The Health and Social Care Bill looks like it will have a bumpy ride through the Commons when Parliament returns this week. There are furious complaints from 38 degrees and others that the reforms will introduce privatisation by the back door, open up the NHS to being subject to competition law and allow the Secretary of State to wash his hands of the NHS altogether. Whatever the merits of these arguments, they somewhat miss the point.
The argument over the inclusion or otherwise of the Secretary of State’s responsibility to provide a comprehensive service in the Bill is valid, something that will have very real practical and constitutional consequences and an issue that our MPs must take a stand on next week.
Regardless of the outcome of this battle, the Bill will radically alter how the NHS works; there will be far more scope for private companies to provide public services and the decision making apparatus to decide this will be more localised and potentially far more accountable than it is at present.
There has been much consternation over the details of this process, not least that it goes against the Coalition agreement, but apart from the focus on increasing private provision, the new system will look very much like that being promoted by this very party in the 90s when GP fundholding was the Government’s weapon of choice for abrogating responsibility. The 1995 policy paper ‘Building on the Best of the NHS’ goes as far as advocating treating public and private providers equally and allowing GPs to form commissioning consortia.
When the dust settles I hope that we will see an NHS that reflects Lib Dem thinking rather more than people perceive it will at the moment. The key though is the localising aspects of the reforms and this is where the big opportunity arises for the party and it is one we must firmly grasp to avoid the reforms becoming yet another trust breaching catastrophe like tuition fees.
The clinical consortia and their scrutinising health and well being boards will now be in control of shaping how health services develop locally. If they perform well, the outcome could be a more streamlined, efficient and integrated provision of healthcare by the NHS. On the other hand there is also the chance that they could make decisions that fragment core NHS services, see treatment restricted and benefit only private sector providers and their shareholders.
It will take local scrutiny to make sure that this latter scenario doesn’t happen and this is where the party must come in. Local activists, patient groups and councillors could make the difference. When decisions are being made, we need to be at the forefront of pushing for the best outcome, be it developing an integrated system of care and support for people with long term conditions or preventing a wasteful PFI contract being entered into. To restore our credibility on the NHS we need to be seen as working to improve it and this can only realistically be achieved on a local level.
Healthcare provision unfortunately suffers from being extremely complex and this is why local activists could and should have the right support to campaign effectively for better local services. Such support and coordination from HQ could bring real dividends to the party which is suffering from the perception that its MPs are out of touch with the voters and the grassroots party membership. Ultimately we’re stuck with a pseudo-privatised health system; we can choose to complain bitterly about the eventual outcome or look to the opportunities the reforms could bring the party and the NHS.
Tom Smith is a senior parliamentary researcher working for Adrian Sanders MP
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29 Comments
The NHS is currently the most efficient health service for a country of comparable size and economic development in the world according to just about every piece of research around.
Just because economic textbooks and “liberal” bloggers think that everything the state does is bad and that humans can’t function without the profit motive doesn’t justify the changes proposed.
It is like a Formula 1 team that operates on a budget half as big as the other teams. If they were still coming in every race in first, second or third place people would rightly think it was crazy to sack the driver and engineers and replace them with the ones they were already out competing.
If it works dont think it.Do you really think Lansley wants to protect NHS when he said in a cloed meeting he wished to privatise it .I voted Democrat for first tme last election I didnt vote for this bill
Ultimately we’re stuck with a pseudo-privatised health system
You could vote against it. We will only be stuck with it if the Lib Dems betray the electorate and allow this bill to pass.
I’m with Tim Farron – a long with the majority of the party.
I think he said that the bill was”far from perfect” and that he would like to see “significant” changes to it in the Lords.
Wonder what it is that 38 Degrees have done to bother the heirarchy (it’s the only organisation mentioned specifically by name)….. I thought we like grassroots and their “furious complaints”?????
“open up the NHS to being subject to competition law”
What is wrong with that? If monopoly is bad for pharmaceuticals, why is it good for hospitals?
The bill is all about fragmentation of a NATIONAL health service. Ever since its inception the Tory party’s aim is to replace it with a US style private system…..I have experience of the US and, trust me, it delivers an excellent service for those who can afford it; but the rest…sorry.
