Opinion: Parliament needs our help on the NHS Bill

We are in real difficulty over the NHS Bill.  Spring conference showed the party at its best.  The membership expressed concerns and the leadership responded deftly with the “listening exercise”.  This aimed to reassure NHS and public opinion by securing substantial changes to Andrew Lansley’s proposals, without too much loss of face within the coalition.

We have not succeeded.  The changes to the Bill have failed to quell fears that the NHS is being fragmented in pursuit of market dogma.  There is no serious support or enthusiasm for the Bill within the NHS; indeed opposition among the health professions is hardening.  If we were confident of our cause we should certainly press ahead; the BMA is not always right!  But the legislation is so complex that even lawyers disagree about its implications.  And as the economy worsens and each week brings new “revelations” of shoddy healthcare, the Bill seems increasingly irrelevant to the real problems faced by the NHS.

The coalition protected the NHS financially but it still faces the toughest four years since its creation.  If we cannot convince the electorate of the value of this legislation, all NHS problems, whatever their derivation, will be laid at our door. LibDem peers are working enormously hard to secure further improvements to the Bill, but their efforts are largely invisible to all but the most avid Hansard readers.  And whatever the outcome at report stage, we will have to convince the public about the positive merits of the Bill.  Claiming to have made it less bad than it would otherwise have been does not make a convincing Focus story when the local NHS is in disarray.

We could start with our own supporters.  If we cannot convince them that Bill is good for the NHS then we need to reconsider while there is still time.  A good model is the special conference that was called to endorse the coalition agreement.  This enabled the leadership to explain and win our support for a radical and surprising course of action.  The NHS Bill has similar implications for the party’s future.  Many are puzzled that we, the party of Beveridge, are apparently committed to the marketisation of the NHS that some informed commentators believe could be irreversible?

We need to hear and be convinced by the case for this highly controversial Bill. A special conference while the Bill is still in the Lords would enable us to take stock and change direction, even at this late stage.

*Dr Graham Winyard is a member of the Liberal Democrat Health Committee

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24 Comments

  • Leviticus18_23 4th Jan '12 - 5:23pm
  • Simon Bamonte 4th Jan '12 - 5:36pm

    This is a very good article and it is one I support 100%.

    We were promised by both Tory and Lib Dem alike an end to Labour’s top-down NHS reorganisations.”

    The opposite is happening.

    Most medical professionals, along with the British public, are against this bill. There is no consensus among the people to push these damaging reforms forward. This bill is, at its essence, anti-democratic because our “leaders” promised us this type of bill was off the cards both before and during the 2010 General Election. These “reforms” only came to light once the ink on the Coalition Agreement was signed. Speaking of which, was this bill even in the coalition agreement? Because, if not, the Tories will have broken their own agreement with us and we have no obligation to support it if that is the case.

    The NHS may need reform. But not this reform. NHS reform should be led by patients and professionals, not private health care companies who bankrolled Mr. Lansley when he was in opposition.

    It is simple: this bill must be amended severely, even further. Or, preferably, dropped altogether.

  • Simon Bamonte 4th Jan '12 - 5:54pm

    @Simon McGrath:

    Do you think shareholders, whose only goal is to maximise profits, will have patients’ best interests at heart?

    Yes, GPs are private providers, but they don’t really make profit. And they have no shareholders. If we are putting private companies in charge of NHS services, where will their profits go, if they make any? Not back into the NHS, of course! Any NHS hospital or trust with a surplus will see that money go back into patient care. Not so with private providers.

