It wasn't in anybody's manifesto, was it?

Sid CumberlandI haven’t read the Health and Social Care Bill (soon to be Act). More pages than a Harry Potter novel, and qualified by a thousand amendments, I’m not sure reading it would throw much light on my darkness. However, there are aspects of the bill I am aware of.

I know, for instance, that the NHS Bill was in no one’s manifesto, and I know there wasn’t the slightest hint of its major elements in the coalition agreement. The government has absolutely no mandate for NHS reform at all. It all seemed so clear … and then I made a foolish mistake. I went back to the three party manifestos, and the coalition agreement, and looked at what they said.

If you’ll excuse a little over-simplification, it seems that the two most significant changes proposed by the bill are the dissolution of the current bodies that commission healthcare (Primary Care Trusts) and the handing over of these powers to GP consortia, and the opening up of healthcare provision to ‘any willing provider’.

Let’s have a quick peek at the Conservative manifesto.

‘…we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers … We will strengthen the power of GPs as patients’ expert guides through the health system by … giving them the power to hold patients’ budgets and commission care on their behalf … putting them in charge of commissioning local health services’. To be honest, that looks rather like the two main elements covered.

The Labour manifesto: ‘All hospitals will … be given the freedom to expand their provision into primary and community care, and to increase their private services … We will support an active role for the independent sector … Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.’ Hmm. Not much about commissioning powers, but a distinct whiff of encouraging private provision – more of the marketisation and competition that dominated NHS reform throughout Labour’s time in office.

So – what about the Lib Dem manifesto? Not much there, actually; there’s the promise that if patients do not get diagnosis and treatment on time, ‘the NHS will pay for the treatment to be provided privately.’ And there’s a pledge to ‘scrap Strategic Health Authorities …’ (top-down re-organisation?).

So – all three parties were in favour of privatisation, to a certain degree, and some re-organisation. And there’s no getting away from the fact that GP commissioning was writ large in the Tory manifesto.

The Coalition Agreement has both the ‘any provider’ element and GP commissioning straightforwardly cut-and-pasted from the Tory manifesto.

I don’t like the NHS Bill, and I don’t understand why the coalition partners have been so desperate to see it enacted; but we do ourselves no favours if we simply condemn it as undemocratic and claim the coalition has no mandate to bring it before Parliament.


First published 28th March 2012 on Liberal Democrat Voice: you can read the Liberal Democrat Voice article and comments here.

How democratic are doctor politicians?

A group of 240 doctors recently threatened to stand against leading members of the government in the next election, in protest at the NHS Bill (Now the Health and Social Care Act). They are ‘shocked at the failure of the democratic process and the facilitating role played by the Liberal Democrats in the passage of this bill’. They follow the example of Richard Taylor MP, a consultant physician who won his Wyre Forest seat from a junior health minister in 2001, campaigning against the closure of the A&E Department at Kidderminster Hospital.

My immediate reaction to this news was essentially that it’s a free country, and anyone can stand for parliament if they like. I’ve seen very little comment about this, however, and I have begun to wonder about the legitimacy of such a campaign.

There were two possible scenarios when this initiative was first announced on 19th March. The first was that the government would bow to the pressure from this group of healthcare professionals and drop the bill. That was always unlikely, and that moment has now passed. The second scenario, which could still come about, is that this group stands 240 candidates in the general election, and wins a number of seats. It seems to me that both scenarios, for different reasons, are a potential threat to democracy.

In the first case, an unelected group would have imposed their will on parliament, forcing the government to alter its legislative plans. Surely, no matter how much one might dislike the NHS Bill, this is not acceptable? The doctors argue that ‘the will of the citizens of this country’ has been over-ridden by the coalition government. Has it? The two major elements of the reforms – the dissolution of the Primary Care Trusts and the handing over of their commissioning powers to GP consortia, and the opening up of healthcare provision to ‘any willing provider’ – were both in the Conservative manifesto. As we know, the Conservatives won more votes and more seats than any other party, and went on to form the coalition government with the Lib Dems, with both reforms finding their way into the coalition agreement.

We don’t know yet whether these doctors still plan to launch their ‘revenge’ strategy. But suppose they do. How would that fit with the way democracy works in this country? We can assume that they will have strong views on the NHS; but there has been no mention yet of their other policies (on free schools, for instance, or how they might stimulate economic growth, or whether they would replace Trident). Even if a small group were to be elected, they could exert considerable influence, given the likelihood of another hung parliament. An NHS campaign would have considerable popular appeal – but would a group of MPs elected solely on the back of such a campaign have genuine legitimacy?

Richard Taylor’s political activities were mostly confined to health issues. Other policies he pursued included support for Section 28, the renationalisation of the British railway system, and the availability of cannabis as a controlled drug. He also opposed the Iraq war. It seems reasonable to suppose that all the new ‘NHS’ MPs would also embrace an eclectic variety of views. I’m not convinced that would be good for transparency and clarity in our political system.

First published 26th March 2012 on Liberal Democrat Voice: you can read the Liberal Democrat Voice article and comments here.

What would Labour have done with the NHS?

Sid Cumberland

There have probably been more words written about the NHS than any other topic since the coalition government was formed nearly two years ago, with most attention falling on the tussle between the coalition partners over the final form of the bill.

But we should not overlook Labour’s contribution to the current maelstrom; no matter who had come to power in 2010, they would have had to grasp the nettles which were flourishing following Labour’s 2006 National Health Service Act, which brought widespread competition into the NHS (though without the public debate that is now taking place). The 2006 Act opened up the NHS to the risk of EU competition law being applied in a way that leaves commissioners unable to choose the best way of delivering services. And Labour’s legislation meant that private providers were favoured over NHS hospitals and paid millions for work which they never did.

Lib Dems, in the Commons and the Lords, are not only fighting Andrew Lansley’s ill-considered reorganisation of the NHS, they are also plugging the many loopholes left by Labour’s 2006 Health Act, including:

  • out of hours work was handed over to the private sector
  • Labour rigged the market in favour of the private sector (e.g.Independent Sector Treatment Centres were paid around 11% more than the NHS price)
  • There was no overall cap on private income for Foundation Trusts
  • There was no provision in the legislation to say all private income profit must be reinvested in NHS services
  • Labour deliberately went out of their way to encourage the involvement of the private sector. Labour’s PFI contracts for the NHS have left the Government a total liability of £65 billion.

The involvement of the Lib Dems will surely leave the NHS in a better position than it would have been had the Tories had it all their own way. But what about Labour? What would they be doing now, if they had won the 2010 election? Well, it’s worth having a quick look at their 2010 manifesto, which includes the following:

“All hospitals will become Foundation Trusts … Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private … services … We will support an active role for the independent sector working alongside the NHS in the provision of care … Patient power will be increased. Patients will have the right to choose from any provider who meets NHS standards of quality at NHS costs … We will expand patient choice, empowering patients with information, and giving individuals the right to determine the time and place of treatment.”

Hmm. Sound familiar?