As for its viability…..these reforms are doomed to fail – which is exactly the objective; why else does the SoS want out?.
The ‘Transparency Agenda’ is designed to fool people into thinking they will be able to be knowledgeable enough to make real choices about where to go for treatment. The next step will be to ‘put the money into the hands of patients’ – and this will be done by introducing private health insurance. It’s the Tories way of ending a publicly funded health service which they believe is unaffordable – but only because they choose to spend the money elsewhere; good healthcare is an investment not a cost.
The NHS is incredibly efficient and very good value for money. The Tories are pushing their privatisation ideology in the face of all the evidence. Time for Cleggie to wake up now and stand up for the greatest social achievement this country has ever had. It’s the very least he can do to redeem the catastrophe that his leadership has been up to now…..
Sadly, I put little faith in Clegg. Lansley’s bill, we were told, took 6 years to complete, it was backed at every stage by most LibDem Mps until suddenly, after the local election/AV fiasco, it needed headline grabbing attention. A few weeks of tinkering and, ‘lo and behold’ a “Persil White” masterpiece.
It’s still, as Shirley Williams points out, a bad bill and, when dealing with something as important as the NHS, the last thing we need is a bad bill.
“What is wrong with that? If monopoly is bad for pharmaceuticals, why is it good for hospitals?”
It will create huge amounts of litigation expenses for NHS providers and commissioners, when they are sued by multi-national healthcare companies who have very deep pockets, over every single contract that their lawyers can find a hole in.
This will divert £millions per annum from patient care.
“The 1995 policy paper ‘Building on the Best of the NHS’ goes as far as advocating treating public and private providers equally and allowing GPs to form commissioning consortia.”
OK, but what have we learned since 1995? We have seen that modernising fellow Mr John Prescott boast about discovering a new partnership between the public and private sectors that would supplant Old Labourism: and we have seen the private sector out-bargain the civil servants and make massive profits out of PFI. Do we have to go through a similar process of leaning from bitter experience ourselves?
The trick is not to set up structures which give the private sector all the cards. Difficult, because in the inevitable tug of war, the private companies are more determined to make a killing than the salarymen of the civil serrvice are determined to stop them.
“Monopoly is bad for pharnaceuticals” because genuine competition, with a public purchaser buying from a choice of private suppliers, at least has a sporting chance of driving down costs.
As to “why is monopoly good for hospitals?”, the answer has to be that anything is better than the awful structure which Lansley is creating. On the one side, a private company organising the buying – the commissioning company (fronted by a nice GP so as to allay the suspicions of the public). On the other side, another private company doing the selling – the hospital company. Of course, it will be easy for the two companies to “help” each other. And in the middle? Public money, from our pockets, with no effective public oversight to stop the privateers from harvesting it.
Why create a structure like that? To help the “right” people make money, of course. That’s what it’s for. That’s what Lib Dems have the option to help or to hinder.
@Original Poster – I agree with Timak, broadly. The figures suggest that the NHS is actually doing very well at the moment and, quite frankly, if we as a party let ideology get in the way of facts then we are no better than all the rest of them.
At the risk of being a bit confrontational this is exactly what I think you are doing here.
@ad – our current system is actually more financially efficient compared to the insurance-based systems of the continent or the systems of Australia or Canada. It also has a (much) lower proportion of people thinking it needs serious change relative to these countries without significantly worse. Basically,
When considering a private versus a public system you have to consider that although a private system results in competition it also results in duplication of resources and a need to actually turn as large a profit as possible. You also need to consider if there’s actually a basis for competition that has any hope of improving the service.
If we consider A&E departments, if you’ve been seriously injured then your choice of A&E would be dictated by which one is closest. The primary basis of competition in this regard is therefore distance and it is unlikely that having A&Es run privately would improve prices or services. This isn’t the case for every sector of the healthcare system but imo it provides a clear illustration of why competition is not always beneficial in the healthcare sector.
