Tony Blair, on the eve of the 1997 General Election, famously proclaimed that we have just “24 hours to save the NHS”. A nice rhetorical flourish, but lacking in objectivity. Perhaps somewhat like the Labour party. Similar language is once again being used this week as the House of Lords debates giving a second reading to the Health and Social Care Bill. Opposition groups have jumped on this by suggesting that this is the last chance to ‘stop’ this Bill. Perhaps unsurprisingly, given the complexity of the inner workings of the House of Lords, this doesn’t properly reflect the role of peers in the ‘other place’.
When we vote on Wednesday, we will not be voting to wave the Bill the through. Voting ‘yes’ does not mean we are simply saying ‘yes’ to the Bill. It means we are voting ‘yes’ to full scrutiny of a Bill, on the floor of the House so every peer can have a say, that we have already improved through the “Pause” after our Sheffield conference, and which will allow us to oppose issues that would undermine the NHS.
I have no doubt that many things still need to be changed, clarified or improved in the Bill. And as our Liberal Democrat Health Minister, Paul Burstow, said at conference:
The House of Lords revises, it improves, it challenges and that is what it will do with the Health and Social Care bill. That is exactly what it should do.
And that is exactly what we will do. Every minute I have spent in the House of Lords leaves me with absolutely no doubt that that Health and Social Care Bill will get full line-by-line scrutiny. For that reason, there is nothing wrong in agreeing to properly consider something that we know requires further changes.
We also shouldn’t forget that this is a better Bill because of the Liberal Democrats and the changes we fought for. The Conservatives wanted Monitor to promote competition. Instead we changed Monitor’s overarching principle to be the promotion and protection of patients’ interests. Private providers will no longer be able to compete for huge numbers of services. Our changes now mean they will only be allowed to provide services for a very limited number of treatments; and only where there is a tariff, ensuring that competition is on quality and not price. This will help bring an end to Labour’s competitive tendering where private companies were awarded contracts for services, such as community and mental health treatments, not because they were better quality than the NHS, but because they were cheaper.
So instead of near-blanket coverage of Any Qualified Provider, we will now have a situation where private, voluntary, and charity providers are only allowed to offer their services for 8 treatments – including mental health services. What’s more, all of these services have been agreed by commissioners and most crucially, by patients. And we shouldn’t forget that it is because of Liberal Democrats that the Bill now includes changes to ensure that no government, present or future, will be allowed to deliberately favour the private sector in the way the last Labour Government did when they paid private providers gold plated contracts which ensured they were given £250 million for operations they didn’t even perform.
Some people are still concerned about the accountability of the Secretary of State. I was personally greatly encouraged by Paul Burstow’s words at Report in the Commons, when he said that
…we are willing to listen to the concerns that have been raised and, if necessary, offer clarifications or make amendments to put beyond legal doubt that the Secretary of State remains responsible and accountable for the comprehensive health service we all want to see.
It’s now our role in the House of Lords to make sure that those words are put into practice. Aside from the role of the Secretary of State, there are a number of issues that we must consider:
What will happen, for example, where a Clinical Commissioning Group and its Health and Wellbeing Board cannot agree on the contents of the Joint Strategic Needs Assessment or Health and Wellbeing Strategy? Will Directors of Public Health have sufficient tools and resources at their disposal, financial and otherwise, to hold local authorities to account and make sure that they take their public health responsibilities seriously? And given the impending demise of Strategic Health Authorities, what will be done to stop the existing medical education system from disintegrating before anything can be set up to replace it? All of these are issues, and many others require careful scrutinising from the House of Lords.
Liberal Democrats can rest assured that this is exactly what we will do.
Baroness Jolly is Co-Chair of the Liberal Democrat Parliamentary Party Committee on Health and Social Care.
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18 Comments
The Coalition agreement states: “We will stop the top-down reorganisations of the NHS.”
Yet this is indeed a top-down reorganisation of the NHS. So both Tory and LibDems are breaking their own agreement and the promises made to the electorate. Your MPs should not have let this bill get as far as it has. Such wonderful representative democracy, eh?
“We also shouldn’t forget that this is a better Bill because of the Liberal Democrats and the changes we fought for. ”
LOL
We also shouldn’t forget there wouldn’t even be a Bill without the Liberal Democrats support. If the NHS dies, your party dies with it.
And when the NHS does not die, what then?
I suggest that people who make silly statementys about the NHS “dying” should first read the Bill as it now stands.
There are good reasons for rejecting the Bill now and good ones for letting it go to full HoL scrutiny. But life or death of the NHS is not one of them.
Tony Greaves
Sorry, you cannot make something that is intrinsically bad, better. Remember Oscar Wilde:
Yet each man kills the thing he loves
By each let this be heard,
Some do it with a bitter look,
Some with a flattering word,
The coward does it with a kiss,
The brave man with a sword!
My experience, as someone intimately connected with the NHS is that it is already dying, slowly being strangled by the leadership who are already implementing Lansley reforms at the behest of the Department. The Bill needs to be killed, with a sword; not the NHS with a flattering word – or a kiss!.
“Private providers will no longer be able to compete for huge numbers of services. Our changes now mean they will only be allowed to provide services for a very limited number of treatments; and only where there is a tariff, ensuring that competition is on quality and not price”
Why not set the quality standards and then choose the provider on price? That way more money will be available to treat patients?
