New regulations announced last week which are due to come into effect in two weeks make it clear that the NHS will be forced to put nearly all services out to competition. Proposals announced three weeks earlier had been withdrawn after a storm of protest, but the new regulations are almost identical. That raises two important questions.
Why did ministers repeatedly make promises that they knew they could not deliver?
Why were the rewritten regulations kept secret until after the Liberal Democrat Spring Conference?
I have always argued that Andrew Lansley’s changes to the NHS would be costly and would damage services to patients, but the issue at stake here is the devious way the government has progressed its privatisation agenda.
Opposition to the Health and Social Care Bill was widespread. Concerns were expressed by healthcare professions, academics and the public. The membership of the Liberal Democrat party were clear in their opposition.
In order to reassure opponents, ministers including health ministers and both the prime minister and the deputy prime minister made a number of promises. In particular they promised that there would be no privatisation, that GP commissioners would have the power to choose what services to commission for their patients and that the NHS would be protected from the full force of competition law.
Almost a year after the Health and Social Care Act was passed and only six weeks before they were to come into effect the government announced the regulations that would determine how the act was implemented. It was apparent that the regulations betrayed promises and assurances given by ministers. In the face of public outcry and with the threat of another emergency motion at the Liberal Democrat spring conference ministers announced that the regulations would be rewritten and repeated promises that Clinical commissioning Groups would be free to commission as and how they felt appropriate and that it would be up to them when and if to go out to competition.
The regulations were rewritten by 5 March, but their release was delayed until after the Liberal Democrat Conference. Now that we have seen the new regulations it is clear that they still go no way to meeting the promises repeatedly given by ministers. It is now admitted that competition law would not allow the Commissioning Groups to exercise the discretion that they had been promised.
It seems clear that a number of MPs and Peers were persuaded to support the Health and Social Care Act on the basis of promises and reassurances that could never be delivered and should never have been given. In particular I wonder how many Liberal Democrat MPs and Peers were persuaded by reassurances from Nick Clegg and Shirley Williams. I wonder what or who persuaded Shirley Williams to drop her outspoken opposition to the reforms. For months she spoke of the damage that would be done by removing the responsibility of the Secretary of State’s responsibility for the delivery of healthcare. She pointed out, quite rightly that the British NHS was one of the most efficient in the world. Then suddenly she changed her tune.
What can I do? Skip to the bottom of this page.
27 March 2012: The Health and Social Care Act 2012 passed
13 February 2013: Statutory Instrument 257 National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 was published. It would come into effect after 40 days unless Parliament specifically decides otherwise.
28 February 2013: Health Minister Lord Howe says that the regulations do not need changing.
5 March 2013: Health Minister Norman Lamb announces in House of Commons that the regulations would be rewritten ““commissioners, not the Secretary of State and not the regulators, should decide when and how competition should be used to serve…patients interests”.
5 March 2013: Lord Howe in radio interview says that as soon as he was aware of concerns he decided to withdraw the regulations and rewrite them. He said that they had already been rewritten and were in his office.
8-10 March 2013: Liberal Democrats meet in Brighton for their Spring Conference. Among the emergency motions for consideration is one stating that “no regulations made under the Health and Social Care Act 2012 are acceptable if they force the NHS to operate competitive markets.”
11 March 2013: Statutory Instrument 500 National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 was published. It would come into effect after 21 days unless Parliament specifically decides otherwise.
14 March 2013: Early day motion 1188 tabled. If passed this motion would annul SI 500.
Broken promises include:
“There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector”
“that competition could only be on quality and not on price”
“Secretary of State will remain responsible and accountable for a comprehensive health service”
“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”
“place safeguards to stop private providers ‘cherry picking'”
“For the first time, there will be real democratic accountability in the NHS”
“to rule out beyond doubt any threat of a US-style market in the NHS”
“make sure that the NHS can never be treated like the gas, electricity, or water industry
to make sure that the NHS is never treated like a private industry.”
“protect the NHS from any threat of takeover from US-style healthcare providers by insulating the NHS from the full force of competition law.”
“you (in a letter to Clinical Commissioning Groups) as commissioners, not the Secretary of State and not regulators, should decide when and how competition should be used to serve your patients’ interests.”
“Clinicians will be free to commission services in the way they consider best. We intend to make it clear that commissioners will have a full range of options and that they will be under no legal obligation to create new markets, particularly where competition would not be effective in driving high standards and value for patients.”
“…it will be for commissioners to decide which services to tender…to avoid any doubt—it is not the Government’s intention that under clause 67 [now 75] that regulations would impose compulsory competitive tendering requirements on commissioners, or for Monitor to have powers to impose such requirements.”
What can you do?
The Early Day Motion 1188 would stop these regulations coming into force. For a week it had pathetic level of support, only 9 MPs (1 Lib Dem, 1 Green and 7 Labour).
Every MP who believes in honesty and decency should sign it, because introducing these regulations is fundamentally dishonest.
Every MP who believes in the NHS should sign it.
Lobby your MP and any MP you know or can contact. (today it has 38 signatures, but that is still not enough.)
You can also sign an open letter to the Press.