Opinion – NHS Reforms: It is not too late to pull back from the edge

If the Party is still licking its wounds and reeling from the catastrophic loss of public support over student tuition fees and the kicking received in the May 2011 local elections, then please be in no doubt, that the punishment it will receive from the electorate for its perceived co-operation in, and reluctant endorsement of, the demise of a much loved and unified national health service, will be on another planet entirely! And that will be despite the valiant efforts and guerrilla warfare carried out by our Peers led notably by Shirley Williams and others.

Essential to Cameron’s election campaign was the promise to protect the health service – his dishonest break with that commitment will prove toxic, not only for him but also for also for Lib Dems. The public and media will not fail to remind us that the current reforms are in direct contradiction to commitments in the Coalition Agreement’s detailed programme (The Coalition: Our Programme for Government), signed by both the Prime Minister and the Deputy Prime Minister.

Whilst GPs and other clinicians do in fact support the concept of clinically-led commissioning, they believe that this expensive upheaval of the health service fails to achieve that and acts as a distraction from the financial challenge facing the NHS. The Royal College of General Practitioners (RCGP) – the UK’s largest medical Royal College supports a greater role for GPs in the planning, design and delivery of services within their local communities – but it does not support a Bill which in their view would damage the care and services that GPs deliver to patients. RCGP Chair Dr Clare Gerada called instead for the ‘consolidation of the current organisational structure, such that PCT clusters remain, with GPs placed as the majority of the Board’.

But it is still not too late for the Lib Dems. Nick Clegg should withdraw our support for the Bill and in doing so halt a damaging, unnecessary and expensive reorganisation with its potential for leaving the poorest and most vulnerable in society to bear the brunt. This position is strengthened through the recently published joint editorial by the Health Service Journal, Nursing Times and British Medical Journal, which predicted the changes would be so destructive that another expensive reorganisation would be needed within five years.

Taking such a bold decision would mark out clear lines in the sand in a public manner, differentiating us from the Tories and creating that vital space for debating our social liberal ideals on the doorstep. As a get out clause, the Deputy Prime Minister could argue that the growing public and professional outcry now shows that the consequences of the bill have turned out to be entirely different from the principles which were originally agreed. This is a plausible position and one which the party grass roots, patients, professionals and wider public will understand and respect.

If we continue along this trajectory, the impact will be disastrous not only for public health services in England, but also for our Party in terms of grass roots de-motivation and further erosion of public confidence in the face of a very difficult General Election campaign in 2015.


* Issan Ghazni is Chair of the Ethnic Minority Liberal Democrats and former National Diversity Adviser for the Liberal Democrats. Issan blogs here

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  • I agree with this entirely and can’t understand why the parliamentary party continue to support this undemocraric and wrongheaded bill.

    If Clegg and Burstow truly believe in these reforms, let them put it forward as part of the discussions for the *next* manifesto.

    It’s not in either party’s manifesto, or the Coalition Agreement, so why are our MPs supporting it?!

  • I think this is the last straw that will break the ‘Camels back’ I know of at least three officers in my local party who will resign if this bill gets through with our support. None of us want to hear the cry ‘we have amended the Bill so the worst parts have been excluded’. No No No we want to hear that thanks to Lib Dem pressure this bill has been binned.

  • I agree with every word, I believe the majority of voters would also. Well said Mr Ghazni.

  • I absolutely agree! Even members on LDV (not known as a hangout for radical Lib Dems) are opposed 2 – 1. It is clear what members, ex members and supporters think. The Tories would have no truck with a measure that was so unpopular with their grassroots, so why are we giving it houseroom?

    The only possible (tactical) objection, is that the Tories would pull out of coalition, a General Election would be called, and we would suffer. In this situation, we may not do all that well, but the Tories would do even worse, and we would be able to say we stopped them ruining the NHS. And what’s more, if our senior Lib Dems called Cameron’s bluff on this, he would realise the likely consequences, and find some excuse / reason to bin the bill.

