Shirley Williams sets the record straight on NHS reform

It has been suggested by one of our readers that we give a higher profile to a speech made in the House of Lords on Tuesday, especially in light of the ongoing debate on these pages. And so, without further ado…

Baroness Williams of Crosby

I want to say a word about competition, and it is appropriate to do so given that the noble Lord, Lord Warner, has just been speaking. He has always spoken with some courage on this issue, which I recognise is not exactly popular with his party. However, I say quite directly that I feel very strongly that we have allowed the issue of competition to become quite different from the reality that we have encountered in the Bill, in this House and from the argument that is going on outside. That is because we have tried to treat competition as an absolute-either we have a competitive market for the National Health Service or we have no competition at all-and we all know that to be false.

We all know that there is a role for competition but the argument is about how limited it should be, what it should be addressed to and whether it is then balanced by, for example, equally strong duties in relation to co-operation, integration and the bringing together of services. I think we all recognise that competition can make a significant contribution in innovation and bringing in new ideas. For example, we have only to look at the recent developments in the treatment of stroke victims and victims of heart conditions to see that there has often been an innovatory role for the private sector. However, many of us also believe, as I certainly do, that the National Health Service should continue to be primarily a public service, that it should be available free of charge and that it should be accessible to all. Therefore, competition must exist but essentially it must be balanced by other considerations which, in the case of what we have been discussing recently, are clearly of great significance-particularly the role of the integration of services and the role of co-operation, which in terms of our main priorities, including the care of the elderly, are absolutely central and crucial.

If we can get the debate on to those issues, what will the outcomes be and what will the practical effects be? We may then be able to contribute to a National Health Service which remains a public service but which is also capable of advancing and moving in innovatory and new directions. Frankly, that is what many of us on our Benches and, to be fair, many on other Benches-the Labour Benches, the Cross Benches and the Conservative Benches-want to see as well. I am thoroughly fed up with reading pieces on social network sites, such as Twitter, which have presented this debate in terms of how we voted on the last amendment and if we did not vote for it then we must be in favour of the marketisation of the NHS. That is simply absurd and it makes me very angry. It adds to what has become a silly debate, a fictional debate which has led a great many people to believe that what is being discussed here is not at all what is being discussed, but some other strange, nightmare battle between marketisers and publicisers and no possible compromise can properly be reached between the two. I feel very strongly about that. I am fed up with reading about how I am actually a secret marketiser, when I know perfectly well that I am not. Many others may feel the same way.

For the full Hansard report on the 5th Day of the Report Stage of the Health and Social Care Bill, click here

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  • Nick (not Clegg) 8th Mar '12 - 3:19pm

    This makes six posts on the subject of the NHS Bill since 6 March. The first four already have attracted lots of comments and lively debate with all shades of opinion from “for the bill”, to “against the bill” via “confused”, “don’t know” and “is the amended bill better or worse than the original version”. Do you guys still not think that you need to debate it at this week-end’s conference?

  • Well Shirley Williams

    You may well be fed up with reading criticisms on social network sites, However, I am sure many of your voters and indeed the majority of the country are well and truly fed up with being lied to and deceived by this government and your party in particular.

    Neither yourselves or the Tories have a mandate to implement this Bill, it was in nether of your manifesto’s or in any coalition agreement.
    This is a total betrayal to the country and no amount of guff or spin will change that!

  • Tony Greaves 8th Mar '12 - 3:25pm

    I hope that other readers can understand his contribution by Shirley. As someone who has a closer working knowledge of the Bill than many people, I think I understand what she is saying. But not long ago Shirley was arguing for the removal of Part 3 Chapter 2 on Competition. And just saying “the Bill is now okay” does not satisfy people who believe the opposite.

    Shirley is now complaining that people outside do not fully understand what has been going on in the House of Lords Bubble. Well yes, plenty of people in the Lords don’t understand either.

    Our team on the Bill have worked hard and successfully to ameliorate some of the stuff in the Bill and they deserve great credit for that. But the fact is that the overall effect of the Bill will still be to increase and accelerate the privatisation and commercialisation of the NHS which Labour started in 2006.

    There are millions more people outside the Bubble than inside and they include the vast majority of people who care deeply about the future of the health service.

    We have lost the argument and our parliamentarians have lost the plot. Passing this Bill, even in its somewhat anaesthetised state, will do great damage to the NHS and great damage to our party.

