Life in the Lords logjam may be death for the health bill

The health and social care bill is slowly working its way through the House of Lords, but the “shoddy” nature of the bill means that it will face a real challenge to make it back to the and through the Commons before the legislation times out.

Fourteen days of committee time were expected for the bill, but as although nine the committee has sat for nine days already, it is barely halfway through. On Monday, the bill committee sat late, and on Wednesday it sat until 12:45 am at night.

Sitting this late would be unusual for the commons; for the Lords, which has many elder and disabled members, it is rare indeed.

It is even possible that there will be a 15th day of the committee, which would be in late December if the time can be found for it. After that, the report stage starts, which requires another seven days, and can’t start until at least mid-January.

The best case scenario for the bill is that it is out by February. That leaves very little room for error; Lords business must be done by the end of March.

At the same time as all of this, a number of other bills, equally contentious, are going through the Lords:

• The legal aid, sentencing and punishment of offenders bill, which promises to savagely cut the availability of legal aid, conditional fee arrangements, and funding for citizen’s advice centres, amongst other things.

• The welfare reform bill, which contains measures to means-test the disabled-from-youth, cost cancer patients up to £94 a week, and introduce a cap on total household benefits, just to start.

• The Scotland bill, which Alex Salmond has made clear will not pass the Scottish parliament in its current form, meaning it now requires a three-way concurrent negotiation between the Lords, Commons and Scotland to pass.

What this means is that, no matter how strong the whip, concessions will have to be made, merely to pass the bill on time. Any one of these bills could probably be given due scrutiny and passed with the remaining time, but all four at once poses a near-insurmountable hurdle.

As for the health bill itself, next week we get into the real game-changing stuff. For all the concern about the symbolic aspects of the bill – such as whether or not the secretary of health has a “duty to provide” services - the discussion about the role of Monitor will shape all other aspects of the reformed NHS.

As we reported, minor concessions were made on this issue in the Commons:

The amendments to the bill that are going through committee on this can be seen in the ‘Government response to the NHS Future Forum report: Briefing notes on amendments to the Health and Social Care Bill’ document (pdf).

The role of Monitor and ‘cherry picking’ are dealt with in pages 16-21. The role of Monitor will no longer be to ‘promote competition’, rather to “prevent anti-competitive behaviour, which is against the interests of people who use NHS services” (clause 149). If we’re being generous, it is a subtle change.

An NHS where anti-competitive behaviour is prevented is a still system based on a belief that competition will inevitably drive down costs – a belief we have demonstrated to be erroneous.

The fact that so much power is being put in the hands of an unelected body remains, as ever, concerning, but the fact is that the byzantine nature of our political system could be the death of this awful bill. For now, that is something to hope for.

See also:

• The House of Lords ties itself in noble knots over the NHS bill - Jos Bell, November 12th 2011

• Life is already hard for cancer patients. Don’t make it harder - Alex Hern, October 25th 2011

• Ten reasons peers should vote against Lansley’s anti-NHS bill - Shamik Das, October 12th 2011

• A ‘protect the NHS’ clause needs to be introduced into Lansley’s bill - Cllr Joseph McManners, July 4th 2011

• How competition in the NHS may push up healthcare costs - Daniel Elton, May 16th 2011