Opinion: We need to talk about the NHS

Later this week , at spring conference in Gateshead, the Liberal Democrats will have the opportunity to debate issues and define party policy. Now, more than ever, this internal democratic process has the opportunity to actually influence what the government does. The NHS is likely to be on most people’s minds, and possibly on the agenda as an emergency motion.

I’m a member of the Liberal Democrats, but as a doctor, I’m also a member of a number of other organisations too. I’ve become acutely aware of the very different ways that these organisations have responded to the health and social care bill over the last couple of months. And in particular how the leadership of these organisations has responded to the views of their members.

Both my professional organisation, the Faculty of Public Health, and my union, the BMA, have had their own lively policy discussions. And both have allowed their internal democratic processes to take place. The grass roots campaigned, raised awareness, called for meetings and presented motions. These motions were discussed openly, and then voted on. In both cases the members voted against supporting the bill, and then, after discussion, the leadership followed suit, changing their position and have now come out against it.

Many Lib Dem members are concerned, however, that the opportunity to discuss the NHS will not be allowed this weekend. Or that the motions discussed may not be those that represent the genuine breadth of members views.

I’m sure the experts on process and rules at the federal conference committee could come up with a way to challenge or stifle debate on the NHS bill in the forthcoming conference. My challenge to them is not to do that. Instead, to allow the party’s democratic process to happen, and to be seen to happen.

I’m not arguing here to vote one way or the other on the NHS. I’m just arguing that a debate should be had. The party’s name seems to support the idea. Lim Dem HQ’s own website describes conference as ‘democracy in action’, claiming:

“The Lib Dem Conference is a recognisably democratic event in a sense that the other conferences can      no longer claim to be. Policies are proposed, amended, debated and voted on in an impeccable  manner”.

That’s what I want to see. However, if the party does not listen to its members, then maybe it’s not so different to the others after all.

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This entry was posted in Conference, Op-eds and Parliament.


  • As a Tory, but a coalition supporter (so I’m allowed on here, right?) I see your conference as the last chance to get the bill dropped. I really hope it happens and it’d be great if we could all forget our party differences and just come together on this issue. Not all Tories support this bill and we’re stronger together than we would be apart.

  • Richard Dean 7th Mar '12 - 7:54pm

    As a LibDem, I support free and democratic debate. But debate is only relevant if some of the people involved are open to rational argument , and open to changing their mind on the basis of what is said. Not Tom, it seems!

  • @Richard Dean

    The same could apply to you as well 😉 I don’t think you are open to changing of opinion.

    As far as the topic goes. I thought Libdems had this “talk” already at your last conference, In fact, I believe conference passed a motion that said part of the bill should be dropped and tabled other amendments. Trouble is the MP’s and Lords of your party are simply choosing to ignore you.

    Hardly democratic in my opinion

  • Richard Dean 7th Mar '12 - 8:39pm

    Aeiiiooow! 🙂 But seriously, no one has yet produced a rational argument that would persuade me to change! Though some do come close.

  • Nick (not Clegg) 7th Mar '12 - 8:43pm

    So, Richard, you’d like those who are opposed to the bill to be rational and open, and to change their minds, while those who are in favour stay where they are and explain to the former the errors of their ways; have I got that right?

  • Richard, I too hope you are one of those who are ” open to changing their mind on the basis of what is said”, and that you – after listening to the arguments – do the right thing and decide to kill the Bill. In other words, change your mind.

  • I fear there will be no real debate on the Bill. The stakes are too high to let ordinary Lib Dem members rain on the Coalition’s parade.

  • @Richard Dean
    I may be the only one, but I find your comparison of typical anti-billers and bi-polar paranoid schizophrenia to be very far over the line of common decency. No it is not PC to make light of an illness that affects many thousands of people, or to compare people who feel passionately about a political debate to those who have a debilitating condition.

  • Richard Dean 7th Mar '12 - 9:30pm

    @Steve Way, OK, you win, As a person who has actually had those mental issues, I will bow my head and not laugh at myself any more. Can we get back to the topic now?

  • Felix – you say you’re a doctor; are you an 3vil private-sector partnership GP, or an 3vil private-practice surgeon or physician, or a good NHS-salaried clinician?

  • @Richard Dean
    Having a condition and being able to laugh at it does not give anyone the right to expect the same of others. You are not simply laughing at yourself when doing so in a public forum where others can be offended. It is not a case of my winning, but you having the courtesy to apologise where offence has been caused.

