NHS bill: Nick Clegg outlines changes aimed at Lib Dems

BBC News reports:

Nick Clegg has set out changes to the NHS reforms which he says should mean the bill can be passed into law.

In a letter co-signed by Lib Dem peer Baroness Williams, the deputy prime minister sets out amendments he wants to see which would limit competition and the role of the private sector.

Downing Street said they were “not significant amendments – they are areas where reassurance is required”.

…Mr Clegg said he supported five “final” changes to the bill which aims to give GPs control of much of the NHS budget and would open up the health service to greater competition from the private and voluntary sector.

The changes suggested are:

-Reducing the remit of the Competition Commission
-Watchdog Monitor to require Foundation Trusts to put patients’ interests first
-Insulating the NHS from the full force of competition law to prevent private takeovers of hospitals
-Members of new care commissioning groups to have to declare financial interests
-Foundation Trusts required to get permission from their governors before carrying out extra private work.

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  • On the 13th February 2012 Baroness Williams suggested a compromise [by]….. “dropping the chapter on competition, and retaining Monitor as the regulator of prices and of the foundation trusts.” I agreed with her. She appears to have found a good reason to change her mind.

  • Clegg should have his own summit, invite those Cameron shunned and see whether these changes will bring the Royal Colleges back on side. In whatever guise it finally gets to, supporting a Bill aimed so squarely at giving GP’s the power to manage a huge amount of the NHS budget without the backing of the majority of GP’s is just stupid.

    Whilst Cameron has been happy to discount them, Clegg should have publicly built bridges with Doctors leaders. I’m not sure such a poll has ever been carried out, but I imagine most people in this Country trust our GP’s more than we trust our MP’s.

    Without GP’s support this Bill will fail in implementation to some degree and that will be pounced on by Labour. The Tories will say if the Lib Dems didn’t make us change it blah blah blah.

    Another Coalition Bill that can benefit only the other two parties.

  • Tony Greaves 27th Feb '12 - 8:01pm

    These changes are not really from Nick Clegg, they are the result of intensive work and discussions over the past weeks by the LD team in the Lords led by Judith Jolly who have – in the context of making the Bill tolerable – done a brilliant job.

    The problem of course is “tolerable to who”? Politically it is a disaster which is why the LDs should have forced Cameron to drop it (and Lansley with it). I fear that LDs will get the worst of all worlds – all the hard work and none of the credit. Indeed all the blame when things go wrong.

    Tony Greaves

  • Passing the bill is political suicide.

    Unfortunately it will also ruin just about the best thing about living in Britain.

    Read the bill – it is awful and pointless

  • As a fan of an amended bill, I worry about the competition “opt-out”. Dropping section 3 as shirl originally suggested would have been cleaner. Now the taxpayer will be lumbered absolutely with the bill to bail out failed or bankrupt hospitals rather than allowing other companies to help.

  • Richard Dean 27th Feb '12 - 11:59pm

    It looks like resistance is futile! Part of the problem seems to be that few outsiders understand what is being proposed. I am one of those outsiders – keenly interested, not to well informed, not too well able to make judgements, but able to spot a biassed or distorted argument with my eyes and ears shut. Here is part of what the Telegraph says:

    Under the Bill, no single person and no single organisation will be responsible for meeting all the health care needs of all the people living in England or specifying the services to which they are entitled. A number of different bodies will have the power to determine the health care you can receive through the NHS

    My questions, naive and ignorant as they might be, are (

    1) Why do people think this is a bad thing? There are many different types of NHS service, maybe too much for one single person to be responsible for, and
    (2) is is true? : Here are the titles of the first few clauses of the bill that can be downloaded from http://www.parliament.gov.uk :

    1 Secretary of State’s duty to promote comprehensive health service
    2 The Secretary of State’s duty as to improvement in quality of services
    3 The Secretary of State’s duty as to reducing inequalities
    4 The Secretary of State’s duty as to promoting autonomy
    5 The Secretary of State’s duty as to research
    6 The Secretary of State’s duty as to education and training
    7 Secretary of State’s duty as to promoting equality of provision

    So it looks like the Telegraph is lying. The Secretary of state seems to be actually be the person, under the Bill, who will be ultimately responsible and accountable for quite a lot.

    Thanks for clear and honest answers. No thanks for anyone providing more lies

  • Tony Dawson 28th Feb '12 - 7:42am


    Passing the bill is political suicide.”

    Plus ca change. Could we even outdo tuition fees?

