Not much to be said, really. This is for my Labour friends who still don’t admit that the last government had any responsibility for the mess we’re in, and who can’t bring themselves to give any credit to the Lib Dems for bringing a measure of fairness to our tax system.
I 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.
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.
Mark Pack‘s excellent infographic – updated to include some budget changes.
The result of the 1962 Orpington by-election, won in a landslide by Eric Lubbock, who became the then Liberal Party’s sixth MP, giving him the nickname ‘Orpington Man’. As Lord Avebury, Eric is still an active parliamentarian campaigning on human rights and other issues. You can read his blog at:
Thanks to Mark Pack for this excellent infographic:
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?
This is well worth a read. Personally, I’d be much more worried if I were Ed Miliband than if I were Nick Clegg – and Alex Hilton’s blog post makes it quite clear why Ed M is in such trouble.
I have a considerable amount of respect for local activists of all parties – I know how hard it can be to keep your own particular faith when your leaders seem to have lost theirs. Here’s an indicator of how hard it is for this particular Labour activist:
“It shocked me that party members, unions and MPs would back you regardless of the fact that you were so clearly not up to the job, have no vision for Britain and can’t communicate very well.”
Oh dear …
Lots of people are getting worried/rejoicing about low opinion poll figures for the Lib Dems. Well, here are some actual figures for the first three months of 2012:
The Parties’ vote shares in local by-elections over the last 3 months were:
Lib Dem 26%
That’s actual voters actually voting (5,000 of them).
Like the summer riots, the Stephen Lawrence case provides us with yet another attitudinal Rorschach test; we screw our eyes up, peer closely, and conclude that what we have seen is just what we expected. At least, that’s my view, after hearing Paul Dacre’s astonishing self-congratulation on Tuesday. For him, the verdict was ‘a glorious day’ for the Lawrences, the police, British justice, politicians, British newspapers (especially, of course, the Daily Mail, without whose ‘relentless campaigning’ none of this would have happened). For me, it was a good day; but it was also a reminder of the arrogance, incompetence and racism of the police, the ambiguousness of our justice system, the laissez-faire attitude of our political class, and, of course the hypocrisy of the British press. (The relentless campaigning the Mail is famous for is reflected by these recent headlines: ‘One out of every five killers is an immigrant’, ‘Each illegal immigrant costs us £1m, says study as Government faces calls for amnesty’, ‘UK migrant total is ‘three times the world average’’.)
The police response wasn’t much better. Cressida Dick tells us that the police force has been ‘completely transformed’ in the last twelve years. Hmm. I wonder if that’s the force which has seen section 60 stop and searches rise from 7,970 in 1997/98 to 149,955 in 2008/09? With black people 26 times more likely to be stopped than white people?
I do wonder if we’ve been distracted by the ‘institutional racism’ tag. I’m thinking of the long string of cases which have nothing to do with racism, where the police have not only misbehaved, but have also completely misunderstood public reaction to their behaviour. Harry Stanley (1999). Pamela Somerville (2008). Ian Tomlinson (2009). Nicola Fisher (2009). Mark Duggan (2011). In all these cases (and more) the police have been asked to account for their actions, and have essentially given us a two-fingered salute. When the standard response from the police to any query about why they have shot/hit a fellow citizen amounts to little more than ‘We felt a bit threatened’, it might be a good time to re-look at the whole relationship between the police and us, who pay their wages.
There is clearly a disconnect between the police and the citizenry. Here are some issues which currently concern people:
1) police officers collecting their wages from the taxpayer, and bonuses from journalists for providing information;
2) police officers working as agents provocateurs (Mark Kennedy, 2009);
3) hundreds of serving police officers having criminal records (including burglary, robbery, supplying drugs, perverting the course of justice)
4) senior police officers promoting the use of plastic bullets and water cannon at protests;
5) and, of course, the inequality in stop and search mentioned above.
Brian Paddick suggests: “The police must accept that many people feel they are over-policed and under-protected. The police need to work a lot harder to convince some people that they are on the same side as the communities they serve.”
It would be a shame if the end result of the Stephen Lawrence saga amounted to little more than black people being entitled to the same shabby treatment as whites. A glorious day for the press, the police, the politicians? I don’t think so.