Tony Greaves writes… The health and social care bill. The party has spoken. What happens now?

The next big event comes very soon and is nothing to do with the Liberal Democrats or the coalition per se – it’s the BMA’s Special Representative Meeting tomorrow (Tuesday) which they say “will form a key part of our activities to step up member engagement and lobbying”. I suspect it will also get a lot more publicity than the Liberal Democrat conference did.

There are some outrider motions of no confidence in Andrew Lansley and calls for “industrial action” which will result in a lot of press noise and no action, but there seems little doubt that the meeting will be at least as critical of the changes as Liberal Democrats were at Sheffield. A momentum for change may be building.

Meanwhile there will be a lot of discussion within the government and the Department of Health. It will consist of civil servants and Tory ministers digging in their heels, seeing it all as a matter of personal and departmental pride and status, and looking for a minimalist response based on “damage limitation”. It’s a crucial moment for Paul Burstow and Nick Clegg, and other pivotal Liberal Democrats at the heart of the coalition such as Danny Alexander and Norman Lamb. Some of them are going to have to put their personal views aside and fight for their party.

Paul said after the debate that “the party has shown its mettle by setting out areas for improvement in the bill. I can assure you we are listening to the party’s concerns and I will be taking those concerns back to the government.” It’s not the party’s mettle that is at stake; that was never in doubt. It’s the mettle of our ministers. If they flunk this one, conference may not be so gentle in future. (Or perhaps the deal has been done already in government? No.)

What of the Conservative Party? Backbench MPs and Tory activists are not immune to the pressure of public sentiment, nor to opinion polls, as we saw over the forests. My guess is that apart from the ideological head-bangers on the right, a lot of Tories would be only too happy to see the health changes substantially watered down. Remembers all the research showing that the people who benefit
most from the NHS over their lifetimes are people who typically read the Mail.

Also “meanwhile”, the Health and Social Care Bill is in Committee stage in the Commons. They are well into it with the next sitting also on Tuesday. It will then go back to the Commons chamber for Report stage. This is when Labour will have the chance to make real mischief by proposing amendments in line with the Sheffield motion. If the government have any sense (always an “if” with any government) they will delay Report until they have decided what changes they are willing to make. If Liberal Democrats stand their ground, that may take some time.

Once the Bill has passed the Commons it will come to the Lords. That will provide another possible interval for reflection. When it gets to us it will be subject to detailed scrutiny in a committee of the whole House, without either a guillotine or the “selection” (ie censorship) of amendments as happens in the Commons. My advice to the government is to sort out the essentials of a deal before it comes to us. To do that they need to involve us (in the Lords) directly in the deal.

My third “meanwhile” is this. The government are (disgracefully in my view) pre-empting the legislation by starting on reorganising the health service, particularly at local level. If they have any sense they will now put all that on hold. But I have even less faith that they will do that – unless, again, the Liberal Democrats with power in government insist.

Tony Greaves is a Liberal Democrat peer.

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58 Comments

  • It really is crunch time, but I do not hold out much hope. It appears the Tories have already begun the process of diggin in.

    http://www.bbc.co.uk/news/uk-politics-12734324

    I believe the coalition agreement give the Lib Dems the right to withdraw support from this Bill and even vote against en masse (ministers as well). That should be the gun they hold over the heads of the Tories.

  • Steve: absolutely. I expect our MPs to vote against this rather than side with the Tories against the wishes of their own party and the interests of their own constituents – even if the cost is a risk of more legislative deadlock.

  • David Blake 14th Mar '11 - 3:45pm

    If our MPs support the Government on this, we might as well pack up.

  • Cleggstatic 14th Mar '11 - 3:49pm

    @Tony Greaves
    What happens now?

    Cue tumbleweed blowing across a deserted landscape …

  • David: I have to agree. Quite apart from the moral issue of us not buggering up the NHS, this is a test case. If the party can’t influence our MPs, whips, and ministers, what are we bothering for?

  • Having reneged on a pledge to a student organisation already (and we all know the consequences of that error of judgement) It is imperative that the party in Westminster accepts the will of the party at large and votes against any of this bad legislation and if that risks bringing the coalition down so be it.

