By Dr Prateek Buch, a research scientist and an executive member of the Social Liberal Forum, and former MP Dr Evan Harris, vice chair of Liberal Democrat Federal Policy Committee
In a move that clearly demonstrates his Party’s unease with the Health and Social Care Bill, deputy prime minister Nick Clegg has taken a firm stance on a vital aspect of Health secretary Andrew Lansley’s NHS reforms – Liberal Democrats will not support a bill that sees Monitor become a purely economic regulator that arbitrates on and promotes competition.
Labour’s shadow health secretary, John Healey, suggests that is somehow new-found opposition to the reforms - in fact Nick’s language strongly echoes what our Party Conference agreed in March - before the local elections.
And this was at a time when the Yes to AV campaign was ahead in the polls so was nothing to do with disappointing results in either.
Mr Healey further states that “Lib Dem MPs have voted for it [the bill] at every stage in Parliament”, but surely must know, as his less Blairite colleagues will have experienced, that in government Labour rebels on foundation hospitals and academy schools did the same thing; they voted for the the host bill at second reading, which allows a bill with some parts that can be supported to go forward for amendment, then for specific amendments at report stage.
What Liberal Democrats have done to date then, is no different;as we believe the bill is amendable to deliver what was in the coalition agreement - policies such as a stronger role for GPs in commissioning, which was also in Labour’s manifesto and presumably remains Mr Healey’s policy too. As with the Labour government, the committee stage is a place for debate and the sole Lib Dem MP on the committee was appointed on the basis that any votes against the government would be saved until report stage.
Indeed when Nick told Andrew Marr recently that no bill is better than a bad one, he made clear that Liberal Democrats would go further than rebels in previous Labour governments - they’ll vote against the bill at 3rd reading unless sufficient amendments are made.
It’s also been suggested that Lib Dems should have raised these issues before the bill was published - perhaps to protect Mr Lansley from the embarrassment of publishing an unacceptable bill, or as some sort of counsel of perfection. Such thinking didn’t prevent the worst elements of the Private Finance Initiative (pdf) and of the scandalous Independent Sector Treatment Centre programme being published and implemented under Labour, so it’s unclear why it would have worked here.
In any case we can assure Mr Healey and other friends of the NHS, that Lib Dems did raise concerns at the white paper stage, but faced two problems:
• Firstly, Conservatives in government were encouraged to believe that these reforms would attract significant support from new Labourites given the backing for the market aspects given by Alan Milburn and John Hutton;
• Secondly, Mr Lansley simply asserted, as he did to the health select committee, that the reforms would be harmless.
It was precisely because Lib Dems weren’t prepared to accept these assurances that our very next conference, in March - that Mr Healey attended - debated in public its rejection of much of the Lansley reforms. It must have been a revelation to a Labour frontbencher to see a party publicly and democratically tell its leadership what they were prepared to accept. And to be fair to Nick Clegg, he didn’t oppose the much-amended conference motion, nor has he at any stage sought to downplay it.
In the end when this bill is gutted, rather than carping about the timetable, people will be pleased that the Lib Dems said no to more marketisation of the NHS, and will be wondering what more things – not in the coalition agreement – the Lib Dems should be blocking from happening!