Lib Dem activists have failed in a bid to force a vote on controversial NHS changes at their autumn conference.
Former MP Evan Harris had led calls for delegates to be allowed to vote on legislation going through Parliament overhauling how care is commissioned and the health service is regulated.
Delegates backed his call but not by the two-thirds majority needed.
Critics say the NHS plans, already heavily modified, amount to partial privatisation and should be dropped.
Read more at BBC Health.
The Lib Dems have a lot to answer for when it comes to the deeply unpopular Health and Social Care Bill. The Orange Book wing of the Lib Dems, of which Nick Clegg is a key member, actually supports the idea of a social insurance scheme with private providers to replace the NHS, which is a key objective of the current bill.
The Lib Dem election manifesto promoted the idea of a market-based healthcare system and abolition of SHAs. The coalition agreement on health reform was signed by Nick Clegg and reviewed by Danny Alexander. The final page of the Bill itself (p367) has the Lib Dem names of Nick Clegg, Vince Cable, Danny Alexander and Paul Burstow as supporters the Bill.
Finally, Lib Dem MPs have fully supported the Bill through its first two readings in Parliament.
However, the political landscape changed when the scale of the public and professional opposition became clear. The Lib Dem’s Spring conference, along with other factors such as the Royal College of Nursing vote of no confidence in health secretary Andrew Lansley, was crucial in terms of changing Nick Clegg’s stance on the reforms and gaining a natural “pause” in the Bill.
Following the trouncing of the Lib Dems in the local elections, Clegg’s demands for changes to the Bill have become increasingly muscular and substantial. He is currently demanding that the economic regulator, Monitor scraps its requirement to promote competition and at the weekend it was reported in The Guardian that he is now calling for a clause in the bill encouraging “any qualified provider” to take over services from the NHS, to be radically rethought or dropped.
If this policy was dropped then it would seriously curtail market forces and reduce the risk and rate of further NHS marketisation and privatisation. Considering that Lansley was “cheered to the rafters” for his reform agenda by the Conservative Party’s backbencher 1922 Committee last week, this is going to lead to very serious divisions in the coalition.
We potentially have a situation where current Lib Dem amendments could water down the Bill so significantly, that they would be incompatible with the main aim of the Bill, which is to introduce more market competition and private sector provision into the NHS.
The Conservatives have made a huge political gamble to radically overhaul the NHS and they will not back down lightly. It will only be worth the risk, if the end product is satisfactory. Since the market policies of choice, competition, and any willing provider are mutually reinforcing, loss of only one of these mechanisms would scupper the functioning of a market system. Thus, we have a potentially explosive political impasse. The input of the Future Forum will be of academic interest only, because it will be the political situation which ultimately decides the fate if the NHS.
So what are the possible political scenarios?
1. Conservatives ditch the Lib Dems and end the coalition. Simon Heffer from The Telegraph wrote an opinion piece about this, encouraging the Tories to go it alone, but this not likely because Cameron would need to be certain of winning an election outright and this certainly doesn’t look likely with the current polls and the fact that the NHS would feature heavily in election contest debates. The “nasty” party would be back on the agenda.
2. Lib Dems ditch the Conservatives and end the coalition on a ticket of “saving the NHS”. This is highly unlikely because of the risks involved. They will look like political opportunists rather than saviours of the NHS and their polling is simply too weak at present to risk it.
3. Coalition to stay together and get the bill through with amendments. This is clearly the most likely scenario, but what amendments are achieved is clearly the main issue here. As Nick Clegg said: “No bill is better than a bad bill”. Opponents of the reforms will need to be on their guard and forensically look at proposed changes. There will be backroom wheeler-dealering and plenty of political rhetoric to form enough smoke and mirrors to hide the plans to keep the Bill as close to the original as possible.
