone and tell the Tories they will be following party policy on the NHS. But you’d better get a move on as I believe there are some elections and an opportunity to vote NO in a referendum coming to a voting booth near you VERY VERY SOON.

  • “I have been reading on this site recently very self-congratulatory posts about how the LibDems have weathered the tuition fee fiasco and broken pledges because people have stopped mentioning.

    I agree that there hasn’t been as much in the way of demos and publicity but I usually find that is normal when people have made their mind up on an issue and I believe the general public have now probably reached an immutable position on LibDem performance on the uni issue.”

    Then again, the BBC has managed to work out that rich graduates will payback very much more than poor graduates:

    http://www.bbc.co.uk/news/education-12767850

    Which can’t, of course, be correct, because the nasty Lib Dems wouldn’t ever have managed to sneak something so progressive past their Tory masters, would they?

  • @ecojon – it really disappoints me that people will use the referendum as a “confidence” vote on the Government – that’s just plain stupid. Fair enough if you’d vote “no” anyway, but calling for a no vote to kick Clegg is just petty (much in the same way that Labour voted against the Maastricht treaty in the Commons in an attempt to remove John Major, despite the fact that they actually supported its content.)

  • @Lee_Thacker

    Yes and we also had Lynne Featherstone, Ed Davey, Susan Kramer, Vince Cable, Nick Clegg and many many more swearing that their local hospitals would remain in their entirety and be protected from ‘reform’ if only people voted Liberal Democrat.

    The senior Tories were even worse with their ‘guarantees’.

    I would actually go further about predictions of death surrounding the party, the party is dying and we are just seen as Tories by many now – it’s very very sad.

  • @Tabman

    ‘I think more generally there is a blind spot in the party and the country about the NHS, and ANY change is characterised as “privatisation”.

    I am sure that there are elements of the proposed changes that need scrutiny and change, but the prevailing atmosphere seems to be one of no change at all (hint – just because interested parties oppose the changes does not necessarilly mean they are right).’

    Were you fast asleep this time last year? I just ask because I seem to remember allsorts of members of the LibDem and Tory hierarchy campaigning outside district general hospitals, guaranteeing their preservation and survival for the price of a vote, claiming that the NHS would just be left in peace to get on with its job. I still have Tory literature regarding my local hospital – guaranteeing that voting for them was a vote for the NHS, Labours’ plans would be reversed etc, etc. Plus there was the Cable, Clegg, Davey, Kramer fronted ‘Save Kingston Hospital’ campaign.

    Therefore, I think that voters should reasonably expect the NHS to be left alone, not hit with the biggest change ever given that both parties were pledging to protect it, leave it alone. Now it’s likely to lead to much heavier involvement of the private sector and that’s just to begin with.

    Dr Charles Alessi, for example, leading light of the National Association of Primary Care (the small group of GPs who are supporting the government) and writer of a tabloid comment pieces backing the radical pro-market plans of the Conservative part of the coalition recommends that GPs sign-up to private US commissioning firms. Consequently, he was only too happy to see 500 jobs go at his Kingston Hospital because he claims they ‘overtreat patients’. He was treating himself to a champagne reception at No10 just recently praising Cameron and Lansley and offering more ideas – I really hope Clegg wasnt there (he campaigned for Kingston to be saved).

    You suggest we should all be a bit more liberal about ‘things’, however, I think you’re taking your ‘liberalism’ so far as to have your head firmly buried in the sand over this one. What’s more, I don’t know about you but I’m also a democrat, a social democrat so I agree that we should ‘challenge vested interests on behalf of the powerless’ although I think that’s exactly what we’re doing when we try to defend the NHS from unnaccountable private interests.

    I thought the party was fantastic at the weekend, showing it’s true colours regardless – I’m thinking of ending my membership holiday.

  • Quite. I don’t remember the ubiquituous Tabman complaining about that, or about the fact that the Coalition Agreement ruled out further reorganisation of the NHS.

  • You have to wonder at the kind of wisdom that thinks blaming Liberal Democrat activists for the Thatcherite NHS reforms is either going to work or not backfire spectacularly considering the May elections are just around the corner.

    The public don’t like these reforms one bit and it’s not the activists with the courage to speak out against them they are going to blame if they are not stopped.
    The same people who ignored and were apologists for the tuition fees debacle will have come up with far better excuses for supporting this Tory lunacy than it’s the activisits/delegates/Labours/doctors fault for not supporting Cameron’s every whim.
    The pro conservative spinners will also have to explain themselves after May since it’s blatantly obvious they will be the ones to blame for that.

  • @ Ecojon

    “I believe the general public have now probably reached an immutable position on LibDem performance on the uni issue”

    Perhaps they have until they see what Labour has to offer in the form of a graduate tax, which of course we will not hesitate to highlight at every opportunity. How fair precisely is an extra tax on graduates’ earnings with potentially no time limit?

    @ Frank

    “the party is dying and we are just seen as Tories by many now – it’s very very sad”

    NO the party is not dying and yes, we are being labelled as Tories and it is up to us to prove that we very definitely are not.

    It is up to Nick Clegg not just to listen on the NHS, but to ACT. If he doesn’t, he’s dead meat.

  • @KL

    I need no lessons from you on how to vote or even why I should vote in a certain way. My vote ergo my decision for my reasons. Democracy obviously means something different to some people on this site than it does to me.