    I suspect the voting public at large would support us on this and perhaps we may if we are lucky start to rebuild the trust we have lost and deserved to lose!

    Come on Mr Clegg if you still have a moral compass lets see it!

  • grace Boddy 14th Mar '11 - 4:34pm

    What happens to the NHS is of vital importance for everyone in England (the proposals for NHS reform do not apply to other parts of GB) The Lib Dem manifesto wanted more democracy at local level but nothing like the current proposals. Market forces in the NHS under Thatcher failed to yield the reduced costs and higher quality services that was promised. Why will it be different now? This is crunch time for me and many other Lib Dems. Our MPs have no mandate from country or latest conference to support the current proposals. I am a long time Lib Dem activist and councillor but this is where I draw the line…
    Grace

  • Dominic Curran 14th Mar '11 - 5:52pm

    The reality of the situation is that the Tories need us far more than we need them. An election now would see them lose power. It would also see us lose power, but if it was over a principled stand on the NHS, we would retain the support that we are in danger of losing (if it’s not gone already), and might even get some support back. Plus, we’re used to being out of power!

    Also, and i don’t know how many times we need to repeat this to our backbenchers: THIS WAS NOT IN THE COALITON AGREEMENT!!!!

  • Emsworthian 14th Mar '11 - 5:52pm

    Lansley merely shrugged his shoulders when asked about it on the politics show. This is a man with a mission honed over the 6 years while he was shadow and he’s not in negotiation mode. If we say we’re voting against it we have to mean it. Fudge it and everybody walks. Who is clamouring for more local democracy anyway?
    People want an effective and accessible treatement, not more elections, committees and groupthink local or otherwise.

  • Does the Party have any actual ideas about how to make savings in the NHS?

    Or does it just want to throw its toys out of the pram when someone else tries to?

  • Andrew Suffield 14th Mar '11 - 5:56pm

    I believe the coalition agreement give the Lib Dems the right to withdraw support from this Bill and even vote against en masse (ministers as well). That should be the gun they hold over the heads of the Tories.

    That’s not how this works – indeed, if this happens then it indicates trouble for the coalition government. Passing bills as a UK government is not often like passing a conference motion, where the final outcome is in doubt until the votes are counted. The government will not place a bill before parliament unless it has reasonable confidence in its ability to pass that bill. It will not let things go to a vote which it expects to lose, and it will not take this bill to the final stages without a firm understanding of the LD parliamentary party’s position and an expectation of sufficient support. Anything else would be a hideous embarrassment, because the whole job of the whips is to make sure that this happens.

    That doesn’t mean the Tories can do whatever they want – far from it. It means that the bill which is finally placed before parliament will be one that has reached some level of agreement between the parties. If the LD MPs vote against the bill that finally arrives, then it indicates that communication within the coalition has broken down, which is bad.

    Short version: the original text of the bill is now not going to happen; the government will not be stupid enough to try that. It will be changed somehow. We can’t easily predict how. This is not a war and “shoot the other guy” is not a sensible approach.

  • @Adam

    When you say ‘legislative deadlock’ deadlock I wasn’t sure whether you meant solely on the NHS Bill or more generally.

    To be honest if all LibDem MPs vote against the Tory proposals I think it will actually reduce legislative deadlock as Cameron will realise that he has to be more careful about the legislative programme and think in advance what a LibDem party with teeth might do especially to dreamt-up policies not covered by the Coalition Agreement and party Manifestoes.

  • ^ What Tony Greaves and everyone else has already said, I’m not sure I can add much more.

    But just in case there’s anyone who doubts what these proposals will really mean, Shirley Williams herself has said that they amount to a “stealth privatisation” of the NHS:

    http://www.guardian.co.uk/politics/2011/mar/12/shirley-williams-nick-clegg-nhs

    I don’t know about you, but I didn’t join the Liberal Democrats to privatise the NHS.

  • Cleggstatic 14th Mar '11 - 6:16pm

    @Andrew Suffield
    Short version: the original text of the bill is now not going to happen; the government will not be stupid enough to try that.