    The topic is easy; of course there should be debate, it should be informed and people should be willing to listen to reason. Insulting people is rarely the best way to change their minds.

    To my mind any debate should be around not so much the aims of the Bill, but it’s unintended consequences. Too much hot air about “wholesale privatisation”, which this Bill is not, and not enough talk about the real issues will be a waste of time…

  • Richard Dean 7th Mar '12 - 10:40pm

    @Steve Way. There’s not likely to be much of a debate if personal attacks dominate.

    It should be pretty clear to everyone that I never intended to cause offence to people with the real mental conditions of bi-polar disorder, or paranoid schizophrenia. But if you look at the arguments used by some of the oponents of the bill, they do show some of the same symptoms of disorganized thought patterns. Go back just a few days and look at how people have changed their arguments in response to my consistent defence of the present bill. As someone else has noted (was it you?) there is 50% emotion, 49% irrationality (?), and only 1% of practicality. And as Maria says above, people are bewildered rather than informed.

    All words in the english language have wide meanings, and the words “bi-polar”, “paranoid”, and “schizophrenic” are in common use as descriptions of strategies of debate, as well as of business and social plans of all sorts, and of course mental illness. If anyone who has those disorders feels offended, I do apologise, but I don’t apologize for describing some people’s arguments that way. If I am debating and I say someone is inconsistent, it’s just a shorthand way of saying their argument is consistent.

    Let’s be friends. I can’t afford Gateshead. If there is a debate there, I wonder if there might be some rather strong language, particularly if the final vote doesn’t go the way some people want. 🙂

  • Richard Dean 7th Mar '12 - 10:43pm

    It’s just a shorthand way of saying their argument is INconsistent!

  • Dave Eastham 8th Mar '12 - 10:05am

    As a coalition partner the lib dems have spent a year engaging with the HSC bill. Quite rightly so, it’s the responsible thing to do in Government. The objectives and party policy were set out in the amended conference motion to seriously amend the Bill in order to make it in some way rational and achieve meaningful reform of the NHS. Rather than the incoherent collection of ramblings that was the actual Bill born out of a completely evidence free White Paper (no evidenced references – Lansley’s speeches do not count) which tortured the language of “liberation” in a way reminiscent of George Orwell’s 1984 .

    The test is has this been achieved?. I have to agree with Evan Harris and answer no to that one. The conference last September was told that it would not be appropriate to have a motion on the agenda whilst it was going through the parliamentary process. Well it has and it is now time for Conference to discuss the results. Federal Conference Committee has a big responsibility on this matter. I trust it will be up to the task and allow conference to at least decide if it wants to or not discuss if it wants to actually discuss the matter or not. Not attempt to bury the issue in a procedural manner. (Always assuming a properly constituted emergency motion on the subject is submitted)

    My view is that support for the Bill should now be withdrawn by the Lib Dems. But I’ve said that for some time.

  • Matthew Huntbach 8th Mar '12 - 10:07am

    Stephen W

    Please do tell me what has so radically changed in the last year

    The coming out in opposition to it of almost all the professional bodies.

    Sorry, I am a democrat, not a Leninist. To me democracy means listening to the people you are elected to represent and changing your plans if it is clear they are unhappy with them, and not ploughing away regardless with the Five Year Plan.

  • Andrew Suffield 8th Mar '12 - 10:31am

    Please do tell me what has so radically changed in the last year that a Bill, which has already been amended to Lib Dem preferences, has suddenly become entirely unacceptable when before it was? Sounds like political opportunism to me.

    Well, that’s because it is. The main objection to the bill is now political, not policy (the ongoing repetition of the same screams about privatisation that were wrong last year are still wrong today, and irrelevant). A large chunk of the party is now willing to put party before country, because the bill would be bad for the party’s electoral chances now that public perception has become so disconnected from the text of the bill.

    In a few days, we’ll find out how many of those people there are, and this will decide the fate of the bill. Politics is ugly sometimes but there it is.

  • Andrew Suffield 8th Mar '12 - 10:35am

    And I should add – I’m not even sure what the bill says any more, after the latest round of amendments. I haven’t bothered to look at it because it doesn’t matter. The reality of what the bill will do no longer has any impact on whether it will pass or not.