Of course, there are currently private hospitals but I think it’s worth noting that their business model revolves almost entirely around not doing the work the NHS prioritises, they compete largely for what the NHS considers non-essential and is therefore slow at.
With pharmaceuticals it’s a different kettle of fish, for all of the ways in which the pharmaceutical industry is special it still ultimately revolves around shipping a physical product intended for a particular purpose that can be shipped (theoretically) worldwide. Trivialities like time or distance aren’t the main basis for competition – perceived quality of the product and price are the main bases. Of course, it’s not perfect, and I could write for a while on that topic, but in this industry competition actually does broadly what it is actually supposed to do.
I’m not convinced that it would or even could in healthcare. In any case, that’s my take on it. There are principled reasons as well as practical reasons, but I’ve decided to focus on the latter for time’s sake.
There is already competition, any contracts let have to comply with European competition legislation. If there are private organisations, they have to make a profit, often 20%, or they will be taken over of go bust. Where is this 20% coming from ? is the NHS that inefficient, even a 5% inefficient ? This just seems a mantra of private good, and public bad.
The sad thing is this bill is all about structures and not about outcomes. Who are GP consortia going to improve outcomes ? We take doctors who are used to practicing medicine and then say here is millions of pounds to manage, stop doing medicine and manage budgets, this is not going to improve outcomes. As to public scrutiny so what if things are scrutinised, the consortium can say and so what. Meanwhile a few people get richer and the patient gets nothing.
If you’re going to say that 38 Degrees, etc, are missing the point then I think it’s important that Lib Dems don’t miss this point:
Is the “Coalition” really a Tory-policy steam-roller?
@Timak and DunKhan, I certainly don’t support the Government’s plans; at root they go against what healthcare professionals say works and what the public want. The problem is as nigel puts it, we already have competition in the NHS and a great deal of private sector involvement, often at disproportionate cost to the taxpayer. That this is the case seems to have come as a complete surprise to the press and all these campaign groups, which is a testament to how misleading Labour’s style of government was.
@David Allen, I only mention the 1995 paper as this was the last time this sort of discussion about the nature of the NHS was in the public eye. All the way up to our manifesto for last year the party has seemingly endorsed the purchaser/provider split and all the inherent contradictions and perverse incentives that come from marketising a commodity as complex as healthcare. Indeed, one of the major problems for the party has been our lack of decent health policy for some time but especially in the couple of years before the general election. It seems to me that either the coalition negotiating committee threw health overboard to get a better deal on tax and so on, or we just didn’t have any depth of material to challenge the Tories. I’m going to lean towards the latter just because there seemed to be absolutely no discussion in the party about the White Paper from over a year ago even though it was the first big ticket item that wasn’t in the coalition agreement.
The system that this bill is trying to create is an absolute dogs’ breakfast for all the reasons previous posters have identified. The disadvantages of the system proposed are obvious, and of course it is going to be a gravy train for the private contractors just like the PFI. It looks like we’re destined to make the same mistakes over again, at the cost of vast amounts of money that could have been spent on patient care.
I had to smile when the original poster felt that to seeking to achieve his objective “support and coordination from HQ could bring real dividends to the party which is suffering from the perception that its MPs are out of touch with the voters and the grassroots party membership”. Top down coordination desirable for organising successful political activism, but complete unnecessary – indeed a positive hindrance – when trying to organise a national health service.
@Alex, it’s important to recognise that the Bill only raises the potential of more privatisation, not actual privatisation imposed from Whitehall. Any steps towards greater private sector provision will be made at a local level by the commissioning groups, which can and should be influenced by the Health and Wellbeing Boards, local media, local politicians and the public. I’m guessing that we’ll see quite a few services going to private provision, but to reduce the chance of this, we need to be out there pressing the case locally where we can make a difference rather than simply whingeing about it.
My main point I suppose is that we shouldn’t see everything seeimngly daft the Coalition does as the end of the matter, rather use them as opportunities.
“My main point I suppose is that we shouldn’t see everything seemingly daft the Coalition does as the end of the matter, rather use them as opportunities.”
