Lib Dem Voice has polled our members-only forum to discover what Lib Dem members think of various political issues, the Coalition, and the performance of key party figures. Some 570 party members responded, and we’re publishing the full results.
LDV asked: The Health and Social Care Bill which will implement radical reforms to the NHS was passed by MPs last September. From what you have seen or heard about the Coalition’s plans for the NHS, do you support or oppose them?
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25% – Support
49% – Oppose
26% – Don’t know / No opinion
So, by a two-to-one margin, Lib Dem members in our survey are opposed to the Coalition’s NHS reforms. This is a significant shift in opinion against the Bill since last we asked the question — in September we recorded a slimmer margin of opposition, 43% to 37%. More than a quarter of party members are unsure.
Quite simply, the Coalition has failed to persuade Lib Dem members of the merits of the the NHS reforms (in stark contrast to the also-controversial benefits cap) — so small wonder that the wider public are also unconvinced.
Here’s a sample of your comments:
I back the changes. They’re not perfect but if the BMA is against it it’s usually a sign that it’s a good idea. We need to break up vested interests in the NHS.
The bill appears to accomplish very little. Most of the good and bad parts have been watered down to the point where it is unlikely to change things much.
I chose support, although weakly so. I think the timing of such reforms is wrong. I do not fundamentally object to the private sector having a larger role to play in healthcare provision so long as it is free at the point of need and that the key criterion used is quality rather than cost when care is provided.
PCTs were an inefficient layer of management bureaucracy too far removed from patients. Support for those procuring will be required though to ensure they are equipped with the skills necessary to achieve value for money in obtaining supplies and services.
In general, decent to good ideas that have been lost in a sea of mud-slinging and political vitriol.
We said we wouldn’t reorganise the NHS. What matters is service, not structure. Deeply concerned that there has been an attempt to open the NHS to more private provision.
Mixed feelings. I do not feel that the case for change has been clearly made but the opposition does not seem soundly based either.
Now is not the time to be doing something so overarching. Some bits of the reforms are very good but it’s simply too complex to do whilst abiding by spending constraints.
Of course I support the idea of decentralising decision making. Objection that I’m aware of seems to just be along the lines of “private companies are evil”. As long as a good standard of care is present and the service remains free at the point of need I’m not fussed about who is providing the care. There may be an argument for not doing this at a time of budgetary restraint but I understand why now and not later.
Reforms should be deferred. Reducing the deficit is the top priority & reforms at this stage interfere with that.
With GP commissioning no provider/purchaser split. Will introduce private companies who will when suits undermine local hospitals. Commissioning will create more organisations/bloated bureaucracy than previously. So where are the savings no wonder so many hospitals now facing having to make huge savings/reductions in services. My local hospital now having to find £37million and other local acute hospital/trust mergers to take place to save £237million. What a farce!
I think the whole thing has become such a mess it shld be scrapped. Don’t think there was need anyway for the use of legislation in this way. Changes cld have been effected without it.
The more I understand about this Bill, the less I like it. I am a competition lawyer and I dread to think what the impact of competition will be on the NHS. I suspect that only people like myself will be the winners.
There are many things that could be done to reduce costs in the NHS. Changing the whole structure is not in my view one of them.
Efficiences, yes; reconfiguration, yes; clinical commissioning; yes. This could all have been achieved through much less disruptive reforms, and without giving it all the sheen of privatisation.
I want our manifesto commitments to be implemented – more choice, local accountability – and the HSC bill does neither.
* Stephen was Editor (and Co-Editor) of Liberal Democrat Voice from 2007 to 2015, and writes at The Collected Stephen Tall.
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12 Comments
I guess you can put most of us ex-members in the oppose camp as well. Some of us might just consider voting for you again if you bring the government down over this.
Agreed solip1, I voted lib dem 2001-2010, and never will again if they allow this bill to pass.
You do realise that the result of such an action would be to hand the Tories a majority, and they would reintroduce the bill as a full privatisation measure with most of the changes taken out? Is that what you’re saying you want to vote for?
Andrew Suffield…
So the choice, as you see it, is to either vote for the ‘certainty’ of a piecemeal destruction of the NHS, starting immediately, or the ‘possibility’ of a future ‘possible’ Tory government acting in a more destructive manner….Hmmm not much of a choice.
Given as you accept that the Tory aim is for “a full privatisation’ whyever would a LibDem vote in favour of allowing the ‘reforms’ which, step by step, will mean an irreversable slide into privatisation?….
