When the history of Britain’s first modern coalition government is written, it is fair to say that two events in particular will mark the turning point in the fortunes of the Liberal Democrats, when swathes of the population came to regard them as hypocritical and untrustworthy. The first of these was, of course, the vote last December to raise university tuition fees from £3,290 a year to £9,000 a year, and to withdraw all funding from arts, humanities and social sciences, when, as I reported at the time, 27 Lib Dem MPs voted for the rise in tuition fees (including 15 ministers), while 21 voted against, five abstained, and three were out of the country. Crucially, as I also explained, “The vote was won by 323-302, so just 11 more dissenters were needed for the vote to have been lost.”
Given that the Lib Dems had actively campaigned against any kind of rise in tuition fees, and that this was a major manifesto promise, with the party as a whole going so far as to pledge the abolition of fees, and thereby gaining a large number of young voters, this capitulation was a death sentence for the party’s credibility, and one from which it may never recover.
On Andrew Lansley’s wretched Health and Social Care Bill, otherwise known as the NHS Privatisation Bill, to those of us who think that privatisation, where intended, should be exposed for what it is, the Lib Dems were not faced with such a stark manifestation of hypocrisy and capitulation in voting for the bill on its third reading. This was because they had not made a specific manifesto promise to protect the NHS from the Tories, although they did promise to “protect frontline services such as cancer, mental health and maternity despite a squeeze on the NHS budget,” as the BBC explained prior to the General Election last year.
Even on that basis, however, it could be argued coherently that the Lib Dems should oppose a bill that, despite tinkering, remains, fundamentally, the juggernaut of privatisation conceived by the Tories, opposed by almost all senior health professionals, and by high-profile Lib Dem dissidents such as Baroness Shirley Williams and Lord Owen, in which no aspect of the service is guaranteed to be free from cuts to frontline services. Either there are strict checks on the extent to which competition is allowed, or, as Lansley and the Tories want, anyone with shareholders and a scythe will be allowed in, and as a result, of course, frontline services, like all services, will inevitably suffer.
Moreover, the Lib Dems should not be the only objects of the public’s ire. As Roy Lilley explained in a useful post on on nhsManagers.net, “Whether you oppose the Bill, or not, here are some things to remember: neither the Bill, nor anything like it was in the Tory Manifesto, nor the Lib-Dems’ or the Coalition agreement” (PDF, page 24), in which the coalition government promised, “We will stop the top-down reorganisations of the NHS that have got in the way of patient care.” This, of course, is exactly what David Cameron repeats when asked about the NHS, when he is not lying brazenly about the supposed extent of support for the reforms amongst healthcare professionals.
As it is, however, the Lib Dems caved in again yesterday after a combative Commons session, with only four MPS voting against the bill (Andrew George, Julian Huppert, Greg Mulholland and Adrian Sanders), and ten others abstaining. By my reckoning, that leaves 42 others and, with 316 MPs voting for the bill, and 251 against, the majority of 65 could have been a defeat by one vote if 33 of those 42 Lib Dems (including those who value their ministerial positions above all else) had rebelled.
The last hope for the NHS, then, is the House of Lords, where there will certainly be a fight.
In the Observer last Sunday, in an article entitled, “Why this flawed bill threatens the very future of the NHS,” the Liberal Democrat peer Shirley Williams made a resounding appeal for the continued protection of the NHS, drawing on the important legal advice secured by the campaigning group 38 Degrees, which I mentioned in an article on Tuesday, explaining that Jacqueline Davis, a consultant radiologist in north London, the co-chair of the NHS Consultants’ Association, and a founder member of Keep Our NHS Public, had written in the Guardian:
They [the legal experts] found that the bill does indeed “remove the duty of the secretary of state to provide or secure the provision of health services which has been a common and critical feature of all previous NHS legislation since 1946″. Furthermore, a “hands-off clause” will “severely curtail the secretary of state’s ability to influence the delivery of NHS care to ensure everyone receives the best healthcare possible”. They conclude the government can now wash its hands of the NHS, while the likelihood of a postcode lottery increases and local accountability decreases.
