Health Policy InsightEditor's blog Sunday 13 March 2011: Lib Dem conference vote changes the game. The question is, how much?
This changes things. The question is, how much?
The Liberal Democrats have had a lot of criticism since forming the Coalition Government with their only realistic option - the party which won the biggest number of seats. Some of it has been unduly harsh; some wholly merited. That's life in the kitchen of politics.
The motion put to the conference by Minister Paul Burstow, whose undistinguished ministerial performance we have already reviewed, has been significantly amended.
Lines 6-15, copied below in italics, have been excised.
The significant alteration is Amendments 1 and 2 proposed by the party's former health spokesman Dr Evan Harris and copied below in bold italics.
Burstow proposes; Conference disposes - the cuts (sorry, 'savings')
Conference welcomes much of the vision for the NHS set out in the Government’s White Paper, Equity and Excellence: Liberating The NHS which commits the Government to an NHS that:
i) Is genuinely centred on patients and carers.
ii) Achieves quality and outcomes that are among the best in the world.
iii) Refuses to tolerate unsafe and substandard care.
iv) Puts clinicians in the driving seat and sets hospitals and providers free to innovate, with stronger incentives to adopt best practice.
v) Is more transparent, with clearer accountabilities for quality and results.
vi) Is more efficient and dynamic, with a radically smaller national, regional and local bureaucracy.
vii) Gives citizens a greater say in how the NHS is run.
The fusilade of 'Bomber' Harris: new amendments carried
Conference recognises however that all of the above policies and aspirations can be achieved without adopting the damaging and unjustified market-based approach that is proposed.
Conference regrets that some of the proposed reforms have never been Liberal Democrat policy, did not feature in our manifesto or in the agreed Coalition Programme, which instead called for an end to large-scale top-down reorganisations.
Conference therefore calls on Liberal Democrats in Parliament to amend the Health Bill to provide for:
I) More democratically accountable commissioning.
II) A much greater degree of co-terminously between local authorities and commissioning areas.
III) No decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed GP consortia.
IV) The complete ruling out of any competition based on price to prevent loss-leading corporate providers under-cutting NHS tariffs, and to ensure that healthcare providers ‘compete’ on quality of care.
V) New private providers to be allowed only where there is no risk of ‘cherry picking’ which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases, and where the needs of equity, research and training are met.
VI) NHS commissioning being retained as a public function in full compliance with the Human Rights Act and Freedom of Information laws, using the skills and experience of existing NHS staff rather than the sub-contracting of commissioning to private companies.
VII) The continued separation of the commissioning and provision of services to prevent conflicts of interests.
VIII) An NHS, responsive to patients’ needs, based on co-operation rather than competition, and which promotes quality and equity not the market.
Conferences calls:
1. On the Government to uphold the NHS Constitution and publish an audit of how well organisations are living by its letter and spirit.
2. On Liberal Democrats in local government to establish local Health and Wellbeing Boards and make progress developing the new collaborative ways of working necessary to provide joined up services that are personalised and local.
3. The government to seize fully the opportunity to reverse the scandalous lack of accountability of publicly-funded local health services which has grown up under decades of Conservative and Labour governments, by:
a) Ensuring full scrutiny, including the power to require attendance, by elected local authorities of all organisations in the local health economy funded by public money, including Foundation Trusts and any external support for commissioning consortia; ensuring that all such organisations are subject to Freedom of Information requirements.
b) Ensuring Health and Wellbeing Boards (HWBs) are a strong voice for accountable local people in setting the strategic direction for and co-ordinating provision of health and social care services locally by containing substantial representation from elected local councillors; and by requiring GP Commissioning Boards to construct their Annual Plans in conjunction with the HWBs; to monitor their implementation at meetings with the HWBs not less than once each quarter; and to review the implementation of the Annual Plan with the HWBs at the end of the year prior to the construction of the Annual Plan for the forthcoming year.
c) Ensuring commissioning of health services has some degree of accountability by requiring about half of the members of the board of commissioning consortia, alongside GPs, to be local councillors appointed as non-executive directors.
d) Offering additional freedoms only to Foundation Trusts that successfully engage substantial proportions of their local populations as active members..