  • Richard Dean 8th Mar '12 - 10:36am

    It certainly seems to be true that most of the discussions are initiatied by people who object to the bill, so that support is mainly seen in defence against criticism. The present discussion seems to be like “talks about talks”, so to stay on topic is to avoid discussing the actual bill. Even so, to try to re-dress the balance a bit …

    One of the positive things I see about this bill is that it re-distributes power in health away from a centre. You can see this in the changes to the Secretary of State’s duties in the first few clauses of the bill. I would expect such a re-distribution to be generally attractive to the LibDem philosophy, in all sorts of areas, not just health. One of its benefits is that it can mobilize a much more committed and wider range of skills, leading to a better service for users, greater ability to innovate, and greater job satisfaction for staff.

    Another positive thing, which underlies the bill and produces parts that attract much criticisim, is the recognition that competition can be a force for good. It can be used as a driver to raise quality standards, and to reduce costs while not reducing standards. It does not conflict with cooperation, though specific training might be needed here to ensure that it does not, and people certainly seem to need much more information and re-assurance about this. Most of what the general public “know” probably comes from ridiculous imaginings like the House TV program.

    Returning to the topic of “talks about talks”, I wonder what the ground rules might be? I would hope that truth prevails, and that people distinguish clearly between what is asserted as fact, what is conjecture, and what is opinion. I would also hope that people do engage in discussion, taking note of other’s views, and replying, rather than a simple contest of who shouts the loudest or cleverest slogan.

  • Noone has explained why decentralising commissioning will save money. That’s because it won’t. Proponents of the bill claim that commissioning will be more democratic pushed down to the GP level, but also that GPs won’t actually do the commissioning themselves but will find someone else to do it. This is a having cake and eating it argument. We can apply localism to the NHS but it will increase the costs.

  • Jayne Mansfield 8th Mar '12 - 12:17pm

    What can I do to raise my IQ and level of academic attainment so that I accept your interpretation of the outcome of the bill rather than that of, for example, Dr Evan Harris or Dr Graham Winyard, Richard?

    Were you as determined in your support of the bill before all the ammendments were made as you are now?

  • Matthew Huntbach 8th Mar '12 - 12:51pm

    Andrew Suffield

    The main objection to the bill is now political, not policy (the ongoing repetition of the same screams about privatisation that were wrong last year are still wrong today, and irrelevant). A large chunk of the party is now willing to put party before country, because the bill would be bad for the party’s electoral chances now that public perception has become so disconnected from the text of the bill.

    Oh, for heaven’s sake – stop this “I know what’s best for you better than you do” stuff. Coming into this assuming you are so right, such a superior person, so endowed with a higher intelligence, that what you want is naturally “right for the country” is really, well, how the worst sort of socialists act. I would hope that as liberals we would not have that arrogance of assuming we are always right and so should just force what we want onto everyone else, and instead should be willing to listen and wiling to accept hat maybe we have things wrong.

    If the Royal Colleges have been taken over by political ideologues who aren’t interested in what is good for the country, wouldn’t there be a substantial number of doctors complaining about it and saying of their opposition to this Bill “Not in my name”?

    It would seem to me that if we really want a new sort of democratic and liberal politics where politicians actually listen, actually do not assume they know everything, actually are prepared to make changes in the face of those who really are in the know saying “This won’t work”, now is the time to show it – by halting this Bill.

  • Who would the “man in the street” trust most; Messrs Clegg and Cameron, or Drs Harris and Winyard? I would respectfully suggest this is one of those ‘no brainers’ again. (This reminds me of the 1960 Presidential election in the USA, the Democrats ran an ad with the caption “Would You Buy a Used Car From This Man?” under a photo of the Republican candidate Richard Nixon. Nixon lost to John F. Kennedy badly.)…….Old age ramblings, no offence meant.

  • Richard Dean 8th Mar '12 - 1:14pm

    @Jayne, I am not asking anyone to accept anything I say or write without thinking, But I am just exercising my human right to make written noises. It is up to you how you interpret them. As far as IQ and academic attainment go, I do not believe I have ever done more than point out that academic attainment does not confer wisdom or authority. You do not have to accept anyone else’s judgments, you are quite capable of making your own.

  • Jayne Mansfield 8th Mar '12 - 3:25pm

    As a matter of fact, I do not think that I am capable of making judgements of my own when it comes to this bill.The original bill and its multiple amendments have proved testing to better minds than mine.