Well, I suppose there may be some opportunities to campaign locally against the changes we have backed at the national level. Our opponents have always accused us of saying totally different things to different audiences. Well, what the heck, if everybody believes we are unprincipled and duplicitous, well then, we might as well act that way!
Sorry Tom, that’s a rather vicious comment for me to make against someone who I suspect has got the best of motives. But apart from anything else, it just isn’t going to impress the voters when we mount bold heroic local campaigns against our own national party…
The Liberal Democrats will not be forgiven for this ill thought through, rushed undemocratic and unwanted change to health care provision. How many hours to consider 100’s of amendments ? Hasty and rushed legislation is bad legislation and it is becoming a hallmark of this coalition government. It is what this government will be remembered for.
Remember that this change is unmandated and unwanted.
As mentioned above, the costs for health care provision will escalate with the NHS being exposed to EU competition law. As with all over privatisations of public sector provision, there will be no discernible improvement for the service users but escalated costs. The only people rubbing their hands in anticipation are the American and continental Health Care providers and people like Serco.
My partner is a nurse and has worked in both private and NHS settings. If you think that private health care providers main concern is the anything but extracting as much profit as they can whilst providing minimal service and low wages for staff, you are kidding yourselves.
Today is a very bad day for the country, and disastrous for the Liberal Democrats in the long term who have signed off the demise of the party.
DunKhan’s post is an interesting one. The question is how useful is competition to the health sector? I don’t really know much about how the NHS works, but DunKhan makes some good points. We should also remember that competition is vital for the private sector to ensure that companies don’t slack and cut quality to increase profits.
This bill does come across as being a bit of a fudge and if it goes wrong the right will blame us for making changes to it and the left will blame us for allowing it to go through.
I think as a party we need to have some foresight on this. If this goes wrong it will be an absolute disaster for the party and could well cause irraparable damage to the party and it may be a long, long time before we ever get back to having 20+% support let alone having aspirations to being the biggest party in the country.
Well, anyway, let’s be thankful the Lib Dems aren’t actually trying to face two ways on this. The parliamentary party is expressing overwhelming support for it.
We can all take note, and vote (or abstain) accordingly at the next election.
17 comments about the most important piece of legislation that could make or break the party and 30 comments of introspection about conference security just shows how far this party has travelled……
@ David, I’m not sure you get my point. The essence of the bill is to devolve decision making to the local level for how health services should be delivered and you can describe this as anything from enshrining the Lib Dem commitment to localism to the Secretary of State washing his hands of the NHS.
So from this new starting point, it’s entirely up to local healthcare professionals, councillors etc whether they do ‘support the NHS’ or get rolled over by private providers. Given that we’re in coalition so can’t actually have things all our own way nationally, we should put some effort into campaigning locally where we can make a difference.
It’s not about campaigning against the Bill locally-what would be the point of that? It’s about using the new structures put in place by the Bill to the advantage of the party, and we can only achieve that if we actually go out there and do something that has a positive impact on people.
@Tom Smith:
“we can only achieve that if we actually go out there and do something that has a positive impact on people.”
Shame that you’ve done nothing positive at all for sick and disabled people who rely on the NHS and welfare to survive.
“it’s entirely up to local healthcare professionals, councillors etc whether they do ‘support the NHS’ or get rolled over by private providers”
So, in other words, if local professionals don’t “support the NHS”, and now that you’ve removed protections to stop this from happening, it’s nothing to do with your party or this awful bill, right?! Why is pushing this bill through, only allowing 12 hours to debate over 1,000 amendments more important than your duty to the public who did not vote for nor want, based on opinion polls, this bill?
The public really don’t matter to you, do they?
Jolly to see an ad for BUPA on this page. After the LibDem’s vote last night, maybe lots more private healthcare group will advertise on LibDem Voice.
I totally support jacktimms – Lib Dems MPs should be ashamed of themselves – the electorate will not forget this abandonment of principles in suporting this bill
@ squeedle, in case you haven’t noticed, I’m writing as someone who is opposed to the Bill. I’m putting forward a more productive response to it to stop it actually damaging health services rather than just jumping up and down shouting out random rhetoric.
