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Liberal Democrats health policy: who is the rebel?

Lib Dem supporters of the NHS have come up with simple, radical suggestions for saving it from privatisation. But the party leadership is trying to suppress their recommendations.

Traditional Labour supporters felt betrayed when Tony Blair's New Labour government turned the wave of 1997 optimism into a tide of pink-tinged conservatism.

But their sense of betrayal pales in comparison to how many Liberal Democrat members feel about how our party has behaved in government.

I shall skip over the clumsy handling of student tuition fees, the attacks on welfare and the introduction of secret courts, important though these are. I want to focus on the treatment of the NHS. 

For the past year I have been sitting on the Liberal Democrat policy working group charged with looking at health and other public services, including the effects of recent legislation and any changes that should be recommended. 

But our working group's chair was reluctant to even discuss the Health and Social Care Act - suggesting nothing more was necessary than to exhort local health bosses not to put everything out to competition. Some supported this 'don't rock the boat' view - encouraged by the party officials, Special Advisers and ministers who attended our meetings.

However loyalty does not, I suggest, mean the blind following of the whims of our leaders, but the adherence to values and principles.

I and some like-minded members of our working group have been consulting health experts and senior doctors. We conclude that there is a logical, simple and radical solution to the problems besetting the NHS. 

For thirty years successive governments, trying to squeeze more healthcare out of every pound spent on the NHS, have given it bigger and bigger doses of the same medicine. They have introduced more and more market competition. 

But markets mean drafting contracts, handling the tendering process, justifying decisions - in the courts if necessary: and raising, paying and contesting bills. Countries where there is market competition in healthcare spend between 20% and 40% of their healthcare expenditure on administration. Before Margaret Thatcher introduced the internal market in the NHS the UK spent only 5% on administration. 

So, we propose, let's scrap the NHS 'market' altogether 

Our proposals are well researched and referenced, but they have not been well received by the leadership. The chair refused to let the working group vote on them. The national policy committee turned them down and refused to publish them so that members of the party and conference delegates could make up their own minds.

In view of the Party’s attempt to suppress our alternative report we are seeking support to publish them ourselves. You can read both the full alternative report on public services and the alternative health policy here. 

This is sadly just the latest attempt by our party leadership to smother debate on the damaging nature of Tory NHS policies, since entering coalition government.

When Party delegates voted at a special conference to join the coalition it was on a basis that the economic crisis and jitters in “The City” required a period of stability. The leaders of the Party may or may not have had other motives. 

We agreed to the coalition on the basis of a brief document which contained only one sentence on the NHS. ‘funding for the NHS should increase in real terms in each year of the Parliament.' An undertaking that has since been broken. 

The Coalition Programme published eight days later promised to ‘stop the top-down reorganisations of the NHS that have got in the way of patient care'. It continued 'We are committed to reducing duplication.' And it promised a democratisation of local health management (Primary Care Trusts (PCTs)) with the board being a mix of directly elected and local authority appointed members.

A month later the government published the NHS White Paper which Andrew Lansley had been working on for seven years.

It proposed the biggest reorganisation in the history of the NHS. 

It threw open the provision of healthcare to ‘any willing provider’ - guaranteed to increase duplication. 

PCTs, far from being made more locally democratic, were to be abolished and replaced by totally unaccountable Clinical Commissioning Groups (CCGs). 

All three promises, broken.

At the Sheffield Conference the following Spring, I proposed a motion to conference in Sheffield condemning Lansley’s white paper, and fragmentation, duplication, privatisation, conflicts of interest and lack of democratic accountability it would inflict on the NHS.

I have some form here - in 2008 I amended Norman Lamb's proposed health policy at conference. I warned against the privatisation and fragmentation being introduced by the Labour government. My amendment, set four criteria that should be met before any further contracts let to external providers and was overwhelmingly supported by delegates. It remains part of Liberal Democrat policy.

But by 2011 the Lib Dem leadership had got better at controlling the supposedly democratic policy process. 

At the 2011 Spring conference I proposed a motion condemning Lansley’s white Paper, but by now the Lib Dem leadership had developed an almost obsessive control for  supposedly democratic process. Health minister Paul Burstow proposed a different motion praising Lansley's white paper, which the Conference committee selected for debate instead of mine. I put an amendment to his motion.

During the debate every speaker criticised the white paper and my amendment was carried overwhelmingly.

Party members 1: Party leadership 0.

In response to Sheffield amendment the government announced a 'listening pause'. But there was no real pause. Preparation and premature implementation of the Bill continued. Neither was there much listening. At the end Nick Clegg claimed to have responded to most of the concerns about the Bill raised in our amendment, though he had made no attempt to consult with those of us who had raised them. 

At the next conference we attempted to bring an emergency motion on the NHS changes. More than half the conference delegates present voted to debate our motion, but procedural rules were invoked and MPs and Peers instructed to turn out and vote against us. Our motion was never debated.

Party members 2: Party leadership 0.

That autumn (2011) Shirley Williams warned of her 'grave concerns' about the bill and its potential to 'wreck' the NHS by being 'fixated' on markets and extending privatisation. 

She warned too that the Secretary of State would no longer be responsible for the delivery of healthcare by the NHS, suggesting that

'to throw out accountability in order to tackle petty interference is to undermine democracy itself.'

By the spring of 2012 Williams had had a complete change of heart. She signed a letter jointly with Nick Clegg, where they claimed that they had:

'made sure that private providers can only offer their services where patients say they want them'

And had introduced

'safeguards to stop private providers "cherry picking" profitable, easy cases from the NHS'

And that they were

'insulating the NHS from the full force of competition law.'

And also that they had

'put in place additional safeguards to the private income cap to make sure that foundation trusts cannot focus on private profits before patients.'

Once more I proposed an emergency motion on the 'reforms'. To avoid it being debated, the leadership proposed a rival motion, cynically entitled “Protecting our NHS: the Shirley Williams Motion”. The motion claimed that everything was now all right and sought conference’s endorsement of the Health and Social Care Bill. Conference delegates chose to delete those lines from the motion. It did not support the Bill.

Party members 3: leadership 0.

It was nearly a year after the passing of the Health and Social Care Act in March 2012 and only Weeks  before the Act was to come into force that the government published the key regulations that in combination with the Act, gave it its full effect.

When the regulations surfaced, we protested loudly. They seemed to compel local health commissioners to put all contracts out to competition after all, despite all the promises we'd been given.

At first, ministers denied there was any problem.

We put yet another emergency motion before conference. The regulations were hastily withdrawn. Norman Lamb, by now a health minister, assured conference that redrafted regulations would address our concerns. Somewhat reassured, conference decided not to debate our emergency motion. 

The day after our conference the new regulations were published.

They were every bit as damaging as the version that had been withdrawn. Now they are in force, across the country CCGs lawyers are advising them that these regulations mean they must tender out NHS services to the private sector - exactly as we warned, and exactly as ministers promised wouldn't happen. We hear only this week that even family GP services must be opened up to corporations.

When the Observer runs a story about Lib Dem rebels challenging the leader on health policy I would turn the story on its head. Up to the present time the party members have supported the NHS and opposed its privatisation. In supporting that view and proposing policies that would deliver a national public service NHS we are not the rebels, we are loyally supporting party members and supporting the National Health Service. We are putting forward evidence-based policies that have the support of senior doctors and that offer the best chance of delivering an efficient, effective and equitable NHS.

About the author

Dr Charles West has been a GP for over 25 years, as well as a health service manager, and was a Liberal Democrat candidate for parliament in the 2010 election.


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