    Just look at Circle Healthcare, who took over an NHS hospital recently. Circle themselves have made losses of £27.4 million in the last year:

    http://falseeconomy.org.uk/blog/circle-has-been-unable-to-make-a-profit-how-will-it-turn-around-a-hospital

    They also made losses in the past two years as well. Yet Lansley seemed to think they were just the people to take over a failing hospital. And they tell us Circle will do well and patient care will not suffer one iota. Well, that is still to be seen. The same happened when ATOS took over a couple GP surgeries in London. They failed to provide a better service and walked out of their contract (of course, that’s no surprise, since ATOS are also incompetent when it comes to assessing the disabled):

    http://www.guardian.co.uk/society/2011/apr/12/nhs-privatisation-future-policy

    Call me a dinosaur, call me dogmatic, but I (and there are millions in the UK like me) simply don’t trust companies to provide the best care when their first duty is to shareholders and patients second. If we can bail out the banks, certainly we can bail out hospitals to save peoples’ lives. Right?

  • “simply don’t trust companies to provide the best care when their first duty is to shareholders and patients second.”

    What about BUPA?

  • A special conference needs 200 conference representatives to call one and would probably be hard to organise at less than 2-3 weeks notice (the post May 2010 one was tentatively planned some time in advance AIUI).

    Assuming you’d need 2-3 weeks to collect signatures is this a realistic option before the bill has completed its Parliamentary process.

    (not to mention whether it’s a sensible use of the £xx,000 it would cost to put on a special conference)

  • @Simon Bamonte

    That would be why private healthcare is on the whole considered superior in the UK? In an open market, with well informed consumers, it is in private companies’ best interests to provide the best possible service. Things only go wrong when you have government ineptly drawing up contracts with little or no scrutiny or accountability and consequently turning to shoddy operators like ATOS or Capita.

    Liberalism differs from socialism in one way by not taking a dogmatic view on how services should be provided-from our point of view there shouldn’t be anything inherently wrong with a mixed economy in providing public services-if done properly. That this bill doesn’t inspire much confidence that the last point can be achieved is a massive but very different issue.

    Many of us, including the author of the article seem to forget that the NHS has been subject to ‘market dogma’ for around 20 years. Whether we like it or not, this bill is something of a natural consequence of successive governments endorsing the open market and it provokes changes that might well have had to happen anyway as a result of decisions in the courts based on the interpretation of existing legislation.

  • Norman Fraser 4th Jan '12 - 7:38pm

    The Bill is far too complex, is too vague on many crucial details and threatens all sorts of possible derogations form the principle of universal healthcare, free at the point of use. This Bill should be killed off and Lansley sacked.

  • Tony Dawson 4th Jan '12 - 9:41pm

    @Tom Smith:

    ” it is in private companies’ best interests to provide the best possible service. ”

    If only. The NHS regularly has to pick up the tab on private operations gone wrong, sometimes critically. this includes NHS contracted operations in private hospitals as well as privately-contracted operations.

    A lot of private medical contractors are paid well enough to be able to afford to put patients’ needs as a high priority – and do so. But private medicine is effectively-unregulated. Some medical contractors, just like workers in any other sphere, work by the criteria of ‘keep most of my patients ignorant/happy enough so they won’t do anything which gets me into trouble and make the most money out of them I can. And they get away with it. Doctors are not saints.

  • This NHS bill is like a faulty French implant. We were told when it was inserted into the coalition agreement that there would be reorganisation but no top down reorganisation. It turns out that there is a fair chance that it includes industrial grade top down reorganisation. What can we do? Did we really have to have to do this to ourselves in the first place?

    Its illustrative that with the implant scandal – private providers have grasped with both hands the opportunity to demonstrate they don’t just dump their responsibilities back onto the State the moment something goes wrong – privatising profits and socialising losses as they wend their merry way.

  • David Allen 4th Jan '12 - 11:26pm

    “It is in private companies’ best interests to provide the best possible service. Things only go wrong when you have government ineptly drawing up contracts”

    There is. of course, a certain amount of truth in this. When a public civil servant spends public money on a private sector product, he/she may be able to get good value for the taxpayer. The advantages of competitive tendering may outweigh the disadvantage of having to fund the private profit.

    However, the new model NHS will see private companies, spending public money, on products from other private companies. Will the commissioning private companies seek best value, or will they forge alliances with the providing companies, such that commissioner and provider both cream off high profits, while the unrepresented taxpayer is the loser?