The health service is safe in coalition hands? Will that be the next election mantra and will the public believe it?
Tom Smith writes:
One point stuck out clearly from all the froth and furore about the Health and Social Care Bill. Labour MPs claim that there is no legal obligation for the Secretary of State to provide universal health care, and neither Andrew Lansley, nor Paul Burstow, nor anyone else in the Department of Health appears to deny it. Instead what we hear from the government seems to consist of two main threads. Firstly, that there has never been such a legal obligation. Secondly, that the Secretary of State has, in practice few tools which he could use in order for him to run a failed hospital, for instance.
I would like to suggest that the government’s arguments are spurious.
The first argument is easily dealt with. It might well be the case that the Secretary of State for Health has never been under the legal obligation to provide an adequate, universal health service, right from the first days of the NHS under Attlee’s government. Having discovered this peculiar fact, does not, however, excuse the present government from legislating to remedy this historical omission. If an engineer were to discover that a bridge could under certain circumstances fail, he would not focus on the fact that the bridge had managed to survive for seventy years, would he?
The second argument is also quite simple. If a hospital or some commissioning authority were to go bankrupt or were otherwise unable to provide adequate care for a particular community, the public would not expect the Sec. of State simply to rub his hands of the whole affair. If he were to say that Parliament had not given him the authority to do anything about it, you could expect people to gather in large numbers outside Parliament complete with pitchforks, torches and other rustic equipment.
Suppose, in the duration of time, England was to evolve to having a National Health Service with a large private contribution to its provision of care, perhaps with a significant insurance based component to its financing. Such a scenario is certainly not unimaginable, it corresponds, after all, in broad terms, to the universal provision of health care throughout our European neighbours. Whether or not such a system is desirable or not is an argument I have no interest in dealing with, there are plenty of other people splattering green ink all over their keyboards on the subject. What I would like to say, though, is that even were we to migrate to such a model, what would the public expect their government to do, were a major health insurer, say, to go belly up? I’ll tell you. We would expect the Sec. of State to take the phone call at four of the morning, get out of his bed, phone the Speaker at ten minutes past four and get him to cancel whatever other business Parliament was dealing with on that day. Then we would expect him to drive straight to his office, dragging in all his senior staff, too. We would expect him to have put in place whatever temporary arrangements were necessary by that same afternoon. And we would expect Whips of all parties to give any MP who felt the need to chunter on about interfering in the operation of free markets whatever abuse they felt appropriate in order to impress upon the malcontent the need to shut his mouth.
So. no, it is not good enough for Andrew Lansley and Paul Burstow to give the answers they have given with respect to this particular subject. This should be corrected.
Further to my previous post, I would like to say that I am sure that neither Andrew Lansley or Paul Burstow would wash their hands were there to be a major failure of health provision. I can also understand that they instinctively fear the potential cost of any open-ended commitment to the universal provision of health care and how a legal obligation might be abused in the courts to force provision of all sorts of things that were not intended. However, I would suggest that they have allowed Labour to argue them into a corner. They really ought to make a (careful) statement of obligation.
The real problems is the enormous scope for dodgy dealing. In a few years from now we will start getting a trickle of stories about backhanders, overcharging and holidays for public officials paid for by health consortia. The scale of the corruption will be on an epic scale, but most of it will go unreported because of libel laws and lack of interest from newspapers worried about ad revenue
Tom Smith said:
“@ squeedle, in case you haven’t noticed, I’m writing as someone who is opposed to the Bill. I’m putting forward a more productive response to it to stop it actually damaging health services rather than just jumping up and down shouting out random rhetoric.”
No, indeed, I didn’t “notice”. When you say things like: “There are furious complaints from 38 degrees and others …… Whatever the merits of these arguments, they somewhat miss the point.” – well, you don’t quite come over as the most committed of opponents, do you?
The public aren’t going to notice the subtleties of your position, either. They are simply going to judge by outcome. If things go pear-shaped and some of Richard in Norway’s “epics” do make big time news, the Lib Dems will get blamed for it. And if local Lib Dems are making a “productive response” which amounts to opposition at the local level, they will only invite derision as well as blame!