  • Daniel Henry 9th Feb '12 - 9:24pm

    This isn’t even a battle of Tory Vs Lib Dem ideology any more. The bill is getting criticism from all sides due to being complex and badly written, not to mention Lansley’s suspicious links to private healthcare companies.

    This is so.beyond politics that we need to work with the Tories on this. If we can find enough Tory backbenchers to oppose it then we can drop the bill without a coalition split.

  • Daniel Henry 9th Feb '12 - 9:24pm

    We need a united cross party revolt on this.

  • And please may we start with a bill entitled:

    “What is the NHS for?”.

  • Stephen W, you (and too often, the Government) are conflating the Nicholson £20bn Challenge with the HSCB. The whole point of the savings was that they were to be efficiency savings based on new ways of working etc. These were brought in under Labour and are quite separate from the HSCB. Any theoretical savings Lansley trumpets would have to be in addition to the £20bn, and in fact the Health Select Committee suggests the reorganisation caused by the HSCB will actually *inhibit* the realisation of the Nicholson Challenge savings.

    You also seem to believe that the HSCB will remove layers of management, something I don’t see happening – Lansley seems to suggest new replacement layers of bureaucracy daily. Also, it seems highly likely that there will be an extra layer of financial management brought in by the CCGs when the clinical doctors realise that they’re either ill-suited or unwilling to run the commissioning themselves.

  • Stephen W. Please can you explain in precise terms what you mean by “liberalise” the NHS?

  • Malcolm Todd 10th Feb '12 - 12:34pm

    Stephen W.
    The bill will only reduce bureaucracy if you believe that bureaucrats employed by GP consortia are not bureaucrats, whereas bureaucrats employed by primary care trusts are.

  • Martin Young 10th Feb '12 - 1:36pm

    The Bill is a total shambles. It’s been picked over so much I doubt it makes any sense what so ever. But from a purely mercenary view, it is an election gift to the Labour Party. Tories are realising that it’s a vote loser, but ite’s even more damaging to the Lib Dem candidate where I live in Devon (a swing seat for LibDems and Tories) the seat has now become a safe one for the Tories. Even defectors from Labour are thinking of returning. As for tactical voting – forget it, and the number one thing that has got people roused, not the cuts, not the job losses but the apparent selling off of the NHS. This is being handled so badly by the tories but who comes in for the flack- the LibDems. The comment by Shirley Williams that ONLY half of beds should be private didn’t help either. The party should quietly back away and let the tories destroy themselves.

  • Daniel Henry 10th Feb '12 - 3:31pm

    Stephen W, the way the health bill has been described by the government makes it seem like a great idea in theory but the bill is so complex and bureaucratic no one thinks that it’ll be delivered in practice. It will just be a big expensive mess.

    As I said, it’s time we started working with the Tories to get an cross party rebellion going. Does anyone here have contact with Tim Montgomerie?

  • Rebecca Taylor 10th Feb '12 - 6:44pm

    Firstly, I’ve never liked Lansley’s plans and I’m still not enamoured with them now, despite the valient attempts of many LibDems to improve them through amendments.

    However I would like to point out that this idea that private patients would suddenly flood NHS hospitals taking up all the beds at the expense of NHS patients is a fallacy because very simply there aren’t enough private patients for that to happen!

    NHS private patient work has been falling every year for the last five years and the number of people with private health insurance has remained steady for around a decade. See article in Health Services Journal for more info: http://www.hsj.co.uk/news/finance/private-patient-income-continues-to-fall/5040560.article

  • Matthew Huntbach 10th Feb '12 - 7:23pm

    Stephen W

    And yes, the professional organisations are thoroughly conservative. Many of them opposed the NHS when it was first developed. LIke all people they want to cling onto what they’re used to

    Clinging onto what you’re used to is no bad thing. There is a big cost overhead in making change. In my experience, change for change sake has been a huge drain on people’s time and energy in so many areas of public services. All those meetings to pan it, all that uncertainty, all that time taken getting used to the new way of doing things? And for what? How many times does one find the big change that is going to solve all the organisation’s problems is the opposite of the big change that was going to solve all the organisation’s problems a few years ago?