    That might be the short version, but the BBC has the real version:
    Downing Street has ruled out “significant changes” to government NHS reforms following their rejection by Liberal Democrat members. No 10 said it would not make large changes to the proposals, but added they could be amended by Parliament.

  • @Andrew Suffield
    Perhaps the gun metaphor was a bad one, but the threat that Lib Dems will, if pushed, vote against the Bill is the only thing the Tories will listen to. This was not in the agreement, therefore neither party is obliged to support it. Just as the Tories are campaigning against the AV vote. If Clegg states publically that he cannot support the Bill in its current form as it would be against the views of his party and the voters who put him in office then Cameron would either have to adapt it or scrap it. It is issues such as this that could show the public the value of plural politics and by extension the value of Lib Dems in Government.

    This should be able to be the case with any legislation not in the agreement where the parties cannot reach compromise. It should not mean the end of the coalition, in fact it would show that coalition Government means that issues outside of the original agreement must be agreed upon. What it should also mean is that post election where there is a hung parliament that more time is spent on the agreement and that we should perhaps expect weeks not days of negotiations as is the norm in other countries with regulalry coalitions.

    Shooting the other guy may not be a good approach, but neither is lying down and playing dead. The party has given Nick clear guidance, he knows what he needs to achieve, if he cannot then he should simply withold support for this single issue.

  • David Allen 14th Mar '11 - 6:49pm

    This is now a game, and the BBC have helpfully described Cameron’s first stroke. Thanks to Cleggstatic for:

    “Downing Street has ruled out “significant changes” to government NHS reforms following their rejection by Liberal Democrat members. No 10 said it would not make large changes to the proposals, but added they could be amended by Parliament.”

    @Tony Greaves: It seems to me that this can be translated as “OK you Libs, let’s see if you dare to vote Lansley down. Because that’s what you’re going to have to do. We have already decided what changes we are willing to concede at Report stage. Almost none.”

    Is that interpretation right, do you think? I fear that it is. There has plenty of time for Dave to ask the key question “are you going to push me really hard on this one, Cleggster?” and for Nick to reply “er, not terribly, old chum”.

    And if that’s so, it will come down to the votes of individual MPs, just like tuition fees did. I wonder if Cameron can engineer a rationale for why a coalition-loyalist rump of Lib Dem MPs should support him and save his bacon, as they did on fees?

  • Just a word of caution… I posted in reply a few weeks ago about why the conservatives would opt for a snap election, it was concerning damage limitation to the conservative party after they had forced through whatever polices they deemed they could get away with in the shortest period of time.

    I think they will be watching the polls as much as anyone else and if, I think if their redline is reached they will call a snap election as damage limitation for future years, I don’t think we are there yet, I do think we are at that stage of pre warning/amber if you like, but the NHS could be used as a trigger point.

    You can see the meeting… Who has got the bigger balls?

    “Nick you either support the reform or we may as well call an election.” Says Dave
    “Dave we cannot support the NHS reforms as they are, we could do this?” Says Nick
    “May the 5th ok Nick?” Dave says smiling

  • I listened to Andrew George carefully on the Westminster Hour last night, to see if I could understand the Party’s PlanB for health service reform.
    But he was very vague and unspecific and left me still wondering what the fuss is all about, except to help to soothe the wounds of coalition..
    I must say the idea of PATIENT CHOICE appeals to me greatly because I nearly always emerge very grumpy from NHS clinic treatment.
    My last clinic, for routine retinal scan, involved waiting for half an hour in a narrow corridor sharing germs with some dozen others. Eventually I am in the hands of a technician who has to tick boxes for my medical history.
    My complaint that I shouldn’t have to wait half an hour, and they should have my records from my GP, did not endear me to her and my treatment was brusque.
    However,.as I left she snapped “enjoy the rest of your day” thus implying that I was a person rather than a simple scan statistic.
    My experience of NHS clinics is that they are very impersonal ; given an alternative I would certainly explore it..
    As for “creeping privatisation”, if the monopoly is inefficient, as described above, surely it deserves to be challenged by an alternative provider.
    The idea seems to be that since the service is “free” you must be grateful for what you get. Although a state pensioner I would rather pay a small fee for a more efficient service.
    Elizabeth

  • I would of course be happy with that result… forgot to add that ^

  • “Short version: the original text of the bill is now not going to happen; the government will not be stupid enough to try that. It will be changed somehow. We can’t easily predict how. This is not a war and “shoot the other guy” is not a sensible approach.”