    Tony Greaves

  • This is now the second pro-bill piece today on Lib Dem Voice.

    Perhaps to address the balance the editorial team could also republish this piece from Evan Harris – clearing marking where the bill as it stands has met with the membership vote held last year

    Or will there be two opinion pieces tomorrow from those in the Lib Dem membership (the majority that is) who oppose the bill.

  • @Daniel Furr

    That was a constructive post wasn’t it.

    I think everybody knows perfectly well what was meant by saying neither of the parties had the mandate to implement these reforms based on the fact that it was in neither manifesto or put to the electorate in the first place.

    Being so pedantic does either yourself or the debate anything constructive 😉

  • Nick (not Clegg) 8th Mar '12 - 4:27pm

    @ Daniel Furr

    Erm they don’t. The Oxford Dictionary defines a political mandate as “political authority supposed to be given BY ELECTORS* to (party in) parliament”. None of the parties requested from the electors (by placing it in their manifestos) consent to a massive top down reorganisation of the NHS and no-one voted for such a thing . So, although, as you say, the government has the legal/ constitutional power to enact this piece of legislation, it has no mandate for it: and will deserve to be severely punished by the electorate , if, in spite of all the opposition, it goes ahead. As the junior partner in the coalition, the LibDems should beware suffering a disproportionate share of that punishment.

    * Sorry, I don’t mean to shout, but I haven’t worked out how to put words in italics on this site!

  • Nick (not Clegg) – have you read our manifesto. It contains no commitment to “no top down reforms”. Indeed it does talk about some major structural reforms with local health boards taking over from PCTs which sounds like a top down reform!

    Also was said we would “Giving Local Health Boards the freedom to commission services for local people from a range of different types of provider, including for example staff co-operatives, on the basis of a level playing field in any competitive tendering – ending any current bias in favour of private providers.” – again that sounds like a pretty major piece of reorganisation.

    Now you can argue that GP Commissioning isn’t the same thing as local health boards or that we’ve implemented something substantially different to our manifesto but to say we didn’t have major reform of the NHS in our manifesto is just plain incorrect!

  • Foregone Conclusion 8th Mar '12 - 5:07pm

    I also find the heavy slant towards ‘pro-bill’ articles quite irritating. I’m sure it’s true that this is the balance of submissions, but if LDV wants to cast itself as truly neutral it should strive actively for balance. If the BBC gets fifteen people saying that the Bill is bad and five saying it’s good, they don’t give two-thirds of their airtime to anti-bill voices, they try to ensure some kind of equality. Simply saying, ‘why don’t anti-bill people send us posts’ is not good enough, especially since you exaccerbate the imbalance by having house commentators like Mr Valladares essentially quoting bits from Hansard favourable to their argument.

    As Ben Parker might have said, ‘with great webtraffic comes great responsibility.’ Please exercise it!

  • If the Liberal Democrats had won the election outright, would they have come up with this NHS reform bill themselves and would they be trying to sneak the bill past the electorate?

    If the answer is clearly No, then really the party has no place in supporting this bill.

    It’s quite simple really.

    And lets not go on about coalition and compromises please. Something as monumental as these changes to our NHS that so many people are reliant on is far beyond the chuckle vision “to me to you” farce that is this coalition

  • Nick (not Clegg) 8th Mar '12 - 5:14pm

    @ Hywel, Are you really trying to kid me , or yourself, that that extract from the LibDem manifesto gives LibDems a mandate to enact Lansley’s bill which, if I have understood the latest version thereof, actually says something quite different? And, although those words might have been in the manifesto, they were kept well hidden from the electorate; none of the leaflets which I delivered contained any mention of them!

  • Tony Greaves 8th Mar '12 - 5:22pm

    It’s interesting that no-one comments on the substance of what Shirley said or what I have written here. Just peripheral and irrelevant arguments!

    Tony Greaves

  • Simon Bamonte 8th Mar '12 - 5:26pm

    David Cameron promised us in the 2010 election “No top-down reorganisations of the NHS.” In fact, the coalition agreement specifically states the coalition will “end Labour’s constant reorganisations of the NHS”.

    This bill breaks your own coalition agreement.

    It’s simple: the public don’t want this bill. The majority of doctors, nurses and other healthcare experts don’t want this bill, either.