    There seems, for example, to be a regular cycle with procurement. One year we are told the solution is to have a big central procurement office, so we’ll all gain by bulk buying, the next to decentralise it so we’ll all gain by using local knowledge. Or admin – one year it’s get rid of all the unnecessary bureaucrats and let the professionals get on with their jobs, the next it’s bring in admin support so the professionals aren’t tied down doing paperwork.

    Part of the problem is the scourge of consultants (one year the efficiency thing is to bring in consultants with all their outside know-how, the next year it’s get rid of all these expensive consultants …) – ever heard of a consultant say “Jolly good, you’re doing everything super, no need to change, and my fee is … ?”. No, they have to recommend change to be seen to earn their fee. Another part of the problem is newly elected politicians, who feel they have to throw their weight around by changing things.

    Apart from the cost and time overhead, change can be deliberalising. People have more power when they are familiar with the system. They know how it works and how to use it. It takes time when it is changed to get used to the new system. How many times when you are in any new situation do you feel powerless because so much that was familiar to you has gone?

    I don’t mean by the above that change should never take place. But I do mean the idea that change is always good and resistance to it is always bad is dubious.

    It is often quoted that the medical professionals were against the NHS when it was founded. Actually, the Labour Party was opposed to the Beveridge Report when it came out. But there was huge popular support for it. Where is the equivalent popular support for what is proposed now? I’ve kept out of discussions on the proposed NHS refroms because I don’t have much knowledge on how the NHS is run. It did seem odd to me, however, that we had a Coalition Agreement in which it was stated there would be no large top-down reorganisation of the NHS (sorry, I can’t recall the exact words), followed almost immediately by plans which seemed to be just that. But now there seems to be almost universal opposition to the reforms from the medcial professional bodies, and no-one much outside a few politicians in favour of the reforms, it would seem to be wrong to proceed. Democracy ought not to be about ploughing ahead no matter what, it ought also to be about listening, to the public and to what those who work in the area the government is meddling with have to say about that meddling. There should be no shame in government saying “Sorry, we proposed this, but we see there is no desire for it, so we will think again”.

  • @ Stephen W. Thank you for your considered and credible reply. There is one more point regarding your original post that I would question. You address a “health reform sceptic” correspondent in this way…….”you support changes almost exactly like these, but do not support these changes for no obvious stated reason except that you don’t want to risk being unpopular.”

    If a Parliament insists on bringing into law a policy that is “unpopular” (as appears to be the case here) then by definition Parliament is acting against the will of the electorate, this is surely unacceptable in a democracy, and smacks of elitist paternalism whereby our rulers appear to be saying ….” well OK we know that people don’t like what we are doing, but we know better than they do what is, and what is not best for them”.

  • Jayne Mansfield 11th Feb '12 - 11:21am

    I am afraid that it is too late to pull back from the bill.

    The democratic process has been subverted, many of the changes have already been made.

    Many PCT’s have disappeared and the NHS has already lost invaluable expertise.

    I have voten for your party apart from one ‘Green’ moment.

    Never again.

    There is nothing Democratic about a party that supported the anti-democratic changes in the NHS.

    It seems to me that you have sold your soul for a mistaken belief that George Osborne understands economics.

  • Malcolm Todd 11th Feb '12 - 2:40pm

    @ Matthew Huntbach
    Thank you for an excellent explanation of the mayhem that can be caused by the very act of organisational restructuring. I’ve been trying to explain this to others but have never managed it quite so lucidly. The trouble, of course, is that one is instantly written off as being against all change and believing that everything is already perfect, just because you recognise that change itself causes significant costs, inefficiencies and disempowerment, which the proponents of reform never recognise when comparing the alleged advantages of new over old.

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