    I’m sorry, but just a few concessions won’t be good enough – Lib Dems have a duty to derail the ENTIRE Bill. Any kind of top-down reform swallows up huge amounts of funds – that means that, with the government only set to give the NHS the bare minimum, any massive restructuring will put frontline NHS funding under unprecedented pressure. Lib Dems need to block ANY significant reforms to the NHS – if not, they’ll pay the price at the ballot box. Like Evan Harris, don’t let yourselves become associated with the recontamination of the Tory brand.

  • Ecojon: I meant deadlock generally. At the moment there seems to be a certain amount of informal (that is, outside the Coalition Agreement) quid pro quo, in which the Lib Dems let a certain amount of Tory stuff through, and vice versa. I’d not be over-upset if this was scaled back so the only areas that were legislated for were: Coalition Agreement (or one of its successors), matters where both parties agree, or responses to urgent matters arising. This would mean quite a lot of things never getting off the ground. (I assume that the Conservative party will not countenance a situation where LD-only policies get passed but Con-only ones don’t!)

    Incidentally, I agree with Andrew Suffield’s clarification, these things should never come to a vote – MPs should make their unwillingless to support unacceptable bills clear in advance.

  • Why does anyone believe the myth that the tories can call a snap election and win it? Have you ever looked at the opinion polls?

  • “That’s not how this works – indeed, if this happens then it indicates trouble for the coalition government.”

    Not at all – this is a measure which was never in the coalition agreement so there is no expectation that either party would support it.

    “Passing bills as a UK government is not often like passing a conference motion, where the final outcome is in doubt until the votes are counted. The government will not place a bill before parliament unless it has reasonable confidence in its ability to pass that bill.”

    Why not – aren’t we about changing the system? Lets see Parliament debating measures that are preordained.

  • Andrew Suffield 14th Mar '11 - 8:58pm

    Lib Dems have a duty to derail the ENTIRE Bill.

    Your proposal was considered by actual Lib Dems at the conference, and was overwhelmingly rejected.

  • Great news to hear that Clegg apologists think that Tuition Fees is now a non-issue.

  • “Your proposal was considered by actual Lib Dems at the conference, and was overwhelmingly rejected.”

    Good for you – but people at the next election will see it differently.

  • @Stephen W
    “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.”

    “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.”

    So where exactly does it state PCT’s are to be scrapped in these statements?

    “Doctors and nurses need to be able to use their professional judgement about what is right for patients and we will support this by giving front-line staff more control of their working environment.”

    So why ignore the BMA and RCN ?

  • David Evans 15th Mar '11 - 8:32am

    The problem is that however well our leaders do in this, and whatever is finally put to parliament, it will still be portrayed by the unions, the Labour party, and particularly the many Labour supporters who work in the NHS (nurses, GPs, etc etc) as the destruction of the NHS by those nasty Conservatives and their little helpers in the Lib Dems. Anyone who expects this to result in an improvement of our perception by the general public is sadly being astonishingly optimistic.

    The only thing that will improve our ratings is a clear strong message that we are not standing for this from Nick et al in the press and TV, coupled with a massive climbdown by the Conservatives, possibly accompanied by Lansley’s resignation. Alternatively voting the bill down in the Commons would have the same effect. All very unlikely to my mind. However, if we did, we could then move on and look to improve the NHS in less draconian ways, possibly then portraying the unions etc as being against all change.

    A nicely negotiated behind the scenes settlement, leaving the bill still in place will be another nail in our coffin for 2015. If the leadership don’t understand this, they don’t understand leadership.

  • I agree with many of the comments above so will not repeat them.