    The LibDems were, rightly, on the side of the public and spoke the loudest against Blair’s Iraq adventure. Yet in just a few short years, we’re now willing to ignore the wishes of the public and those in the NHS and press ahead, fingers in ears as if the public are just a distraction. Where’s the democracy in that? Where is the democracy in committing to something only to go back on your word once power has been achieved?

    Again, this bill is unwanted by the majority of people in the UK. Passing this bill will only further damage the already broken trust we have with most of the electorate. Yet supporters of this bill muddle on, seemingly ignorant to the further damage it will do to our party. The government has refused to debate the most popular e-petition, calling for the bill to be withdrawn. So much for Clegg and Cameron’s boasts of the e-petitions being a “new dawn for democracy”. Like usual, they just ignore anything that is inconvenient to their plans, treating the public as if we don’t matter. Our MPs and Lords who support this bill are acting just like Labour did over Iraq: ignoring the public and ignoring the experts.

    Why are the people of this country being ignored on this bill?

  • David Allen 8th Mar '12 - 5:36pm

    Hywel’s quote from the manifesto: “Giving Local Health Boards the freedom to commission services for local people from a range of different types of provider, including for example staff co-operatives, on the basis of a level playing field in any competitive tendering – ending any current bias in favour of private providers.”

    Masterful stuff. On first reading “They’re encouraging staff co-operatives, discouraging private providers, and seeking expanded choice under the governance of a quango”.

    On second reading “They are preparing the ground for increased competitive tendering by private providers, while throwing out a distracting nod toward staff co-operatives, along with flying pigs no doubt”.

    Danny Alexander wrote this stuff, didn’t he? Clearly he’s not as daft as he looks!

  • Nick (not Clegg) 8th Mar '12 - 5:40pm

    @ Tony Greaves. Sorry you feel that way. I, frankly, did not understand Shirley’s speech, but I agree with your initial comment: particularly the last two sentences. So are you supporting those LD members who have petitioned for a debate on this at Gateshead?

  • Richard Dean 8th Mar '12 - 6:35pm

    Great news! Though not exactly concise prose! I am glad that Shirley now supports the bill. I believe the electorate would have no choice but to blame us if we block it. They now have the opportunity to respect us for having had a huge debate and for having decided that we support the bill as it is now.

  • Tony Dawson 8th Mar '12 - 7:14pm

    The problem with this quote from Shirley Williams is that it is OK as far as it goes, which is to assert that the political motivation behind how Shirley and her friends are acting is not ‘marketeer’. Anyone who does not accept that is really living in cloud cuckoo land. This does not, however, translate to the conclusion that the Lib Dem peers’ voting will definitely not effect things within the NHS which Shirley might not wish to see happen. For, keen advocate of the NHS that she is, Shirley does not necessarily have the best technical grasp of what the various clauses of the Bill would actually achieve in practice. Other trusted peers, such as Lord Greaves, clearly take a different view to hers, as do a lot of people involved in the NHS who have looked at these proposals long and hard.

    My own view is that the political downside of implementing this Bill is possibly more damaging than the Bill itself is to the NHS, which is, in itself, not inconsiderable. When the last Labour government’s 20 per cent cuts in the NHS (which the Colition have largely left alone) come through the pipeline, there will be much wailing and gnashing of teeth. And a lot of the blame will be laid at the door of ‘the changes’ whether true or no.

  • Stuart Mitchell 8th Mar '12 - 7:20pm

    Interesting piece by MD in this week’s Private Eye about a letter by a Dr Sam Everington to the government asking for the bill to be withdrawn. This is particularly interesting because Everington is a founding partner of a highly acclaimed and innovative practise in a deprived area of London where Lansley chose to make his first speech as health secretary. He was also Lansley’s “special guest” at the Tory 2010 spring conference.

    When people like this call for the bill to be withdrawn, we ought to consider what they say carefully. His main criticism of the bill is that it introduces a huge amount of unnecessary bureaucracy (something Lib Dems normally don’t like??) and that this will have an adverse effect on patient care.

    Full text of letter here :-

  • MacK (Not a Lib Dem) 8th Mar '12 - 7:51pm

    Your coalition agreement states:
    We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise.
    “The Local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations” Conservative and Liberal Democrat Coalition Agreement. Crown Copyright May 2010.

