Writing in today’s Observer, Liberal Democrat peer Shirley Williams says:
As the passage of the Health and Social Care Bill has ground on, the doubts and questions that accompany it have become ever more difficult to address. This is a bill that has been subjected to a listening exercise, extensive consultation and a report by Steve Field, chairman of the Future Forum, redrafting by Parliament, more than 100 hours of debate, and dedicated efforts by the deputy prime minister, Nick Clegg, and the Liberal Democrat minister of state for social care, Paul Burstow, to amend it to meet the worries Lib Dems expressed at their conference last spring.
Now that 38 Degrees, a group of concerned citizens, has sought the advice of leading lawyers, the confusion thickens further. The central issue is whether, if the bill is passed without further amendment, there will be any legal duty on the secretary of state for health, Andrew Lansley, to provide and secure a comprehensive health service for the people of England, free at the point of need – the heart of what the NHS is all about…
More than £80bn pounds of taxpayers’ money is poured into the NHS every year. Taxpayers have been willing to pay for a service most of them deeply care about and find satisfactory. But they expect the government, the minister and, ultimately, Parliament itself to be held accountable for the delivery and quality of the services for which they pay. Mr Lansley is right to want greater freedom for doctors to work with their patients and to restrain political interference in the NHS. But to throw out accountability in order to tackle petty interference is to undermine democracy itself.
You can read Shirley’s piece in full here.
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10 Comments
I just hope all Liberal Democrat MPs will listen to Shirley Williams and vote against the creeping privatisation of the NHS that the bill is intended to pave the way for. It is clear that the Conservatives want to privatise the NHS, just as they want to privatise everything, but know that this would be very unpopular, so don’t dare to put it forward directly as a policy.
I’m sorry to say this but Shirley is wrong on this one. I am a Non Executive Director on a PCT and there is virtually no accountability at the local level. Abolition of PCTs and SHAs will not improve or worsen the situation but the moving of public health to local authorities and the new Health and Well being boards will. The current system is bulky, unresponsive and doesn’t control secondary care spending effectively. My only concern is that the move actually centralises a lot of commissioning through putting them under the auspices of the National Commissioning Board. Don’t be surprised if the DH actually achieves more centralisation and bureaucracy by these moves. It is ever thus with central government departments.
@David
Are you aware that the most popular and respected part of the NHS, GPs are already private contractors.?Do you wish them to become civil servants?
I agree with Shirley. This bill is a complete monstrosity, for reasons including but not limited to what she has pointed out. I don’t think that PCTs are particularly accountable, incidentally, but I can’t see the new planned system being anything but less accountable.
I truly hope that our MPs kill this bill, and although it would be wishful thinking to say that they will do so, I do believe that many of our MPs and Lords believe that not enough has been done to make these proposals acceptable and that their using their “nuclear option” is not out of the question.
Simon McGrath has a point. Privatisation of GP practices is arguably tolerable because oversight by public bodies like the PCTs has acted to keep watch on the public purse. But in the proposed new system, privatised GPs will spend public money on privatised hospital services. This is a standing invitation to introduce conniving, corruption, and the misuse of public funds.
The end of the NHS as we know it is an issue which dwarfs tuition fees. As most of the grass roots know, it is the litmus test for this party’s claim to have rediscovered its independence and spirit.
Those who concentrate on administrative efficiency are largely missing the point. Of course the present system is imperfect. All large complex organisations, whether public or private sector, are imperfect in terms of efficiency. Before the election, it seemed to be agreed by all that a period of quiet steady development, rather than the continuous quasi-Maoist permanent revolution of the past twenty years, was going to be the best way to improve a National Health Service which, for all its failings, was more cost-effective than many other national systems. The Tories are not genuinely seeking efficiency when they privatise. They are seeking money-making opportunities for their friends.
A few months ago, Shirley Williams and Evan Harris thought that tweaks and compromises would be enough to stamp Lib Dem influence on the Coalition proposals and create a much less damaging reform. It is very much to their credit that they have looked at the evidence, seen the disgraceful back-stage manoevering of the McKinseys and their like, and concluded that they were too optimistic. Will the rest of the Lib Dems have the courage to stand alongside them?
It could come to an election, of course. It would be a “Thus far and no further” election, at which the Lib Dems could hold their heads high.
Alternatively, our MPs could cop out, draw their salaries for three more lucrative years, and then go off and get slaughtered in 2015. What a choice!
I am a Non Executive Director on a PCT and there is virtually no accountability at the local level. Abolition of PCTs and SHAs will not improve or worsen the situation but the moving of public health to local authorities and the new Health and Well being boards will.
But the PCT Boards meet in public and have to publish their minutes and commissioning strategies, and in that sense they ware accountable. It won’t be the local authorities who take over this role, but the
GPoops! Clinical-led Consortia. They are the people who will be deciding whether to commission services within the NHS or to privatise healthcare by offering the juicy bits to the profit-driven private sector. Will they meet in public? And how transparent will their commissioning processes be? Where Clinical-led Consortia are commissioning services from their own GP practices… just how transparent will they be.I loath Shirley Williams, and very much doubt she will see this through, but on this occasion, I wish her well.
If all LibDems were like Shirley Williams then the NHS would be safe, and LibDems would be on 30% in the polls. As things stand it is not and they are not. Both are facing total change. The NHS is facing privatisation, and the LlbDems’ oblivion. The two outcomes are very very closely linked, but most LibDems just don’t seem to ‘get it’ or even care.
@Neil Bradbury.
“I am a Non Executive Director on a PCT and there is virtually no accountability at the local level. Abolition of PCTs and SHAs will not improve or worsen the situation but the moving of public health to local authorities and the new Health and Well being boards will.”
How short are Lib Dem memories! The Coalition agreement states: “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.” Crown Copyright, Liberal Democrat and Conservative Coalition Agreement, May 2010.
Why didn’t the Lib Dems insist on implementing the above if accountability was the real issue? Why did they cave in to Tory demands for the abolition of the PCTs? No, even as this paragraph of your Molotov-Ribbentrop pact was being agreed upon the Tory wolves were licking their lips at their secret plans to privatise the whole service which, of course, they had no intention of telling you about and which Lansley had been secretly planning for years! How can you go on supporting these people? Heed Shirley Williams’ words or you will go down in history as the party that colluded with the Tories to destroy the NHS. If your MPs and Peers have any integrity they will vote with Labour to kill this bill.
Can someone provide a potted summary of what the current proposals amount to, without political rhetoric or value judgements, please? I have searched the websites of the Guardian, the Independent, the Telegraph, the Mail, the BBC, LDV, LabourList and ConservativeHome, but all to no avail, just sonorous editorials, opinion pieces, everything written has a heavy political hand. No facts. I have neither the time nor the expertise to delve through hundreds of pages of the Bill, amendments and technical papers. Surely there is a straightforward laymans guide somewhere? Can anyone help?
@Paul McKeown
This link will lead you to the Legal Advice 38 Degrees received about the revised bill: https://secure.38degrees.org.uk/nhs-legal-advice