Yesterday’s Guardian had for once, a reasonably argued editorial “Health and social care bill: A dismal alternative to real reform”. This bill is frankly a misnomer. It goes nowhere to fulfill the integration of Health and Social Care it claims. When I first read the white paper upon which it is supposedly based, having spent most of the last twenty years campaigning against the various “privatisation” initiatives of both the Tory and Labour government’s, I saw it for what it is and remains, the introduction of a fully market based Health Care system. Whether a USA or a European model is not really the argument and I really don’t want to start waving the shrouds or indulging in the shorthand privatisation mantras. It really is not the point.
The NHS is never perfect and always needs improving and refining as new needs and technologies emerge. It has survived multiple tinkering by various politicians over the year. The outrageous talking down of the service by the Tory press and politicians, when for all it’s faults it is the most cost effective when compared in GDP terms for outcomes and the latest Patient satisfaction survey (which Lansley cancelled the funding for remember and it was rescued by charitable funding) is a disgrace. This bill is not a meaningful contribution to that process.
I have re-read our manifesto on health and this bill does not fit it’s aspirations in my humble opinion. The “listening” phase as a result of the Lib Dem conference motion last year, was not really that and the Bill remains seriously flawed.
The final straw for me is the latest claim from Lansley, that so much has been implemented that it really now cannot be stopped is frankly unacceptable. There is always a certain amount that any government can do to facilitate the implementation of a proposed bill – but to claim so much has already been implemented (before Royal Assent) that we may as well pass the bill anyway is, well, intellectually bankrupt is the most polite way I can express it.
It has been reported that Nick has agreed that the bill must be forced through. I hope he and the rest of the PLDP will take some note of this polling result from the Lib Dem activist base and call a halt to this travesty now. In saying this I am not suggesting that the party flounces out of the coalition, after all in truth, this measure is not in the coalition agreement.
As Dave Eastham says above, the scope of these reforms was not in the coalition agreement. We don’t have to “bring the government down” in order to stop this, we are perfectly within our rights to refuse to vote it through.
I have supported the coalition from the start, I think most of our ministers have done a good job in government and I while I’m not thrilled about a lot of what we have agreed to support I think we have got a fair deal in relation to the relative democratic ensorsements the two coalition parties received at the election. On top of that, I have a lot of admiration for Nick Clegg and would vote for him as leader again (as I did the first time).
So basically I’m not one of the usual suspects when it comes to moaning about the compromises of coalition and how lovely and pure it was before we got involved in this nasty, messy government business. BUT I have to say that this bill is approaching a red line issue for me and I will be hugely disappointed if Nick decides to force it through. Combined with last week’s reduction of benefits for disabled people (and the gratuitously nasty accompanying rhetoric, admittedly from the Tory minister but unchallenged from our side), I am questioning my party allegiance for the first time.
Andrew
I think it highly unlikely that if we did pull our support for this bill, that a The Tories would make it an excuse for a GE, and b if they did, they would not lose substantially. One thing Tories DO NOT want, ever, is to fight a GE on the NHS! Can you just imagine the leaflets, from us, as well as Labour, of course. “Cameron promised the NHS was safe – we saved it from his ravages” etc.
A pity Chris Huhne isn’t still there in Cabinet. I’m not sure any of our remaining four will have the guts to wield the axe. I an glad you are changing your opinion, Catherine.
Perhaps a large enough group of our MPs will say they’ve had enough (together with Dr Sarah Wollaston and several more sensible Tories) and vote the whole thing out.
As far as I can make out, your argument is “any change to the NHS is accepting the principle that the NHS could be changed which might lead to privatisation!”, which I reject on the grounds that it is silly. The current bill in no way relates to privatisation of the NHS – that’s one thing which it definitely does not do, and explicitly prohibits.
They’d be fighting it on Labour’s economic incompetence and LDs unwillingness to govern. They would promise anything they liked regarding the NHS, and those promises would last maybe for the whole first year of their government.
Andrew Suffield… Posted 9th February 2012 at 6:24 pm ………As far as I can make out, your argument is “any change to the NHS is accepting the principle that the NHS could be changed which might lead to privatisation!”, which I reject on the grounds that it is silly. The current bill in no way relates to privatisation of the NHS – that’s one thing which it definitely does not do, and explicitly prohibits………..