    I have many reasons for voting NO and one of them is that I agree with Nick Clegg that it really is a miserable little compromise or words to that effect. I don’t do miserable little compromises or sordid deals with the Tories.

    When the LibDem Parly party no doubt votes 3-ways yet again but this time on the NHS the final result will be total oblivion.

    Therefore will the last member in Cowley Street switch the light off please and at least help save the planet if they are unable to save the NHS.

  • @RC

    The way things are going you may be right perhaps we’ll have the next LP Manifesto out with the details you require before this Coalition Govt actually produces the detail that was promised months ago on for the legislation they have already passed.

    There are some interesting variations in http://www.bbc.co.uk/news/education-12767850

    Of course we aren’t really in a position to come up with figures as accurate for students from a poorer background as we just don’t have the details I mentioned above.

    I have no intention of going over an old battlefield that is littered with the corpses of broken LibDem pledges and promises and dead dreams. The public will make their own mind up about the performance of the LibDems over tuition fees at the ballot box and I think it will be scathing.

    But hey if you think they love you just carry on being the Tory bagman – it certainly suits me and the LP 🙂

  • @R C

    Yes, sorry RC, I was being melodramatic and, yes you’re right, the party is very much alive as was seen at the weekend.

  • @Frank

    I thing the problem for the LibDems is if all that happens is that Ministers just listen to the Party and don’t actually carry out its will as expressed in resolution.

    I am pondering whether Burstow’s strange attack on Labour is going to be the Parly Party Leadership line when they don’t move the conference resolutions in the Commons but Labour does.

    I wonder if the party will still be alive if conference motions are ignored or have to be moved by Labour. Or should Labour not support LibDem resolutions in the House which would seem to be the Burstow position although I have to say I find his reasoning strangely naieve.

  • “We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.”

    Liberal Democrat/ Conservative Coalition Agreement May 2010 Crown Copyright

    NO SIGN OF THE ABOLITION OF PCTs THERE!

    “The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.

    Liberal Democrat/Conservative Coalition Agreement May 2010 Crown Copyright

    NO SIGN OF THE ABOLITION OF THE PCTS THERE!

    “We will stop the top-down reorganisations of the NHS that have got in the way of patient care”

    NO SIGN OF A ROOT AND BRANCH REORGANISATION THERE!

    “We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.”

    LibearlDemocrat/Conservative Coalition Agreement May 2010 Crown Copyright

    ONLY A PARTIAL ROLE FOR GP COMMISSIONING THERE!

    I am frequently hearing from the usual propaganda sources that Andrew Lansley is so ‘knowledgeable’ about the NHS and has been preparing his lunatic reforms for years when he was in opposition as Shadow Health Secretary. Yet as the relevant paragraphs from the coalition agreement above show, there was no intention that the PCTs should be abolished rather, the intention was to strengthen them, and there was certainly no expressed intention to make GPs entirely responsible for commissioning, indeed, the PCTs were to remain in order to commission those services that were best undertaken at a wider level. These paragraphs show that the true scale of the Tory reforms were not presented to the Liberal Democrats and therefore do not constitute part of the agreeement between them and the Tories. The Tories pulled the wool over your eyes, Lib Dems, so why do you and your MPs feel you have to go along with them? If this was a commercial contract the Tories would be in clear breach of it if only because it was agreed between you to retain PCTs and you could walk away from it. So go on. Show some spine and tell the Tories NO!

  • @MacK

    You know when you see it all spelt-out like that it is so frightening it’s untrue. Never mind the absence of legality in what is happening – where is the morality or Democracy?

    And yet the right-wing LibDems see nothing wrong with what is going on. They kept their head down it would appear at conference to go away and regroup and have private discussions on how to subvert conference policy and keep supporting the Tory line.

    I just don’t understand Burstow’s attack on Labour on this one – I would do a deal with the devil to stop the Tories getting away with this naked dismantling of the NHS so it can be privatised to bring profits to shareholders.

    There is always efficiencies that can be made in the NHS as well as improvments although often the improvements mean additional costs beyond the efficiency savings and that has got to be recognised.

    But what is going on is criminal with not even a figleaf of a manadate from the public – why are LibDem MPs supporting this?

  • @ecojon

    I couldn’t agree more. I emphasised the legality of the Coalition Agreement to encourage pusillanimous Lib Dem MPs that they have a very strong case for walking away from the NHS reforms. But the actual democratic case against the reforms and the agreement itself is far stronger. The coalition agreement was never voted on by the British electorate. Parts of it were then abandoned or changed beyond recognition again without it being submitted it to the electorate for a vote. Hence the outrage about the privatisation of the NHS. At times I feel that this is a coalition that even Gadafi would feel comfortable being in. If Gordon Brown and Labour were doing all this to the British people just think what the Tories and the Lib Dems would have to say.

  • “but health care isn’t like choosing a supermarket or a pair of shoes. I believe that choice has a place in the NHS, but I don’t subscribe to the false idea that choice will solve all its problems. When you have a heart attack or a serious accident, and are rushed to hospital, no one wants to know that they could have had the choice of a hospital fifty miles away with better funding and better equipment. What people want is their own local hospital well-funded, well staffed
    and well-equipped to give them the best possible chance to survive and recover.”

    not my words… any one know who said them?

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