4. Coalition to stay together with withdrawal of the Bill. This initially would seem highly unlikely because as stated above, the Tories have put so much political capital and risk into this Bill. It would be a disaster for them because they would get the worst of both worlds. Unpopularity and political damage resulting from the fallout, plus no end result. However, this could be very attractive for the Lib Dems. They could get a lot of public support for this and the Tories would be so politically weakened that they could not end the coalition because they would not win an election. This means that the coalition would need to struggle on until the next election, which would give the Lib Dems time to rebuild their credibility.
This is clearly a crucial time. As an opponent of the reforms, I would personally favour option 4 because I think that the bill is unamendable due to the mutually reinforcing nature of market based policies. I also think that this is the best way for the Lib Dems to regain their credibility.
They really do have the power to save the NHS. It will be a serious U-turn of course, which will be highly criticised, but they could always claim that it was ‘in the national interest’. I would support that and I think that most of the public would do too.
Traditionally, the Liberal Democrats have always stood on a political platform promoting a more just and progressive society, based on a mixed economy, supporting public institutions to ensure equal opportunities for all.
They have a proud heritage in assuming responsibility for the social security and health of the nation’s citizens, which includes David Lloyd George’s introduction of a welfare system between 1908-14. This was followed by the Beveridge report in 1942, which led to the creation of the Welfare state and set the foundations for the formation of the NHS by the Labour Party.
Not surprisingly they have a long history of visceral dislike of the Conservative Party.
However, in 2001, the Lib Dems policy review, chaired by Chris Huhne, forged the party’s first steps towards the erosion of public monopoly in public service provision. This change in policy direction was rubber stamped by a defining moment in the history of the Liberal Party with the publication of the Orange Book in 2004, with contributors including the current cabinet ministers Nick Clegg, Vince Cable, and Chris Huhne.
This signalled a major change in direction of policy towards the right, with a focus on free market economics and the use markets as a solution to social and societal problems. Notoriously, the Orange Book called for a social insurance scheme with private providers to replace the NHS. It was therefore no surprise that the 2010 Liberal Democrat manifesto suggested market reform of the NHS, including abolition of SHAs, a direction of travel now emulated by the coalition government’s Health and Social Care Bill.
It should therefore be of no surprise that the leadership of the Liberal Democrats are supporting the Bill, which aims to dismantle the NHS and betrays their Party’s underlying principles to protect public services. However, many backbench Liberal Democrat MPs and grassroots Liberal Democrat members do not subscribe to the Orange Book camp’s view and they must surely be extremely concerned about the direction of travel that Nick Clegg has taken them. In fact, there is a significant section of Liberal Democrat MPs who belong to the centre left Beveridge Group, which was formed to counter the right leaning Orange Book liberals.
One member of this group, Andrew Carmichael, MP, stated that: “Should the party of Beveridge and Keynes approach issues with a prejudice in favour of the free market system? Should we enter every policy debate with an underlying belief that private is always better than public? I certainly do not think so.”
These MPs could therefore hold the key to preventing the demise of the NHS as a publicly funded and provided service. The whips will be making sure that they vote in favour of the Bill and this was successfully achieved with the second reading of the Bill. I would therefore like to make a plea that they start to listen to the concerns of the medical profession and move away from the market-based policies that are designed to cause the ‘creative destruction’ of the NHS. This will end up destroying their own party and they will have no excuses.
I would also ask that doctors that live in the constituencies of Liberal Democrat MPs, write to them or meet them in their surgeries to discuss the damaging consequences of the Health and Social Care Bill.
If the Bill passes, then the Liberal Democrats must be made to shoulder the blame for the demise of the NHS. This must include the Beveridge Group, who have been so weak as to allow their own party to become hijacked by politicians who share almost identical ideology to their Conservative masters.
The following list of Liberal Democrats belong to the Beveridge Group. You can contact them here.
Norman Baker MP
John Barrett MP
Tim Farron MP
Don Foster MP
Mike Hancock MP
John Hemming MP
Simon Hughes MP
Chris Huhne MP
Mark Hunter MP
John Leech MP
John Pugh MP
Dan Rogerson MP
Bob Russell MP
Richard Younger-Ross former MP
The NHS is facing a £63bn bill for PFI hospitals which are only worth £11bn, an analysis of Treasury figures reveals.