    A conference to clarify this and other pitfalls with the Lansley proposals could be a game-changer. If the constitutional hurdles which Hywel mentions get in the way, is this something which an independent non-political organisation – for example the BMA or a health think tank – could be persuaded to organise?

  • Tom Smith,

    “shoddy operators like ATOS or Capita.”

    Is this the same Capita that collects Council Tax on behalf of smaller local authorities? And it’s a shoddy operator?

    I have heard a lot about how wonderful private healthcare is in this country compared to the NHS. And in some respects it is. You get treated sooner, the food is better, and your surroundings are more commodious than in the NHS. Other than that, patient care probably differs little. The same doctors work in both sectors. What is worrying about private healthcare is the fact that many of the hospitals used by the private providers are small-scale and unable to cope with medical emergencies; and are sometimes cleaned by cheap labour cowboys, increasing the risk of septicemia.

    The Health & Social Care Bill is not yet law, but much of it has already been implemented. We now have shadow GP consortia, and a number of services open to competition.

    Like Mitt Romney, Lansley doubtless affects to believe that people will be much healthier without the intervention of the state. The sane among us beg to differ.

  • John Carlisle 5th Jan '12 - 8:34am

    Any mixed private/public service is a dog’s breakfast, particularly when the business model used is that of the worst practices, i.e. lowest cost tendering, shareholder-driven. It is supposed to be user-driven, and that is characterised by this dreadful misnomer: “choice”. The user cannot choose because, unlike car owners and restaurant customers, they do not have the knowledge or experience so to do – and often does not wish to. If I am unwell I go to that most trusted institution, the hospital or clinic, where there are doctors who will not charge me and will make me better. If I am very unwell (mentally or physically) then I am in no position to choose. This choice issue is such a fundamental lie.
    There is a lack of system thinking. The utter farce of targets illuminates that, i.e. unintended consequences. Now we are looking at the increase in re-admissions. Why? Because of the target regime. The cost to the SYSTEM is enormous. This simplistic view of service cost is deadly – as is the bonus culture. I am a businessman, and I know that the best private companies do not use targets and bonuses. But somehow the politicians take the advice of advisers in short pants and bankers, and not John Lewis, or Gore, or even Warren Buffett! They model both the private and public services on the worst.
    So, yes, call a conference. I will move heaven and earth to be there.

  • “It is in private companies’ best interests to provide the best possible service.”

    Rubbish – it is in a private companies best interests to make as much money as possible.

  • Dave Eastham 5th Jan '12 - 12:19pm

    Surely, the questions raised by this Voice contribution merit discussion and not a series of comments on the alleged merits or otherwise of Circle and/or BUPA?. The time for that is long past. Large questions remain and John Pugh’s contribution really does focus on the issue at hand. Lansley’s Bill is essentially, in my view, give or take a few smoke and mirrors, an eventual implementation of a full scale Marketisation/Privatisation of the NHS. (Begun under Thatcher and carried on in no small way by the last Labour Government) leading essentially a US model. Whether or not that is to be desired is another story. Personally, I don’t think is a desirable objective at all. The bolt on of some long cherished Lib Dem health ideals to Lansley’s Bill is sadly, on balance, window dressing, as I suspect the outcomes of the Market will be counter productive and the implementation of worthy bodies such as Health and Well being boards, undermined by the Tories market agenda. The position of the status, responsibilities and powers of the Secretary of State as defined by the original NHS Act is key to this. As is being raised by Shirley Williams et.al.

    It must be remembered that the Bill is, as we swap LDV voice comments is being implemented, prior to the Bill becoming law. Contracts are being let, The Wirral comes to mind for one. Not to mention the selling on of previously outsourced GP Practices in Camden from the private sector winner of the original tender, to another provider, with no consultation with the local users (or is that customers?) What price choice and where is “No decision about me without me” now?

