Nick Clegg and Shirley Williams reassure MPs

Much effort has been expended by Liberal Democrat leadership to persuade their MPs and Peers, Party members and the general public that they have somehow radically improved Lansley’s disasterous Health and Social Care Bill.

It would seem that so far they have had some success with persuading the MPs and Peers. They worked very hard at the Party conference last weekend to persuade members of the Party, making the maximum possible use of their secret weapon: Shirley Williams.

They failed. Party members were less easily persuaded!

The letter that was sent to all MPs and Peers was also released to members and the public. It is examined here by an expert economist with long experience of EU and UK competition law and with no party allegiance.

The full text of a letter co-signed by Nick Clegg and Baroness Williams sent to all Lib Dem MPs and peers about the Health and Social Care Bill: in italics with comments interspersed.

“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.

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.”

The changes made do not re-instate the responsibility of the SoS for the ‘provision of services’. In the absence of this phrasing the amendment is worthless as the SoS cannot be held responsible for any service provision decisions made in relation to the provision of services within the NHS or by sub-national bodies.

“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.

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.”

This large number of amendments to a poorly drafted Bill has actually made the outcomes worse. The application of logic should have indicated that it is better to scrap the Bill in its entirety

“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.”

A petty and irrelevant party point scoring comment. No-one is suggesting that Labour got it right.

“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.”

This is nonsense. A challenge by a private provider in such circumstances will be upheld under competition law.

“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.”

Under public procurement rules transparency etc is already guaranteed.

“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.”

It is difficult to see how the new competitive market structures will promote the integration which is required. To claim that the Bill structures will usher in such comprehensive integration is simply nonsense.

“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.”

This claim cannot be substantiated.

“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.”

Even if this amendment is sustained in the Commons, it will make no real difference to the role of the Competition Commission in relation to health services. The Commission will still be responsible for ensuring that competition is maintained. This is an example of getting lost in the detail of the Bill and proposing specific amendments which appear to change the overall approach of the Bill and the role of competition, but in practice will not.

“Second, we want to keep the independent regulator of Foundation Trusts, Monitor, to make sure hospitals always serve NHS patients first and foremost.”

Again this is irrelevant. The core principle of the Bill is that competition is the means to preserve patient choice and patient focus.

“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.”

Competition law is like pregnancy. You are either pregnant or not. Competition law either applies in full or not at all.

“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.”

No problem here but the impact will be minimal

“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.”

Having a cap will do no such thing. The imperative for all Foundation Trusts is to increase revenue and reduce costs. The destination of profits is a subsidiary issue.

“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.”

This is irrelevant; no-one is suggesting that the Labour government got things right, The issue is that this Bill will massively extend the limited marketisation of the NHS introduced by Labour.

“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.”

Again this suggestion that there is some way of introducing competitive markets on the scale envisaged which will distinguish between patients interests and organisational profits show a high degree of economic illiteracy.

“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.

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.”

And some of us believe in fairies!

“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”


Another authoritative analysis of this letter by an eminent Health Economist with no political allegiance can be found here.

The original letter from Nick and Shirley without comments can be found here.

The Lib Dem leadership sent another longer document to their Peers which listed 40 points where they claimed to have altered (?improved) the Health Bill. That document can be seen together with comments here.

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