    The above is a commitment to maintaining PCTs, democratizing them further and extending their scope. It is not a commitment to abolishing the PCTs. We are told that Lansley had been working on his revolutionary NHS reforms for years prior to the general election yet there is no mention of the abolition of the PCTs in your agreement. At the time that your coalition agreement was being negotiated the Tories obviously lied to you and to the British people about their intentions. That is why, with complete equanimity, you are entitled to kill this undemocratic bill. Why don’t you?

  • @MacK (Not a Lib Dem). Brilliant. I totally agree.

  • “But I also think if we demand of our politicians that they be in touch with the public and accountable for their views, then the public is failing to use our powers to hold them to account properly by losing touch with them.”

    Oh I agree, and parliament are always wanting to champion there “Tsar'”s as advisers to the government. who in return receive multi million pound contracts

    So Instead of Tsar’s that are running multi million pound government contracts at the expenses of the tax payer whilst engaging in highly questionable and “alleged” unethical processes, lets have Tasr’s appointed from Disability organisations like Disability Rights or Mind, who have the subjects best interests at heart and not those of the companies like A4e who have executives payroll who live in some weird possibly appearing like a ” polygamy community” in a multimillion pound estate which has been accumulated from funds paid by the tax payer

  • Mark Valladares Mark Valladares 8th Mar '12 - 11:22pm

    Foregone Conclusion,

    With the greatest of respect, this piece isn’t a comment piece, it’s a reporting piece, included because we were asked to do so by a reader. And, as a member of the Editorial Team, I’ll publish articles regardless of my personal view of their accuracy, reason or whatever, as long as they fulfil our editorial policy. In this instance, I was assisting a fellow team member by sharing the publishing burden for the day. As we’re all volunteers, most of us preparing to travel to Gateshead, spreading the workload seems like a good idea.

    At the moment, we are receiving articles of the NHS reforms at a rapid pace, and you’ll be seeing a lot more of them over the coming days. So, don’t be so quick to judge…

  • Martin Pierce 9th Mar '12 - 8:23am

    Well I’ll respond to Tony Greaves and say “well said Tony”. It is indeed very hard to follow all the nuances when you have main focus on job and family even when you’re interested. What Shirley has said isn’t unreasonable of itself but (a) it does sound different to her previous position and (b) is it what will happen? There’s nothing in the bill to promote joined up working and plenty it seems to bring in much more private sector. Also I’m confused – have we or haven’t we got the things that were in Nick and Shirley’s letter? I agree this is a political disaster for us unless – as even Tim Montgomerie recommended to us – we now summarily vote to kill it.

  • See page 8 of the Foreword to the Coalition Agreement:

    “For example, in the NHS, take Conservative thinking on markets, choice and competition and add to it the Liberal Democrat belief in advancing democracy at a much more local level, and you have a united vision for the NHS that is truly
    radical: GPs with authority over commissioning; patients with much more control; elections for your local NHS health board……… [especially] Together, our ideas will bring an emphatic end to the bureaucracy, top-down control and centralisation that has so diminished our NHS.”

    See also page 24 under the heading NHS – “We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.

    I suggest that we all have another good look at page 24, Section22 on the NHS and compare it with what is being written into this Bill.

  • Jayne Mansfield 9th Mar '12 - 9:12am

    I just don’t understand how Dame Shirley has moved from her position of last February to her current position.

    In a Guardian article, ‘NHS threatened by disruptive reforms’, she criticised Lansley’s bill saying that ‘ it will “dismember” the service through ‘untried and disruptive reorganisation.

    I hold Dame Shirley in high regard and respect her opinions, but I can’t get my head round this one.

  • Richard Dean 9th Mar '12 - 11:05am

    @Jayne. Dame Shirley is a human being, She makes mistakes, like the rest of us. She also makes statements based on information that changes over time, and so her conclusions change too. And I imagine she might occasionally misread or misunderstand things, like we all do, and need to correct herself.

  • Stuart Mitchell 9th Mar '12 - 7:39pm

    @Richard. Dame Shirley is also very loyal to her party leadership.

  • I believe Nick Clegg wants a the LibDems to move on. The problem is that all the real experts believe that this bill is severely flawed and should be dropped.
    Imagine how many LibDems will be in positions in 10 years time when all the country is still bitter and smarting and the health of this nation is beyond repair.

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