The article by Dr Evan Harris was published in the Guardian’s ‘Comment is Free’ section on 4th April 2011.
Our determination to amend the health bill demonstrates the value of the junior coalition partner’s democratic processes
The public aren’t keen on the proposals, while healthcare professionals and NHS employees are opposed. The Labour party is now opposing not only some of the new NHS plans and the pace of change, but even those policies which it espoused in government, such as an NHS market and an absence of local democratic oversight. Organisations such as the NHS Confederation, the Nuffield Trust and the King’s Fund all have serious criticisms to make of key aspects of the health and social care bill. But for the government as a whole and the Conservative party in particular, the biggest problem they face is the opposition of the Liberal Democrats to significant parts of the changes, expressed in very clear terms overwhelmingly at our party conference in Sheffield on 12 March.
What that conference motion did was recognise that four key aspects of the shakeup were included in the coalition agreement, namely an increase in the role of GPs in commissioning (from the Tory manifesto), an independent national commissioning board (from the Tory manifesto), a recognition of the right of non-NHS bodies to provide NHS services (Tory manifesto), subject to safeguards (Lib Dem manifesto), the abolition of strategic health authorities (Lib Dem manifesto) and the location of public health functions with local authorities (Lib Dem manifesto). However, the motion also identified that the health and social care bill contained gross breaches of the coalition agreement with a total absence of locally elected representatives on commissioning bodies, and the proposed abolition of those commissioning bodies (the primary care trusts).
The motion also called for a repudiation in the bill of the full-blown NHS market envisaged, and a redefining of the role of Monitor, the regulator of NHS Foundation Trusts, as economic regulator. Specifically, the motion called for an enterprise commission, statutory safeguards to prevent, through cherry-picking of straightforward patients and/or profitable procedures, the undermining or fragmentation of remaining NHS services, finances, research and training. Lib Dems also demanded that GP commissioning bodies be co-terminous with local authorities which commission social services, and much stronger democratic oversight and accountability at a local and national level of the commissioning decisions of GPs.
This is not a wish list – unless these explicit requirements are satisfied, Liberal Democrats cannot be expected to follow the government whip. It was tough enough for the party to find itself voting against its own policy on issues which were agreed compromises set out in the coalition programme. It is simply not tenable to expect parliamentarians to be whipped against Lib Dem policy and the agreed coalition programme in support of unpopular, rightwing Tory ideological proposals. Even if a few MPs or peers can’t see this, the party itself can. Indeed, a petition demanding the changes set out in the conference motion has, within a few hours, attracted hundreds of signatures of party members. This indicates that the party is digging in on both the principle of respect for the party’s policy and the coalition agreement and the need to protect the NHS from excessive and damaging changes.
The determination of the party to amend the health bill can only help Nick Clegg’s negotiating position and demonstrate in times of adversity for a junior coalition partner the value of its democratic processes and its progressive outlook.