    There is still time for the Lib Dems to get together with major Doctors’ leaders and salvage our NHS. This does NOT require the NHS Bill to be passed.

    The proposals as they now stand could have been brought forwards within months of the Lib Dems’ Liverpool conference in 2010. The Lib Dem members being consulted at the time said it all. Who listened?

    Giving this Bill artificial respiration t the last moment is not exactly the best move, politically. Do we really want to save lansley’s political life that much?

  • Jayne Mansfield 28th Feb '12 - 8:49am

    I ‘would be wary of taking ‘reassurances from a man who promised there would be ‘no top down reorganisation of the NHS’ when his Health secretary had been working on the biggest reorganisation of the NHS since its inception.

    I would also be wary of taking ‘reassurances’ from a man who according to the Guardian stated that’ Let me make it clear, there will be no privatisation of the NHS’ when the guardian disclosed in the same article, details of e-mails involving senior health officials about handing management of up to 20 NHS hospitals to international private companies.

    (‘Shirley Williams plunges NHS Reform into fresh turmoil’ The Guardian, Sept 2011.

    Today’s guardian main article on the reforms provide a link.

    The whole NHS and Social Care Bill is descending into farce with politicians demonstrating unedifying and unprincipled face- saving manoeuvres that have nothing to do with improving the NHS or reforming it to face the challenges of an ageing population and ever more expensive treatments. .

  • Not good enough by any stretch of the imagination.

    Shirley Williams’ stated aim of scrapping section 3 was a step in the right direction and a compromise I might have grudgingly accepted. The Clegg- Williams letter is a compromise of a compromise, leaving us with a fudge too far.

    The only sane thing to do now is for conference to vote to scrap the bill.

  • Martin Pierce 28th Feb '12 - 9:23am

    On this one, I wholeheartedly agree with Tony Greaves. The really scary thing for me was in reading the changes that have been proposed, that these things are still in the Bill as of today. So Foundation Trusts AREN’T required to put patients first in the current bill? Private takeovers of hospitals CAN happen in the current bill? Members of care commissioning groups DON’T have to declare financial interests in the current bill? The Competition Commission STILL has a role in the current bill? Only LD Party activists’ efforts seem to have stiffened Clegg and the leadership on this Bill all the way through (don’t forget he co-signed the Forward to the original version). I suggest the message we should take from this latest move is that ‘one more heave’ in Newcastle just might kill it.

  • Richard Dean 28th Feb '12 - 9:59am

    So, no-one is actually criticising the bill itself. Instead, everyone is criticising what someone else has written that is not in the bill! How pathetic.

  • This is heading ominously for exactly the same outcome as tuition fees – while Rome burns Clegg fiddles.

    I forsee only one outcome – in a couple of years time there will be all sorts of scandals involving the private sector’s relationship with the NHS. The Lib Dems will be blamed by the electorate (unfairly, but that’s politics) and they will suffer at the ballot box – no amount of self justifying about the need to keep the coalition afloat will suffice, in exactly the same way that the arguments about tuition fees were drowned out by the gut feel that people had been betrayed.

    The party is once again behaving as if rationale debate will always win the day when larger forces are at work. What exactly is the party’s gain from continuing to support this?

  • Sometimes bad luck, unfortunate timing or plain human errors can rebound on a political party. If the Lib Dems suffer electorally due to the NHS Bill (I have little doubt about this), none of aformentioned can be blamed. Experienced LibDem politicians are pushing through a huge institutional change that is unwanted and unpopular with the electorate, and for which their is no democratic mandate. This is the biggest example of electoral self-harm since Michael Foot almost destroyed Labour. I am being as kind as I can be!

  • I understand going into a coalition to prevent economic meltdown.
    I don’t believe we went into a coalition to engage in gratuitous t**d polishing.
    This bill is going to end badly – noone has a big enough shovel to dig us out of the mess it will create if it passes.
    Kill it – move on.

  • @Simon Not sure how pulling the health bill damages the coalition. Arguably Cameron would appreciate a guilt-free way out and I can’t see it as anything other than a win for us politically or public perception wise.

  • Richard Dean 28th Feb '12 - 5:24pm

    Apologies for going a bit over the top again in my last comment.

    I’m trying to get across the view that we should be discussing, or arguing about, what is actually being proposed in the bill, not about what is not in the bill but in someone’s agenda’d argument for or against it. In the case of the Telegraoh article, it looks like the writer didn’t do the relevant research, but repeated a biassed and incorrect view which has now ended up scaring everyone un-necessarily. I imagine the Guardian and other papers are not much better.