Essentially, if this leads to action, it will leaves Mr Lansley without much of his Bill still intact.
It moves towards the reinvention of PCTs with the call for co-teminosity with local authorities.
It moves away from the 'regulated market' concepts that were key to Lansley's thinking and which explain why he picked David 'Utility Privatisation Can Teach Us Much' Bennett to chair Monitor.
It moves towards broadly ruling out additional private providers, by outlawing cheery-picking and mentioning training. Private providers usually want to cherry-pick and usually don't want to train.
It moves away from having private sector providers providing the backing-up of GP commissioning consortia.
It represents the rejection and undermining of almost all the mechanisms that Secretary Of State For Health Andrew Lansley has proposed will drive meaningful NHS reform.
Are the Lib Dems serious?
The Liberal Democrats have stuck to the second part of their name as regards policymaking: the party's policy is now consitutionally bound by the amended motion.
(Little could be more pathetic than Treasury Secretary Danny Alexander's efforts to sell Dermot Murnaghan of Sky News on how 'listening' Minister 'Who?' Burstow is in accepting the amendments. Alexander knows perfectly well that Minister Who has no choice.)
Lib Dem jefe and Deputy Prime Minister Nick Clegg ran Alexander a close second in the Weekend's Most Ironic Politician stakes, attempts to diss Labour's shadow health secretary John Healey as "hapless".
Healey's crime? Attending the Lib Dem conference debate, and smartly issuing a press release to capitalise on this policy reverse for the Coalition.
This is what the DPM deems "hapless". Ahem. Given the fairly universal opprobium that the Health And Social Care Bill has raised, including among his own membership, Health Policy Insight's Order Of The Pot-Kettle-Black (Second Class) is winging its way to the DPM PDQ.
How will Lib Dem MPs react, though? The motion is unambiguous, and if MPs try to fudge or ignore its commitments, their own members' voices will be leading the chorus of criticism.
They are caught between a rock and a hard place - especially those who hitherto have raised no murmur of concern. Honourable exception mentions goes to John Pugh, who voted with the Opposition MPs on the Bill committee last week.
The rock is disagreeing with the senior partners in the Coalition on a key policy.
The hard place is opposing their own party policy.
Feeling slightly sorry for Andrew Lansley
If there is a potential issue ahead for Lib Dem MPs, that is as nothing to the issues facing the Prime Minister and the Secretary Of State For Health.
For the first time since he published his White Paper, I am feeling very slightly sorry for Andrew Lansley. This look likely to mean that the bulk of his reform plans are finished in all but name.
His appearance on today's BBC Politics Show (from 16 minutes) saw him resort to figures on what organisations he is already abolishing (PCTs) used to spend on management consultancy. It's hardly compelling.
And he utterly failed to answer whether consortia commissioning could be contracted out to private sector providers. Likewise, he did not say that there would be "full transparency" on consortia decision-making. However, his answer to the question of how his reforms are going over in the country can now be found in the dictionary under the word 'disingenuous'.
His line, picking up from Minister 'Who?', is that people have simply misunderstood what is in the Bill and his intention is to make things more clear.
We know that PM David Cameron has invested some of his political capital in supporting Mr Lansley's reforms.
A question for That Nice Mr Cameron is whether he would be throwing good political capital after bad by continuing to back his Health Secretary.
The question, however, for Andrew Lansley is whether sufficient of his Bill can now survive the changes to save his face - let alone his political life.
The answer, given how Labour are sure concertedly and repeatedly to use the Lib Dem's new official policy, looks set to be a straight no.
A Saviour and Liberator may be many things - but in politics, meek is not one of them.