They also conclude that the bill “will increase competition within the NHS at the expense of collaboration and integration and/or make it almost inevitable that UK and EU competition law will apply as if it were a utility like gas or telecoms”. So despite the coalition’s repeated denials, this legal opinion believes that “these plans will lead to a system geared heavily in favour of private companies”.
In her column, Baroness Williams highlighted another compelling part of the lawyers’ analysis, in which they stated:
“Effectively, the duty to provide a national health service would be lost if the bill becomes law.” By passing these duties down to an unknown number of commissioning consortiums, the government … will be “effectively fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate”.
She also explained that she remained deeply troubled about the proposed role of the private sector under the reforms, stating:
Why have so many of our politicians, Labour and Conservative, sought to introduce a market into health? I am not against a private element in the NHS, which may bring innovation and good practice, provided it is within the framework of a public service — complementary but not wrecking. But why have they been bewitched by a flawed US system? I worked in the US for a decade between the 1980s and 1990s and saw the misery of people who could not afford even to insure themselves against the catastrophe of serious ill health.
The answer, of course, is that the endless push for privatisation has indeed “bewitched” politicians, leaving a gaping hole in our political life where those, like myself, who want a brand-new political movement based on the needs of the people rather than the profits of private companies and corporations are endlessly sidelined.
As Baroness Williams also noted, pertinently:
The NHS is recognised by the OECD, the US Commonwealth Fund, most of our own medical organisations and many of those who use it as one of the most efficient, least costly and most effective in the world. It could become more productive and more innovative, especially through greater integration of services and sensitive reconfiguration, ensuring that treatment is undertaken locally or at home rather than in hospitals. But reform need not mean upheaval and disintegration. The remarkable vision of the 1945 Attlee government — of a public service free at the point of need for all the people of England — should not be allowed to die.
Another prominent critic, who is expected to provide ferocious opposition to the bill in the House of Lords, is Lord Owen, who wrote an article for the Independent in April, in which he laid out his position:
Like the sailor returning to the sea, so as a doctor writing about the NHS I feel that is where “my heart will always be”. Yet the NHS needs our heads not just our hearts if it is to be saved from the fatal flaws within the 353 pages of the Health and Social Care Bill.
The Conservative/Liberal Democrat coalition has no mandate for this legislation. If it were to go on the statute book in anything like its present form, over one, or at most two, decades, in England the NHS would be unrecognisable. During the general election, David Cameron defused the NHS as a vote loser for the Conservatives. He not only promised no more top-down reorganisations, but he convinced people that his heart was with the NHS after the care given to his late son.
Suddenly all that changed and, surprisingly, the Liberal Democrats too abandoned the evolutionary reforms of the past 30 years of an internal market, and instead embraced Andrew Lansley’s external one – a market of price competition, with the EU’s competition policy progressively poking its nose into every nook and cranny of our NHS. Furthermore, the proven democratic control of a rationed health service that maintained record levels of satisfaction among the public was to be abandoned.
So as the bill makes it way to the House of Lords, where, as Roy Lilley explained, it may spend three months or more, returning to the Commons in February next year, we must wait to see if the Lords can do what MPs in the Commons failed to do: protect the organisation that, above all, is cherished by the people of Britain. As Colin Leys, a former professor of political science at Queen’s University in Canada, wrote in an article today in the Guardian‘s Comment is free, entitled, “The end of the NHS as we know it“:
What Wednesday’s vote on the health and social care bill shows more clearly than anything is that many, if not most, of the political elite no longer care whether they are carrying out the wishes of the electorate, and barely pretend that we are any longer a democracy.
After reiterating that the government does not have a mandate for its planned changes, Ley notes a depressing truth about today’s society, placing responsibility on the public as much as on politicians. “The principle,” he writes, “seems to be that if an official lie — such as that the bill does not imply privatisation — is repeated often enough, most people will feel it must be true.”