  • Billy Wright 28th Feb '12 - 6:04pm

    @Richard Dean

    Say what you feel as soon we will not only be associated with the birth of the NHS but also the death of it.

    You will also notice that the more ‘prominent’ libdem voice activists do their best steer clear from this subject which is much to their shame.

  • David Allen 28th Feb '12 - 9:02pm

    It’s sad to see Clegg leaning on Shirley Williams in an attempt to boost his credibility. When “Downing Street” say that the last-minute changes sought by Clegg are only window-dressing, for once I’m inclined to believe it.

    How can one think what it must feel like to be an eighty-year-old famous politician, sharp as ever despite the passing of the years, but bereft of so many old colleagues, and ironically, facing greater challenges and responsibilities than ever? Perhaps that leaves you strong enough to work behind the scenes constructively, not strong enough to rebel in the way that is really needed?

  • Clive Sneddon 29th Feb '12 - 12:21am

    I can believe Tony Greaves that the Lib Dem team in the Lords has made the best possible job of amending the Health Bill to protect the NHS and the British public from the consequences spelled out by Max Pemberton in the Daily Telegraph. I can believe that Shirley’s idea of deleting the Competition section altogether is impractical if there needs to be a vehicle to get rid of what Labour introduced in 2006.

    What I can’t believe is that there is still no positive narrative from the leadership setting out what we intend the Bill to contain when complete, and how it will ensure local decision making through empowered citizens, public health officers, doctors, and providers of housing and social care. I suspect this is because Nick is only able to push Lansley and Cameron one step at a time. The five points listed by Nick and Shirley are substantive changes to the Bill, so ‘window dressing’ is Cameron’s way of concealing the fact he previously said the Bill would not change further.

    However, we still need a convincing narrative if we are to be certain we have done the right thing and to persuade the public. If the Bill itself only delivers a client role given to private interests, and that is its current narrative in the media, then supporting it will never be justified. I am still reluctant to reach the conclusion that the Bill must be voted down in the Commons, because the vision of locally driven health care is a good thing, but if this vision cannot be realised then the only thing left is to vote it down. We have a lot to discuss at Conference if, as we were told a few hours ago, it is no longer possible for the Bill to complete all its stages before Gateshead.

  • Jayne Mansfield 29th Feb '12 - 6:36am

    I cannot comprehend your support for the bill, Richard Dean.

    The government had no mandate for the destruction of the NHS as we know it.

    Today’s Guardian has Dr Sam Everington chair of a Clinical Commissioning Group in Tower Hamlets arguing for the bill to be dropped . What possible agenda could he have?

    He argues that the involvement of GP’s such as himself in such groups should not be interpreted as support for the bill.

    It has been argued from the beginning that a bill was not necessary to achieve the stated aims of the government., the government being the Tories and the Lib Dems.

  • Jayne Mansfield 29th Feb '12 - 7:32am

    Could someone also tell me whether it is true and Tory ministers helped to write Shirley Williams and Nick Clegg’s letter on the NHS and Social Care Bill?

    Also, why is the bill not being debated when the e-petition has received well over 100,000 signatures?

    It seems increasingly clear that only direct action will be the way in which we save our democracy against a government that will not listen

    Lansley has the front to explain away the lack of support from Dr Everington by saying that he and the CCG do not understand the reforms.

  • Jayne – you ask “why is the bill not being debated” but it is being debated – in the House of Lords this week and then subsequently back to the House of Commons.

  • Jayne Mansfield 29th Feb '12 - 9:12am

    Dr Pack,
    I signed an e=petition so that this bll was given time for debate in the House of Commons not the House of Lords which I consider to be an unrepresentative chamber.

    Caroline Lucas has stated that she has received 800 e-mails on thie NHS bill in the last week alone. She agrees that the bill is of such importance, a full debate should be held around the issue of the bill being dropped, not ‘amended’.

    Those of us who signed the petition signed a petition for the bill to be dropped not amended.

    It seems Lib Dem MP John Hemmings supports the Backbench Business Committee which could not get a Tory to support the debate I and others want. He is reported as saying that giving time to this bill will mean less time to discuss other issues.

    Does he not realise that this is the most important issue of the day?

    As someone whose only direct political actions of the past has been to boycott Nestle products, I feel disillusioned by our so called democracy.

    I, nor anyone else voted for this NHS reorganisation that can be ‘seen from Mars’.