    The idea of a special conference is possibly attractive, although apart from cost, I would wager it would be a lively affair!. Perhaps serious thought ought to be given as to what such an event would achieve. It might not be what anybody expects or wants. Still that of itself is not a reason for not doing it

  • David Allen 5th Jan '12 - 1:04pm

    Libby,

    OK then – It is often in a private company’s best interest to provide a decent product or service, since that will help them win business. However, this will only happen when the customer has a real interest in the quality of what is being purchased, and a motivation to seek both high quality and low price. It tends to work best when the customer is an individual, e.g. a private shopper. It may work when the customer is a disinterested public employee, though the motivation may be less certain. It is unlikely to work at all well when the customer is a private organisation, has its own commercial axe to grind, is not the actual consumer of the product being produced, and is not spending its own money!

    We can certainly expect hospitals to conduct marketing and hospitality charm offensives directed toward the “GP” commissioning organisations and companies. We can expect private providers to outspend NHS providers and win business that way. We can expect to see learned discussions as to whether it is bottles of whisky, or seats at the Olympics, or money in plain envelopes, which constitute bribery. We can expect to see the winning private providers stay just on the right side of the risk of going to jail, and to sign up the “GPs” very effectively. It’s almost as if it was designed to enable pushy businessmen, not to say crooks, to take over the industry! (Did I say “almost”?)

  • Why is any of this neccessary? All the Lib Dems had to do was have a little backbone. The Tories could hardly claim that they had a mandate for NHS reform, Dave said there would be no more top down reform of the NHS.

    The only conclusion I can reach is that Nick Clegg and other senior Liberal Democrats want to breakup and privatise the NHS. For god knows what reason. Another example of how the Lib Dems have betrayed their own supporters.

  • @libby

    I think quite a lot of my sentences will sound rubbish if you only quote the latter half! What I actually said was that it is in the private companies interest to provide the best possible service IF you have a market of well informed consumers.

    It’s incredibly unlikely that we actually have that situation now or if we can ever expect all individual patients to have the level of knowledge necessary to make a rational decision. The Bill obviously ignores this point and will almost certainly lead to many cases of the taxpayer and service user losing out, as with much of the last government’s outsourcing. That isn’t to say that involving the private sector is wrong in every case; to put the most positive spin on the reforms, you could have a group of health professionals, together with councillors and patient advocacy groups, commissioning intelligently to make sure quality of outcome really does happen.

  • Graham Winyard 5th Jan '12 - 4:16pm

    I am grateful to Dave Eastham for re-raising my original question, which was not about the Bill (which I believe to be fundamentally flawed) but about what we as a party might do about it. We are pushing through legislation that very few people in the NHS think is sensible, with no serious attempt to explain why. The likely outcome is that we will be held responsible by the electorate for all the NHS’ problems at the next election. This feels politically on a par with tuition fees, yet we sleep walk forward as reluctant partners in the potentially irreversible marketisation of the NHS.

  • Anon Lib Dem 5th Jan '12 - 5:44pm

    I recently had to write a report part of which involved looking at the implications of the bill for the pharmacy sector. The more I looked at them, the less comprehensible any of the various briefing documents were. It was very hard to be sure that what I was writing made any sense, since there was a disastrous lack of clarity about how the new structures would fit together. When I interviewed those affected by it, they didn’t understand it either. I think this is probably a microcosm of the whole mess that has emerged

    This whole thing is a shambles and frankly needs rethinking from the start or complete abandonment.

  • @Geoff Payne

    But BUPA don’t have their first duty to shareholders as they don’t have any so profits stay in the organisation. In that respect they are a varient of mutual organisations.

  • GW “This feels politically on a par with tuition fees”.

    No, the NHS is much more important and the result of this legislation will affect almost everyone in the country.
    If, as you say “we sleep walk forward as reluctant partners in the potentially irreversible marketisation of the NHS.”
    at the next election I can see no prospect of you being able to campaign as Dems.
    By that time you will be ‘the Government’ and be judged on your performance as such over the term. Protests of the small things you’ve been able to achieve will be as nothing as the whole Coalition project is laid bare for the public to scrutinise.

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