The Liberal Democrats claim that the NHS will have to pay back £7.3bn in PFI payments over the next Parliament alone.
Norman Lamb, Lib Dem shadow health secretary, said: “Labour’s scandalous mismanagement of the NHS has left many hospitals facing PFI bills they simply cannot afford.
“Despite the enormous amounts of money we for these hospitals, many of them will never end up in public ownership. Hospitals all over the country are mortgaged to the hilt and there are serious concerns that these repayments will lead to cuts in vital services.”
Under PFI, the public sector enters into a long term contractual arrangement with private sector companies to finance, design, build and operate an asset such as a hospital. The NHS does not make an upfront capital payment but is contractually obligated to pay an annual leasing and maintenance payment to the private sector for the use of the facilities.
The figures reveal that the most expensive PFI contract is for Wythenshawe Hospital, where the NHS will pay back 16 times the original capital value.
Lamb said: “We need a new approach to public services in this country. By setting up an infrastructure bank the Liberal Democrats will ensure that key projects get access to the funding they need to revitalise our economy.”
A DoH spokesman said: “The cost to the public sector of undertaking long term capital investment has always been spread over a number of years - PFI is no different. All PFI schemes must demonstrate that they are good value for money and affordable when compared with the public funding alternative.
“Thanks to PFI, we have been able to undertake the biggest hospital building programme in the history of the NHS, opening the 100th scheme in October 2008 - two years before our NHS Plan deadline of 2010. The long-term benefits for patients of PFI are also clear: Norfolk and Norwich Trust has estimated it is treating 23,000 more patients each year as a result of moving to new PFI premises.”
Read more on PFI.
The Liberal Democrats are proposing to scrap strategic health authorities and reduce the Department of Health by half.
Lib Dem health spokesman Norman Lamb told the party conference in Bournemouth that the NHS had become a “bureaucratic monster”.
As part of the party’s proposals to cut public spending, he pledged to abolish many of the quangos and cut by a fifth the amount spent on the rest.
Lamb said health quangos cost £1.2bn a year and employ 25,000 people, and that 24 bosses are paid more than Gordon Brown. The pay of health quango chiefs should be capped at that of the prime minister, he said.
Unlike the Conservatives, who have said they would ring-fence health from any budget cuts, the Lib Dems have said the NHS cannot be immune from the drive to make substantial savings across government and the public sector.
Lamb supports party leader Nick Clegg’s commitment to “bold and even savage” cuts in government spending to bring down the ballooning public spending deficit.
The Lib Dems do plan to recruit an extra 3,000 midwives while giving ward sisters power to set their own budgets.
“Rather than dictating to experienced NHS staff about how to improve our hospitals, we should listen to what they have to say,” Mr Lamb said.
“The Liberal Democrat message is to get rid of nanny and put sister in charge.”
All hospitals would be forced to reduce the costs of operations to the lowest tariff in the country under controversial plans by the Liberal Democrats to cut waste in the public services.
As Britain prepares for the tightest spending round in a generation, the Lib Dem leader, Nick Clegg, this week will outline plans to rein in hospital trusts that are using their monopoly position to drive up costs. The plan will be seen as one of the most radical ideas of any of the main political parties to save money.
Under the Lib Dem plan, hospital trusts would be forced to charge the same rate for operations as the cheapest and most efficient hospitals in the country.
Clegg said: “It is a very specific but rather radical idea, of saying that all hospital tariffs under the ‘payment by results’ system should match the most efficient tariffs in the hospital system. We think that would save about £2bn a year.”
Clegg admitted this would be controversial because many hospitals would say they could not compete with those that reduced costs by performing many more procedures. He said the policy would be flexible and standards would not suffer. “There has to be suppleness in it,” Clegg said. “We are not going to be stupid about it.”
Read more at The Guardian.