    Now that the Members have spoken and totally rejected the proposals as they have been presented, it is time for Nick Clegg et al to show their mettle! They have the backing of the Party Members – we have given them the mandate to change this.

    We put them in power – we can take them out again – they should not forget that either. If we, as a Party, pride ourselves as being the Party whose Members formulate Policy, we need some evidence to show that OUR Policies can actually reach the Parliamentary table and, ultimately, the Statute Books.

    If our wishes are not taken into consideration, why have we all been bothering to go to Conferences and formulate policies at all for the last 20+ years or longer?

    Let us not forget that, at the moment, the NHS Reforms are still just PROPOSALS – they are not yet in Bill form.

    Now is the time to minimise the impact of these changes and to moderate the aspirations of DC & his little Tory helpers – Andrew Lansley particularly.

    This must NOT be allowed to reach a Bill stage without substantial change at the Proposal level. If it does reach the Bill stage, then I would urge the House of Lords/Peers/Nobles (whatever they are going to be called – and that’s a nonsense too) to BLOCK its progress completely and throw it out of the House(s) altogether –

    Back to the drawing-board boys (mostly) and girls (few of you)!

  • The only reason the conservatives are tempted to privatise NHS at all is they think they can get away with it, and that a large portion of the blame will fall onto Liberal Democrats.

    As for the Conservatives calling a snap election, the moment Liberal Democrats get balls and say we cannot support you in this, and importantly vote against, then the game is over.

    You took 30 pieces of silver, conservatives will expect you earn it

  • ex liberal democrat 15th Mar '11 - 10:01am

    Nothing. Your leadership masters will nod and wave and follow the Tory policy.

  • @Stephen W

    I note the points you have stated that are in the Coalition Agreement. On reading them I can’t help but wonder whether they were skilfully crafted by the Tories who already knew what they wanted to achieve vis a vis the NHS.

    I have no means of knowing this but looking at just how well the Tories have politically filleted their much less-experienced Libem colleagues I think it is worthy of consideration.

    If that is what the Tories were up to then I hardly believe that the LibDems could be held to an agreement which was tainted by subterfuge. Again us mere mortals – the voters – might never really know until the memoirs and diaries are published.

    I am also concerned about the comment: ‘But these people should be ignored. The Above is the program agreed by Conservative MP’s and the full triple-lock procedure of the Lib Dem party. It should therefore be implemented.’

    I may well be in agreement about ignoring a lone dissenting off-the-wall opinion but that would only be after examining it and ensuring there was nothing of value in it at least in my opinion. But whether the vast majority of the LibDem Spring Conference should be ignored is a step that even I as an LP member wouldn’t take 🙂

    There’s also a lack of recognition that people and organisations, despite the best will in the world, get things wrong and make mistakes. It seems clear to me that the LibDems made a terrible mistake in firstly not seeing the trap woven by the Tories in the Coalition Agreement as regards the NHS and an even bigger one when elements of the Parliamentary Party started supporting the dismantling of the NHS.

    The mistake has now been recognised and an attempt made to reverse or dilute it which surely is the moral thing to do. Triple locks are meant to be unpicked and principled LibDems are fully aware that the public interest is more important than their own party on some occasions and I happen to think this is one of those occasions.

    On a purely personal note about personal choice I remember 35 years ago when one of my children was struck down by a very serious illness and given weeks to live. His illness was right on the frontier of medical knowledge and I was totally emotionally wrecked. I was in no condition psychologically to make any decisions as to his treatment and couldn’t understand it anyway. I am intelligent and well-educated but it was way beyond me.

    Then 12 years ago I had a life-threatening illness and I was too bloody scared to make any rational decisions about my medical care.

    What I’m trying to say is I’m not capable or interested in making informed choices about my healthcare. I want a brilliantly trained team of specialists that I can trust on a professional level making those decisions and spelling out the alternatives, if any exist, to me.

    What is paramount however is that I don’t want any of that team making the decision based on financial considerations for them personally, their partnership or their employer. I do accept that their may be wider financial considerations as to whether society can afford certain medicines or procedures or whether at a certain age you don’t get them but that is another issue.

