Health Policy InsightEditorial Monday 27 February 2012: A bullshitometer reading of the Clegg-Williams letter to Lib Dems in Parliament
The splendid Politics Home has obtained the text of the letter to Lib Dem peers by Deputy Prime Minister Nick Clegg and Baroness Williams.
It follows below, with the bullshitometer results in italics.
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Dear Colleague,
The Health Bill currently in the House of Lords is now undoubtedly a better Bill because of the Liberal Democrats. A number of people deserve credit for improving this Bill. Firstly, and most important, are our Party members who made it clear at our conference in Sheffield in March last year that we would not accept a Bill that puts profits before patients. We secured a “pause” in the legislation, which led to a number of substantial changes to the Bill, for instance that competition could only be on quality and not on price. Since the “pause”, there have been further changes, which owe a great deal to the hard work of our Health Minister, Paul Burstow and our parliamentary health committee led by co-chairs, John Pugh and John Alderdice. Second, our Liberal Democrat peers in the House of Lords, led superbly by Judith Jolly, have done an outstanding job scrutinising the Bill line by line.
Ooh, I almost shouted 'bullshit' there. There is going to continue to be competition on price, because the tariff will not cover all services: currently, it covers about 60%.
Profit is going to be put before patients, by such as those lovely GPs in Haxby. They aren't the majority, but there will be enough to cause some serious issues to public trust.
The pause was horseshit, as this website said at the time and the Prime Minister's then-director of strategy James O'Shaughnessey effectively recently admitted, calling it a "tactic".
There is also the slight problem for Nick Clegg that last year, he declared that the Lib Dems had "won" the pause. As those young people do be saying, 'Awkward!"
With the help of the House of Lords Constitution Committee, several eminent Conservative peers, Labour’s Lords team led by Baroness Thornton and Lord Hunt, and a determined group of cross-benchers, many members of the medical professions, an all-party consensus has now ensured that the Secretary of State will remain responsible and accountable for a comprehensive health service financed by taxpayers, accessible to all and free at the point of need.
Pffft. The SOS duty is largely ornamental and symbolic. Nobody in their right minds could seriously think that the public would accept that the Secretary Of State For Health is not answerable for the NHS.
This should guarantee the future of the NHS, one of Britain’s greatest social achievements. In addition, led by Phil Willis and others, arrangements have been put in place to make the UK a world leader in medical research, to raise the status and protect the independence of the Public Health service, and to ensure that all profits from the treatment of private patients in Foundation Trust hospitals must benefit the NHS.
A guff-rhetoric mash-up. Lovely. FTs' profits can't be used for non-NHS purposes already: that battle was fought and won in 2003.
The Bill has now undergone more than 200 hours of scrutiny and had more than 1,000 amendments made to it, amendments that have put patients and the people who know them best at the very heart of the legislation. This is not the Bill that we debated as a party last March. Crucially, some elements of Labour’s 2006 Health Act, which opened up the possibility of a US-style market in the NHS, have been radically changed, such as the gold plated contracts for the private sector, which allowed a Labour Government to pay private providers a total of £250million for operations that weren’t even performed. We can also take pride in the fact that it was the Liberal Democrats who changed this Bill to ensure that no government will once again be able to favour the private sector over the public sector like the last Labour government.
And indeed no government will be able to favour the public sector over the private sector - it cuts both ways. No argument that Labour signed rubbish contracts with the private sector, particularly for Wave 1 ISTCs.
The Bill also now has in place safeguards to stop private providers “cherry picking” profitable, easy cases from the NHS, and we have made sure that private providers can only offer their services where patients say they want them. We are also clear that no one should be allowed to spend public money without telling us how they are going to use it. That is why we have insisted that decisions about patient services and taxpayers’ money must be made in an open, transparent and accountable way.
The logic of the Bill requires private providers (new primary care companies) to 'cherry-pick' profitable, easy cases formerly offered in acute settings, so this is as specious as the 'only where people say they want them' line. There is no clarity about CCG board meetings having to be held wholly in public.
We now have a Bill that delivers on the issues that Liberal Democrats have campaigned on for years. For the first time, there will be real democratic accountability in the NHS through new Health and Wellbeing Boards that will give councils a real role in shaping local health services. Public health will finally be returned to its rightful place in local government. Integration between health and social care will become the norm rather than the exception.
No definition of integration; nothing about how integrating heath and social care will be funded. Have you seen the marvellous new play Waiting For Dlilnot?
However, given how precious the NHS is, we want to rule out beyond doubt any threat of a US-style market in the NHS. That is why we want to see changes made to this Bill that have been put forward by our Liberal Democrat team in the House of Lords to make sure that the NHS can never be treated like the gas, electricity, or water industry.
First, we propose removing the reviews by the Competition Commission from the Bill to make sure that the NHS is never treated like a private industry.
Other than by leaving the EU, the really important decisions abut whether the NHS is an protected public good undertaking will be decided there.
Second, we want to keep the independent regulator of Foundation Trusts, Monitor, to make sure hospitals always serve NHS patients first and foremost.
Brilliant. Let's saddle Monitor with a fat intrinsic conflict of interest between being a sector regulator and an economic regulator. As this website pointed out last September.
Third, we will introduce measures to protect the NHS from any threat of takeover from US -style healthcare providers by insulating the NHS from the full force of competition law. We will also insist that anyone involved with a commissioning group is required to declare their own financial interests, so that the integrity of clinical commissioning groups is maintained.
The latter point is silly: the Nolan Principles of Public Life already guarantee the latter, and CCGs are statutory bodies.
Finally, we will put in place additional safeguards to the private income cap to make sure that Foundation Trusts cannot focus on private profits before patients. These changes are needed, not just because of this Bill, but also to plug the holes left by Labour’s 2006 Health Act that allowed private providers to make profits at the NHS’ and taxpayers' expense. It was that Act that started the process of the marketisation of the NHS by allowing private providers to be paid on average 11% more than the NHS. These changes will ensure that competition and diversity in the NHS will always be done in the interests of patients and not profits.
Deeply, deeply confused. 'Private profits before patients' is just rhetoric. The 11% premium was in fact to encourage ISTCs to set up in the NHS in England; i.e. buy plant and import surgeons for the principle of additionality. And it arose out of 2000's The NHS Plan and the 2003 Health And Social Care Act.
Next month we will return to where this process all began a year ago when we meet at our party’s Spring conference. Once these final changes have been agreed, we believe conference can be reassured that it has finished the job it started last March and the Bill should be allowed to proceed.
{Lifts carpet, sweeps debris underneath, replaces carpet}
We believe these changes will appeal to those in the House of Lords and the House of Commons who share our commitment to the NHS, and believe it can now embark on the reforms that matter: putting patients at the centre, working with local communities, and responding to the financial challenges of an ageing population.
That will demand a united effort not only from the NHS but from all of us who cherish it.
Then the essential work will begin to ensure that the necessary changes are introduced as smoothly as possible in full collaboration with everyone who works in the NHS. The real test will be to demonstrate tangible benefits to patients. After all, in the end, it is the interests of patients, which should count most of all.
Best wishes,
Nick Clegg
Baroness Shirley Williams