He adds that, “by using existing powers to abolish PCTs and set up “pathfinder” so-called GP consortia, and making arrangements with foreign private companies to take over NHS hospitals, the government has also pre-empted such debate as MPs are inclined to have. The Conservative MP Dr Sarah Wollaston, who originally denounced the bill, now says that changes have already gone too far to oppose it any further — a remarkable statement of political impotence.”
As Ley proceeds to explain:
The bill will end the NHS as a comprehensive service equally available to all. People with limited means will have a narrowing range of free services of declining quality, and will once again face long waits for elective care. Everyone else will go back to trying to find money for private insurance and private care. More and more NHS hospital beds will be occupied by private patients. Doctors will be divided into a few who will become rich, and many who will end up working on reduced terms and with little professional freedom for large corporations (the staff of the hospitals that are being considered for handing over to private firms will have noted that the firms in question want “a free hand with staff”).
The costs of market-based healthcare — from making and monitoring multiple and complex contracts, to advertising, billing, auditing, legal disputes, multi-million pound executive salaries, dividends and fraud — will soon consume 20% or more of the health budget, as they do in the US. Neither the Care Quality Commission nor NHS Protect (the former NHS Counter-Fraud Unit) are remotely resourced enough, or empowered enough, to prevent the decline of care quality and the scale of financial fraud that the bill will introduce.
The Tories’ plans, if allowed to proceed, will complete a privatisation project that began under Margaret Thatcher in the 1980s, and was accelerated under New Labour — although it should be noted that the last government threw money at the NHS while stealthily introducing privatisation, whereas all that now remains is for leeches to take without giving.
As Colin Ley explains, and as I noted in May, in my article, “Act Now to Save the NHS, as Government Advisor Claims Reforms Will Show “No Mercy” and Allow “Big Opportunity” for Profiteering,” the key players in this are “private healthcare companies and consultancies like McKinsey and KPMG,” who have mounted their privatisation campaign through “the lavish corporate funding of pro-market think-tanks — the quiet subversion of some of those, like the King’s Fund, that are still rather quaintly described as ‘independent’ — and the deep penetration of the Department of Health and Labour’s senior ranks.”
As Ley laments, and as we all should note, “No countervailing argument has come from pro-public think-tanks, because none exists with resources equal to the task. And how many MPs have actually read through the bill they are in the process of endorsing, or even the explanatory notes that accompany it?”
In conclusion, Ley praises the opposition that has come from “the social media: 38 Degrees, Facebook, expert bloggers and tweeters,” and adds, “Along with the million-plus people who work for the NHS, a steadily growing portion of, especially, younger voters, have been exposed to a different narrative and see through the spin. At the moment most of them may be more cynical than politically active. But if the bill becomes law and the reality begins to be felt in people’s daily lives it is this counter-narrative that will make sense. MPs — and now the Lords — would be well advised to ponder the implications of this.”
Part of me shares his optimism, but the other part — aware that far too many of my fellow citizens have allowed themselves to be distracted by showbiz, or, even more depressingly, by missing the point and blaming immigrants and the unemployed for society’s ills — thinks that the majority of people may not notice until it’s too late.
While I hope that the battle for the NHS will be won in the Lords, and encourage readers to follow the advice of a blogger at Liberal Conspiracy and sign up to the TUC’s “Adopt a Peer” campaign, which involves people adopting a member of the House of Lords and then writeingto them (and an excellent template letter regarding the NHS campaign is here), I also hope that the current dissatisfaction of living under a Tory-led government committed to culling the state, privatising whatever hasn’t already been privatised, and protecting the rich and the super-rich, will provoke people to think about what they really want and need, and to recall that, throughout history, the vast improvements to our lives have not come about through doing nothing, but through actively wresting them from the hands of those who, like David Cameron, George Osborne and Andrew Lansley, don’t actually care about us, and, at present, are actively involved in making life more miserable for all but the top 10 percent of earners.