    The thought of us going down the road where unscrupulous GPs could be diverting patients to treatments or treatment facilities that they have a financial stake in and take a profit from really is Dr Frankenstein scary to me.

  • “What is paramount however is that I don’t want any of that team making the decision based on financial considerations for them personally, their partnership or their employer. I do accept that their may be wider financial considerations as to whether society can afford certain medicines or procedures or whether at a certain age you don’t get them but that is another issue.”

    Well, no, they ARE the same issue and that’s the point.

    There is a massive blind-spot in this country about healthcare, and it goes like this:

    – everyone wants the best possible healthcare for them and their family and friends, and no doubt for wider society too
    – as the population get older, and more complicated and innovative treatments become available, that creates two doses of demand
    – the majority of people accept that there has to be a limit to the health budget
    – if demand increases at a rate that outstrips the supply of cash to pay for it, there will be rationing (there already is)
    – someone, somewhere, has to make a decision about how that demand is rationed; there has to be control over budgets
    – if you remove budgetary constraints from those making clinical decisions, then the budget will be busted

    Hence – we already have the situation where treatment decisions are made on the basis of what their employer (the NHS) can afford.

  • Most sensible Conservatives would have nothing at all to do with further privatisation of the NHS, nor costly stupid re-organisations for willy-waving points for Lansley. The Lib Dem motion, plus (possibly more important) the BMA resistance will give the saner Tories (including Cameron i think) an opportunity for re-appraisal and major modification to this Bill.

  • Tony Greaves 15th Mar '11 - 2:36pm

    One difficulty is that the coalition agreement is quite vague (and remember this is the Programme for Government – the full document and not the headline agreement that the party signed up to when it agreed to the coalition). For instance the words about GP commissioning obviously meant different things to different people. There was what had gone on before and there was the wholly new idea that GP consortia should replace PCTs and the rest (other than the public health that goes to LAs).

    Lansley obviously got the words he wanted, even if no-one else understood them, and then went off to do his own thing.

    By the way the HoL does not reject government Bills as a whole – it subjects them to scrutiny and revision. But on occasion that can be fairly brutal.

    Tony Greaves

  • David Allen 15th Mar '11 - 3:05pm

    Stephen W,

    You seem to want to have this both ways. Anything that is in the Coalition Agreement and which the Tories want to retain or hugely inflate in importance, such as GP commissioning, is sacrosanct. Anything that is in the Coalition Agreement and which the Tories now find inconvenient, like the key role for PCTs, can be quietly dispensed with.

    Whatever the LD Manifesto said about PCTs is irrelevant. The agreement that was actually signed up to assumed that PCTs would continue. That would not have been compatible with the quasi-privatisation scheme which Lansley is now proposing. That is the crucial point, not whether some clever lawyer can twist the words to make them seem to be describing something a bit like the Lansley plan.

  • David Allen 15th Mar '11 - 4:34pm

    Stephen W,

    No, I am not a Tory. I am a left-of-centre Lib Dem opposed to the coalition in its current form. Are you a Tory?

  • Stephen W

    The Lib Dem manifesto proposed replacing PCTs with elected boards. The present proposals involve replacing them with GP consortia.

    Saying that this should be considered a “bonus” is rather like saying that the introduction of a military dictatorship would be a bonus, because it would involve the abolition of First Past the Post!

  • Having watched this evening’s BBC news, it appears that the government is already rubbishing the BMA stance calling it confusing. As Lib Dems we must persuade Nick Clegg to immediately adopt the Spring Conference decision and advise DC accordingly. If Lib Dem MPs go along with Lanley’s proposals it will be the privatisation of the health service and we will have a system such as that in the USA (great for those with money, desperate for those without).

    For the sake of the majority of the British public and perhaps, just perhaps, the salvation of our party, it is essential that our MPs either ensure that SIGNIFICANT changes are made to the bill or otherwise vote against it in the Commons. Failure to do either will certainly mean that I will be be destroying my party card although I will continue to work for the local party in local elections. Tuition fees were bad enough and I almost made the decision then, complicity in the destruction of the NHS will be the final straw.