    As a voter, I find I must decide the issue on the basis of trust.

    Do I trust Lansley ? ( His office was partly bankrolled by a private healthcare company when he was drawing up these ‘reforms’).No.
    Do I trust Cameron? ( No top down reorganisation of the NHS). No
    Do I trust Nick Clegg? ( Who signed the original White Paper, when according to reports , Shirley Williams claimed he had
    not read it? ) No
    Do I trust the government and the House of Lords when so many of them who support the bill have financial interests or are in the pay of private healthcare companies? No

    Occasionally, I have found my trust or my mistrust misplaced, but on the whole, it has stood me in good stead. I would like to see the bill dropped and a full discussion taking place on how the NHS can be made fit for purpose in the coming years. I would like that discussion to include all those professions who work within the service and those who are dependant upon it.

    I am sick of the arrogant dismissal of those who oppose the bill as ‘vested interests’, people who ‘misunderstand’ the bill , or’ left-wing wreckers’.

    When it comes to ‘vested interests’ I would like the spotlight to fall more fairly on those who have promoted, supported and railroaded this bill through parliament when I am still unpersuaded that there was a democratic mandate for the bill in the first place. Where was the groundswell of bottom -up local opinion that this massive top- down re-organisation was necessary? Who voted for it?

    My concerns are now not only limited to the health bill, but also what sort of ‘democracy’ we live in. Most of us don’t want to spend our time keeping closer tabs on our politicians, the gap between what they say and what they do, but this bill has made me think that we should. What a chore!

    Thank you for taking the considerable time that you have taken to respond to my posts. I am sorry that you have suffered past bouts of illness, I hope that you are now in good health.

  • Richard Dean 8th Mar '12 - 6:25pm

    @Jayne. I think we are on the same page. I managed to keep clear of politics for almost 60 years. I only recently developed an interest because of the obvious incompetence, dishonesty, and sometimes apparent outright corruption of many of our leaders, elected and otherwise.

    I believe that much of the problem with this bill has been due to the arrogance which allowed the government to present it as a fait accompli and without any care to explain it, leaving people in the quandry you describe. But arrogance is a reason to object to the approach,not a reason to obhect to the bill. As I got into this debate, two things became clear to me. One was that the actual bill, available on http://www.parliament.gov.uk , does not appear to be all that bad. The second was what seemed to me was the obvious wrongness, and sometimes what appears to be trickery, of the objectors’ arguments. And as I look into the actual bill in more detail, I don’t see any evidence of the problems people identify.

    I believe that you are not only capable, but also you are being asked, to make your own judgments, using whatever criteria and information you may have or may have time to find. That is democracy – it does not mean everyone has to be an expert! In my case, my answer is to explore whether to get involved. These are my first steps, and I find the experience quite illuminating.

  • Former LD voter 8th Mar '12 - 6:30pm

    Aftera decade of voting only for the liberals. I am thoroughly disappointed in how the LD have dealt with the NHS reforms. It is absurd that the politicians, especially the LD MPs are pushing ahead with this controversial uprooting of the current NHS, without a mandate and without the support of any of the professional health bodies. Do they not understand that whatever the LD believe and state it is poitnless without public support, The public eityher failo to understand the massive bill, or are agains tthe bill. Only 29% of the piblic are agains the adapted bill.

    I voted for the LD as they always seemed liked they had one of the British characteristics that I cherish, common sense.

    This is the time for the LD to prove themselves. Of never again the partyu has been seriously corrupted by power and will never deserve vote. I will not forget this undemocratic shambles this party is involved in.

  • Richard Dean 8th Mar '12 - 6:46pm

    @Jayne. You do have that ability. Democracy does not require everyone to be experts. It just asks people to make up their minds with whatever information they have, or have the time to find.

  • Former LD voter 8th Mar '12 - 9:50pm

    sorry for the typos….my previous message sounds like a rant, because it is.

    **the party does not understand that whatever the LD believe and state it is poitnless without public supporting their actions, The public either fail to understand this massive bill (as many politicians do), or are against the bill. Only 29% of the public are for the adapted bill.

    **This is the time for the LD to prove themselves. the question needs to be asked, have the LD been seriously corrupted by power? if they fail to heed the publics demands it will be remebered and will never deserve my vote. I will not forget this undemocratic shambles the LD are involved in.

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