    As a consumer,I have a vested interest in the NHS. The NHS had the highest satisfaction rates since its inception. Every research paper I have read has found that it was an efficient organisation.Apart from minor niggles, the occasional cancelled appointment etc, I have nothing but praise for the NHS based on my personal experiences.

    I am not against reform, what is proposed is not reform, that could have been done without this costly bill.

    How can we ever trust politicians again when the current government were voted in on the basis of what many would argue was a blatent lie?

  • @Mark Pack. OK so the Lords are doing some tinkering around the edges of this Bill. BUT this is not what (I believe) the majority of LibDems (and the electorate) want, which is for the Liberal Democrats to withdraw support for this Bill. I do understand that such a move would have unpredictable consequences – perhaps a general election. And why not have an election? To have an general election to determine the future of our NHS would be excellent. Let the people have their say about “no top-down reorganisation”.

  • We were specifically promised no top down reorganization of the NHS. What changed? Lansley has in theory been planning these reforms for many years. Why weren’t the Tories honest enough to put these plans before the electorate at the General election? Why are all the Tory MPs with healthcare backgrounds kept well away from these reforms? How are these reforms going to save money when we are told competition will be on quality not price? Where are the successful large scale trials that demonstrate these changes will be beneficial for patients? What is the magic number of amendments after which one decides to cut ones losses?

  • Jayne Mansfield 29th Feb '12 - 10:12am

    In resonse to Richard Dean.
    Stephen Cragg QC of Doughty Street Chambers, a leading health lawyer, scrutinised the bill on behalf of 38 degrees.

    He concluded that ‘
    ‘Effectively, the duty to provide a national health service would be lost if the bill became lawand would be replaced by a duty on a number of commissioning consortia with only a duty to amke or arrange provision for that sction of the population for which it

  • Jayne Mansfield 29th Feb '12 - 10:15am

    … pressed the wrong key on my computer….
    ” for which it is responsible”

    It replaces a duty to provide”

    Dr Pack,
    Time is of the essence, this undemocratic government has already put in place changes before the bill has been passed.

  • Richard Dean 29th Feb '12 - 10:49am

    In response to Jayne Mansfield:

    Thanks. Lawyers can be tricky. Taking this one’s words at face value, and looking at the first seven clauses in the bill again, I see a future in which the Secretary of State will be responsible and accountable to Parliament for the National Health Service, and local commisssioning groups will be responsible and accountable [to the Secretary of State?] for the provision of those aspects of the NHS that are provided in their areas.

    Some aspects of this kind of heirarchical structure are probably already practiced within the existinbg NHS. It means that issues that need to be addressed at national level will be so done, and issues that are better addressed at local level can be done at local level. I’m not too sure why that is felt by some to be a bad thing. Of course it does mean that rekevant arrangements at national level have to be carefully preserved, such as national databases, national blood transfusion services, and national organ donor services. Is the bill proposing to discontinue these?

    So I don’t see this as a duty being “lost”, Huge duties are always shared in practice, even if there is just one frontperson who takes the heat. This looks like sharing, not losing. It looks like the arrangements for carrying out the duty are being organized in what appears to be a rational and potentially effective way, a way that removes domination from the centre of those aspects that can be better managed locally, while (hopefully) preserving oversight.

    As ever, I stand ready to be corrected, and am even now preparing my humble hat ….

  • Richard Dean 29th Feb '12 - 11:12am

    In further response to Jayne Mansfield:

    What I would agree though is that the wording of the titles of the first seven clauses is worrying. Foe example, for clause 1, rather than “duty to promote”, I would have preferred “duty to provide a”. Has this been the subject of an attempted amendment? The wording is also scrappy in that clauses 2 to 6 start with “The” while clauses 1 and 7 don’t.

    These things do seem to be indicative of astonishingly incompetent parliamentary drafting, and so of astonishingly incompetent oversight by 650 MPs and countless Lords. But are they symptoms of a conspiracy to destroy the NHS? Judgment call I guess.

    Such incompetence does also the raise the worry that the re-organization proposed in the bill may have omissions and inconsistencies. But none on the arguments presented so farby the bill’s opponents seem to have touched on any such issues in any believeable way. I have never read any objector even pointing to a clause or omission of the bill and demonstrating that this clause or omission will destroy some particular service, let alone explaining how and why.

    I have purchased a second humble hat, as the first one is really very threadbare from overuse ….

  • Jayne Mansfield 29th Feb '12 - 11:13am

    QC’s with specialist expertise tend to be quite good at interpreting documents such as the NHS and Social Care Bill, Richard Dean.