It is a pity that the BBC doesn’t accept that the vote at the Sheffeld Conference forced the ‘Pause’. However continued resistance to the Bill is the recognition that this is still an imperfect piece of legislation and is by and large unacceptable to most of the Medical profession and the public. Sometimes politicians should recognise that certain decisions are so emotionally charged that they are best dropped.
@Roger “and is by and large unacceptable to most of the Medical profession ”
Just like the NHS when it was formed then.
Simon
A simplistic reply. The doctors who were against it in the first place were outside the NHS and were consultants who Bevan had to buy off. The doctors who are against it today are in it, know it, appreciate it and are therefore informed experts. You would do well to listen to them.
To Baroness Jolly
At the bottom of this deranged Bill is Lansley’s obsession with competition. WHY ARE YOU ACCEPTING THIS ASSUMPTION THAT COMPETITION WORKS BETTER THAN COLLABORATION? Where is the evidence?
Mrs Thatcher nearly wrecked the Civil Service when she introduced internal competition. Why do you accept it?
The extent to which successful businesses rely on collaboration has never been fully recognised. It is one of the secrets behind Japan’s manufacturing success in the last thirty years. Why are we accepting dud business models to justify structural changes in the NHS?
I saw what the IMF Structural ReAdjustment Programmes did to developing countries: greed, inefficiency, corruption, with the poor (the ultimate users) getting screwed at every point. That is what will happen to the NHS p because our LibDem politicians were either too intellectually lazy or too happy to kowtow to the Tories to seize this opportunity to become a great Party who really did stand for fairness.
@ John carlisle
i’d be careful of promoting japan’s manufacturing success in the past thirty years in support of your argument, given that it has stagnated for the past twenty!
Is there not a danger that we risk loosing political capital and leverage in the Lords by focussing on the re-writing of one badly flawed Bill?; there are many other flawed Bills before the House at the moment which deserve proper scrutiny from our team – for example the Welfare Reform Bill has some odious provision which will withdraw benefits such as ESA from people with degenerative conditions, and the Legal Aid, Sentencing and Punishment of Offender which abolishes 66% of civil advice provision. If we want to have a postive impact on the legislative agenda, especially on tory proposals, then surely our peers need to spread their efforts more evenly accross different pieces of legislation.
Increased competition in the NHS has not harmed deprived neighbourhoods, according to new research from the Centre for Health Economics (CHE), University of York.
“Our findings echo similar results from previous research into the Conservative ‘internal market’ reforms of the NHS in the 1990s, all of which points to little change in socio-economic equity in health care over the past two decades. Neither Conservative nor Labour attempts to introduce competition into the NHS appear to have had any measurable effect on socio-economic equity in health care.”
http://www.york.ac.uk/che/news/che-research-papers-66-67/
I heard two-thirds of the debate yesterday and almost all the LD contributions. It made me proud to be a Liberal Democrat. Do not underestimate the ability and commitment of the Lords to knock this Bill into a much better shape. The debate yesterday and today is just the beginning not the end of the process. Do not understate the progress that has already been made as a result of LD pressure in the Commons and within the government following the Sheffield conference in the spring.
Owen’s amendment is just silly. It would send important parts of the Bill to a tiny select committee chosen by the party whips and meeting in an obscure committee room out of the public gaze. The best way forward to sort these things out is to scrutinise them and change them on the floor of the House where all the expertise can be brought to bear.
There are in my view good reasons to stop this Bill in its tracks now. I personally will vote for this if it’s put to the vote this afternoon. But there are good arguments to get the Bill into House of Lords committee (of the whole House) and give it the kind of thorough line-by-line and issue-by-issue scrutiny and improvement that only the House of Lords can do. That is what is very likely to happen: it will not be a defeat and a disaster if it does.
Tony Greaves
@london liberal
Do not confuse macro-economics with businesses. That is a common mistake and one I have rather come to expect from a Party that has no micro-economic policies worth a damn (slightly improved with Vince Cable). Until February this year it was the world’s second largest economy. Not bad in a country with such few natural resources!
It has three out the world’s ten largest car makers. Toyota is the world’s biggest.
So put that prejudice back in the bin, and think again about what I wrote and why. Then give me evidence that suggests that INVESTING in competition is productive.
As well as being dismayed and numbed by today’s votes on the health bill, it also reinforced how deeply STRANGE some (most?) Lib Dem politicians must be. For example, Shirely Williams campaigns against the bill but then apparently doesn’t bother to vote – huh? Guess it’s no worse than breaking a tuition fees pledge… Like psychopaths who (stereotypically) lack empathy, it seems that LD politicians lack the gene that gives normal people principles…
This coalition feels like a coup. From the viewpoint of a voter, LDs are a menace to democracy.
In spite of some of the comments above – WELL SAID JUDITH. The proof of this pudding will be in the eating, and as someone with a very active interest in the NHS as a patient, I shall be looking forward to tasting it when the Lords have finished their cookery.
ExLD, Shirley Williams has not been campaigning against the bill, she has been campaigning to improve the bill. She voted against Lord Rea’s attempt to drop the bill entirely. She’s been regularly meeting with Lib Dems including ministers, backbenchers, party members who are involved in healthcare in some form, and with Conservative ministers to put across Liberal Democrat views. I personally think that is admirable and that is why many people including peers in their speeches paid tribute to her work.
Chris