That is not my argument; no organisation is so perfect that any change is inconceivable.. However, how anyone can accept this’reform’ as anything other than ideological, is beyond me. Cameron, explicitly, promised, “No top-down reorganisation of the NHS” and now we know this was a major part of his thinking.; to our everlasting shame our leaders initially wholeheartedly supported the ‘unmodified’ version until our disasterous local election results.
As far as ‘explicitly ruling out any move towards privatisation’…..The proposed changes will hand over control of most of the health service budget to groups of GPs, who will buy services from the private sector, competing with NHS hospitals….. When the BMA committee chairman (who, presumably knows what he is talking about) states…”We will quite quickly see parts of the NHS bought up on the cheap by foreign companies and see bits of the NHS run from abroad. This really is just the beginning. Parts of this government want to see all NHS management in private hands”, one should tread carefully..
One should always remember that Osborne and Cameron have an, unshakeable, ideological belief that “Public = Bad….Private = Good””
Excuses, excuses and more excuses…
Change one word and the above line would rhyme with Mark Twain’s lament and be more apt. The NHS “reforms” have never been about efficiency or better patient care. It has always been about privatisation and creating unnecessary activity so that the government of the day appears to be “efficient”.
Public Finance Initiative, Patients Choice, NHS Reform, Liberating the NHS, Financial Prudence…they are all hollow words and banners which serves no one but their political masters.
Even way back in 2007, industrialised countries like the United States of America were already looking at the NHS as a prime example of a extremely efficient, well organised and fully integrated healthcare system which they could learn from.
Despite only costing 1/3rd of the US healthcare system in 2006 per capita and 1/7th of the total health care cost, the gross health indicators of life expectancy and infant mortality per 1000 are still better in the UK.
This is not withstanding the fact that up to 47 million Americans have no healthcare insurance and over another 10 million have insufficient insurance coverage for their needs.
In 2005, the total US healthcare costs about USD $2 Trillion dollars, rising to USD $2.5 Trillion in 2009 and still rising.
About half of this comes from federal funding for health, 35% from healthcare insurance and the rest is out of pocket from individuals.
Imagine this, the out-of pocket health care spending by Americans in 2005 would be sufficient to fund the total NHS budget for the year 2010 of about £100 billion. This includes Acute, Primary, Secondary and follow-up care in the community in the UK, from cradle to grave.
Despite the significant higher costs incurred in the US, they have insufficient Primary physicians and comprehensive electronic healthcare record systems are only 1/3rd of what is available in the UK. Furthermore, the NHS is able to finely tune the supply and training of not only medical students but also GPs and Consultants, something which the Americans are unable to do and continues to struggle with.
It is completely ludicrous to hear the likes of David Cameron and Andrew Langsley repeating their drunken mantra and self-deluding belief that they are actually doing something good for the NHS and the people of UK with their senseless blunderbuss misguided good intentions.
All the above figures are from a position paper released by the American College of Physician in the Annals of Internal Medicine Journal in 2008, serendipitously entitled:
“Achieving a High-Performance Health Care System with Universal Access”.
Please see “Two Ships Passing in the Night” at opennhs dot org for more details and how to download his paper. It is essential reading for all stakeholders in the NHS, Doctors, Surgeons, Nurses, Patients and Politicians alike.
Many of us fail to see how the NHS reform bill can make the NHS any better, and the politicians needs to be stopped from proceeding with their folly.
It is not about pensions. It is not even about the 5 year pay freeze that the healthcare professionals in the NHS have to endure. It has always been and always will be about fighting for our patients and putting them and their best interest first.
In addition, the privatisation process will adversely affect future training and retention of all healthcare professionals (doctors, surgeons and nurses included) in the public service where it matters and is needed most.
As health professionals, we know better than the politicians, and it is time for us to stand up and speak out before it is too late.
Of course the NHS can be improved.
But we must stop the politicians in their short-sighted ignorance and haste from throwing out the baby with the bathwater first, before we can even start to think about improving the service and care to our patients.
I leave you with these inspiring words by Mr Bevan, written over half a century ago:
“Since this chapter was written, new legislation on the National Health Service has been announced. It confirms our worst fears. If they are carried out the proposals will mutilate the Service in many of its most important activities.
There is, however, ample evidence that the British people are reacting sharply against them. This sustains my contention that no Government that attempts to destroy the Health Service can hope to command the support of the British people.
The great argument about priorities is joined and from it a Free Health Service is bound to emerge triumphant.”
(Excerpts from Bevan, A. 1952. “A Free Health Service”. In “In Place of Fear”: 77-97)