    I have just heard Andrew Lansley state that the Nick Clegg and Shirley Williamns ‘amendments’ were a joint effort.with him. That hardly inspires confidence.

    I look forward to listening to the Daily Politics show and to hearing what the opposition have to say on the matter.

    I am in full agreement with you on one thing, the disgraceful behaviour of David Cameron who prefers to hurl insults rather than answer questions.

    Nick Clegg has lost my confidence but I do fell sorry for him having to sit next to his uncivil partner.

  • Jayne Mansfield 29th Feb '12 - 11:18am

    Sorry, Richard Dean,
    I have just noticed that you have made a further response which I must know read.

    These e-mails take an age for me to tap out.

  • Billy Wright 29th Feb '12 - 8:48pm

    @Mark Pack Debates in both the Commons and Lords don’ t mean much these day; the libdems are whipped into line constantly, we’ve even seen libdem lords vote against their own amendments; its an absolute farce.

  • “so either we work to strengthen changes to the bill or you are slitting the party’s wrists and storing up bigger problems for the NHS in the future.”

    What a lot of old nonsense. How withdrawing support from a bill that pretty much no-one wants based on the likely wishes of our party at conference is “slitting the party’s wrists”, I don’t know. Yes, the pause was the perfect time for Nick to wash his hands of the bill but he didn’t and now, he should say, having tried to fix the bill, we find it’s unfixable. We may not be remembered as the party that saved the NHS at the next election, but we certainly wouldn’t be remembered as the ones that sold it down the river in the name of political expediency.

    On your second point, ditching an ill-conceived bill is no “road-block to reform” or however you want to paint it. The NHS can be reformed without the need for a bill, as anyone who worked in a PCT up until politicians mooted their abolition can tell you. Sensible, well-thought out reform and the implementation of new, more efficient working practices are things the NHS is quicker to adapt to than the conventional wisdom would like to admit; unfortunately it’s a rare politician that suggests such things.

  • Richard is right that we should be sceptical of legal opinion and any quick google search will throw up any number of opposing legal opinions on the Bill. We should be especially sceptical of the one Jayne Mansfield highlights. Again, a quick google search reveals that Stephen Cragg is not a QC and is actually quite a junior lawyer. Furthermore, if you read the 38 degrees legal opinion in detail, it actually contradicts what they say frequently. For example, procurement law currently applies fully to NHS services-the Bill won’t change that and the legal opinion seems to agree, but 38 degrees claim that procurement law will all of a sudden apply and cost a fortune while demolishing services.

    That’s not to say that the intent of the reforms and the way they are being implemented isn’t incredibly foolish but the biggest problem we have as a party in trying to oppose them is the sheer extent of misinformed campaigning against the Bill that puts up all sorts of straw men that the government can easily knock aside and look quite reasonable in doing so.

  • Richard Dean 29th Feb '12 - 10:38pm

    Additional response to Jayne Mansfield,

    The Department of Health’s response to the Cragg review is at http://www.scribd.com/doc/64081752/DH-legal-response-to-Stephen-Cragg-and-38-Degrees. A summary of the results of the review is provided at http://www.38degreesbath.org.uk/#/legal-brief/4558932776. I cannot find the full version of the review on their site.

    Both parties may have their preconceptions. Cragg’s document as summarised by 38 degrees is not solely factual, it makes interpretations and judgments too. For example, the statement about the effect of the “hands off” clause is a judgment, not a fact. The Department of Health’s response seems to indicate that Cragg is a bit out of touch with practical reality. Essentially Cragg looked at the same clauses as I listed in an earlier posting. He identified the same worries as I indentified, but presented them in what I would regard as more inflammatory terms.

    38 Degrees appears to suggest that Cragg is part of Harrison Grant solicitors. Their website (www.hglaw.co.uk) says they were founded in 2004. It does not seem to mention Cragg, nor does it seem to mention any experience in the field of health. Their list of cases looks remarkably thin for 7 years – I’m a consultant in a non-law discipline and in my discipline that means the consultant has mostly been out of work! Stephen Cragg’s photo is on http://www.doughtystreet.co.uk/barristers/stephen_cragg.cfm, where he looks young and keen and is described as a “Junior” in 2010. To describe Cragg as “a leading health lawyer” may be a misleading overstatement of his experience.

    I think it might be possible that my view is as authoritative as his – i.e.not at all authoritative, just an opinion. To avoid anyone suing me, I would like to point out that, as a consultant, I have no money, and anyway I am happy to retract any statement if there is a clear demonstration that I have erred. All you have to do is post your response here!

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