  • John Fraser 15th Mar '11 - 7:53pm

    Excellent article Tony.

    As a former Lib dem I am genuinely interested in how many of you think Clegg aculayy believes in these privatisation reforms.

    If not why has he not kicked up a stink before ?

    If Clegg does not fight tooth and nmail to amend thes proposals ..what do you guys think should happen next in the party ?

  • @Stephen W
    “And abolition of PCT’s was the one reform that was actually in the Lib Dem manifesto”

    Ummm no actually, unless I’m missing it somewhere. Moving their commisioning responsibilities to elected health boards was.

    “Empowering local communities to improve health services through
    elected Local Health Boards, which will take over the role of Primary
    Care Trust boards in commissioning care for local people, working
    in co-operation with local councils.”

    Two real points here:

    1. An elected health board would not be a profit making organisation, GP’s are. They would have had the good of the community, and only the good of the community at the heart of their organisation. Also their is great expertise in the PCT’s that the GP’s do not have.

    2. PCT’s have a number of rolesoutside of this that have not been properly ctered for. For example, in my area Health Visitors do not know who they will be working for. They are concerned for theirs terms and conditions (and these are no fat cats). TUPE does not totally protect them in particular their pensions.

  • Well Cameron has said he’s changing nothing – the only problem is lack of proper presentation.

    http://www.ft.com/cms/s/0/f1acca90-4f4d-11e0-9038-00144feab49a.html#axzz1Gi0UJn5n

  • @Elizabeth

    There are private health services, and health clinics, in the uk. The NHS does not have a ‘monopoly’ as such, you can choose to purchase private healthcare if you wish, although you it is unlikely you would ever be paying a ‘small’ fee, since private healthcare is expensive in every country (especially so in countries where there is no public competitor).

  • @Rob & Jonathan Featonby

    Yes there is a private health sector in this country with a very large element of NHS consultants involved.

    Not only do they benefit from the training that most of their medical staff have received in the NHS but the NHS is their security-net when things are botched or just go wrong.

    On the opposition day motion it will be interesting to hear what LibDem MPs especially Ministers have to say especially as Cameron has ruled out any changes to the Bill following the LibDem Conference resolution.

  • Ecojon: the tories saw sense on selling off forestry, they may see see sense here too. I know this isn’t at the same stage of legislation, but perhaps not all hope is lost.

    Totally agree with regard to private healthcare at present being parasitic on the NHS – this makes it look artificially effective and efficient.

  • Tony Greaves 16th Mar '11 - 6:13pm

    As a matter of fact the Health and Social Care Bill is at exactly the same stage of legislation as the Public Bodies Bill was when the forestry clauses were abandoned (committee stage in the first House it went to) except it started in the Commons and not the Lords.

    As for the Labour Party, they would do better trying to work with Liberal Democrats rather than use Commons debates to try to cause us embarrassment. As it is, it’s hard to think that the Labour Party really do want to change the legislation – they prefer to be able to attack. Their behaviour is really rather appalling. (But it’s the Labour Party and what we all expect of them).

    Tony Greaves

  • @Tony

    You are in government not labour they will obviously attack where it will hurt – what do you expect a quiet time?

  • Quite surprised at how few LibDems spoke in the NHS debate – just seemed to be Pugh, Mulholland and George and a couple of interventions from Hughes but I don’t think he actually spoke.

    I would have thought this would have been an ideal time for LibDems to put a bit of pressure on Cameron – they didn’t even need to vote for the Labour motion. As I say it quite surprises me especially so soon after the conference resolution.

  • On these plans it’s entirely possible that the Labour Party find themselves in the happy position of being able to follow their own party policy, stick one to the government, and gain popularity by doing so.

    It’s important that our ministers don’t feel that the need to look strong in the face of Labour criticism overrides party policy, manifesto commitments, and public will.

  • I think that the only thing that will re-assure the country that the threat to the NHS has passed is the abandonment of the bill and Lansley’s resignation. That is the size of the Liberal Democrats’ task.

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