"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 31 March 2011

Health and Social Care Bill: Full Steam Ahead!

Will the Health and Social Care Bill be substantially changed? I think not.

Cameron's "chairman of the board" role to leadership has clearly failed with the Bill. He has allowed a thoroughly unpopular bill to get this far through Parliament with very few amendments. This shows that Cameron has been lax and inattentive.

Cameron created the execrable "Patients' Passport" policy for the 2005 election that the Tories lost, so he knows something about NHS policies and how not to get them implemented. So Cameron knew that Lansley's policies were controversial, and as a consequence he refused to discuss the details of Lansley's plans at the 2010 election. Competition was not mentioned, the cull of skill NHS staff was not talked about, and never did Cameron say that he would implement the £20bn cuts that McKinsey had recommended. Cameron (or most likely, his strategist, George Osborne) was successful in deflecting any scrutiny of Lansley's plans.

Yet, when pitched against one of the most unpopular Prime Ministers in recent times, Cameron failed to get a majority, so clearly his general message did not convince the public. If Cameron had been honest about Lansley's policies he would not have gained the number of seats he currently has, so clearly the policy of obscuring Lansley's plans was a success. Look at the parliamentary numbers. Cameron has the minimum possible number of MPs. The number of Lib Dem ministers he needs to guarantee a majority reflects exactly the proportion of Lib Dem MPs in the House. Any fewer Tory MPs and Cameron would not have a majority with the combination of the Tory MPs and the "payroll vote" meaning that Lib Dem backbenchers would be far more powers. If Cameron had been honest at the election about Lansley's plans, it would have reduced the number Conservative MPs, and hence the likelihood that the Bill would have existed.

The public were conned at the election, and they are now starting to realise this. The deception at the election was successful, and further, Lansley was given a free reign after the election by Cameron to implement his plans. In fact, Lansley was even allowed to extend them, since he realised in "late May, early June" that he would abolish PCTs and rescind one of his stated policies (in the "NHS Autonomy and Accountability" policy document, 4.28 to 4.30) "PCTs will remain local commissioning bodies" and the statement in the Coalition Agreement that "[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". Clearly breaking the Coalition Agreement within a month of agreeing it is serious, so why didn't Cameron notice this? A "chairman" is supposed to keep an eye on what the board are doing and make sure that cockups do not happen, but Lansley's policy was a massive cockup waiting to happen right from the publication of the Tory draft manifesto on health in Jan 2010 and it deteriorated as the policies were fleshed out in government.

The fact that the H&SC Bill has got this far is because Cameron allowed it to, a "chairman" of a corporation who oversaw a the development of a policy that would affect one sixth of the corporation's turnover and then suddenly decided that the policy was seriously flawed would have no choice other than to reconsider his/her position. Cameron will not do this, but even so, any substantial changes to the Bill will reflect very badly on him.

Changes to the Bill will also reflect very badly on others in government. Oliver Letwin and Danny Alexander were asked by the Prime Minister to review the Bill at the end of last year. According to Cameron they "had questioned health secretary Andrew Lansley "forensically", and had heard "good answers"" consequently they gave the Bill their approval.

And then there is Lansley, who has consistently said that the Bill must not be amended. (Sarah Wollaston has complained about this, she was told that only government amendments would be allowed - hers would not). Indeed, the committee stage of the Bill has been the longest of any bill since 2002, it has had 100 votes on amendments, and not a single opposition amendment was accepted. This is a Stalinist grip on the committee. Lansley's response to the white paper consultation was basically "full steam ahead!" and his response to the Lib Dem Spring Conference motion was that the Bill will not be changed. He is intransigent, and any significant changes to the Bill will be deeply damaging to him.

Call me cynical, but I do not think that Cameron will allow such damage to happen, only cosmetic changes will be made to the Bill.

Much of the talk about amending the Bill emanates from an article from the political columnist in the Times, Rachel Sylvester. The artcle simply says that the Bill is in trouble, it does not say that it will be substantially changed:
"ministers insist that the broad principles will be retained"

"David Cameron ... is now said to be coming round to the idea of making some 'clarifications' on the speed and scale of the proposals."

"a Tory Cabinet minister says: 'The Bill is not quite as scary as people have made it seem'"
None of this indicates that the major policy issues of "Any Willing Provider", removing the responsibility of the government to provide healthcare, of removing accountability in commissioning, none of these will be amended. If they are taken out of the Bill then the Bill will no longer exist. What is being suggested is a new campaign to convince the public that they want the Bill. A charm offensive perhaps (although, it is unlikely to be fronted by any of the charmless health ministers).

As a final note. The review of the Bill at the end of last year was by Letwin and Alexander. Both signed it off. Both will be damaged if any substantial amendments are made to the Bill because it will appear that they did a bad job reviewing the Bill. The most damaged will be Alexander because, as a Lib Dem, this was never a bill of his party. In fact, why hasn't he been castigated so far? The Lib Dem Spring Conference said that they disagreed with substantial parts of the Bill Alexander signed off, doesn't that show how out of touch he is with the Lib Dem grassroots?

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