Monday, 11 April 2011

Lansley's health reforms must be resisted

Finally, it seems, the Lib Dems are starting to give the Tories serious headaches on Andrew Lansley’s ill-conceived health reforms.

It’s about time. Quite why Lansley’s been allowed to take the government down this particular cul-de-sac only Cameron and Clegg know. My guess is that the level of public hostility to the proposals was completely unanticipated - and that ministers didn’t give the detail of Lansley’s plans sufficient consideration.

Whatever the truth, Lansley no finds himself under the cosh from the Liberal Democrats as well as one or two of his own backbenchers. And rightly, too. Not only are his NHS reforms unnecessarily controversial, they also are contrary to what was agreed in the coalition agreement.

A little reminder as to what was actually agreed:

• Top-down reorganisations of the NHS will be stopped

• Local communities will be given greater control over public health budgets with payment by the outcomes they achieve in improving the health of local residents. GPs will also be given greater incentives to tackle public health problems.

• Directly elected PCT board members

• GPs will commission care on patients’ behalf. PCTs will commission ‘residual services that are best undertaken at a wider level, rather than directly by GPs’. PCTs ‘will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations’.

Now that is quite different to what Lansley has been proposing in recent months. The Lib Dems’ victory in ensuring directly elected PCT boards now seems a pretty hollow and futile one given that Lansley is now bent on scrapping PCTs. What also happened to the pledge to cease further top-down reorganisation, or to empower local communities?

I have for several years been an active health campaigner. The “permanent revolution” and control freakery which characterised Hewitt’s tenure as Health Secretary had a detrimental effect on local NHS services, and while record amounts of money were being poured into the NHS frontline services suffered. The consequences of giving a £75million budget to someone as incompetent as Hewitt included the closure of several A&E facilities and maternity units. The services offered at many district general hospitals were “slimmed down” with many closing altogether. It seems a long time ago now, but the future of the NHS became the big issue that seemed set to bring down the government – hardly a month went by without reports of major cuts to services. And all this occurred under the patronising pretence of facilitating “patient choice”.

A network of local campaigns sprang up in protest at the heavy-handed, top-down and bureaucratic reforms. Fortunately Gordon Brown intervened to remove Hewitt from office, but lessons should have been learned.

Lansley clearly hasn’t learned these lessons. Not only has he pressed on irrespective of the commitments outlined in the coalition agreement, he has ridden roughshod over it. He has shown such blatant disregard for the coalition government that it’s a surprise he hasn’t been challenged before now.

Lansley’s reforms are not welcomed by health professionals. Both the British Medical Association and the Royal College of Nursing are opposed to them. And rightly so. Putting GPs at the centre of commissioning NHS services (essentially allowing them to run key parts of the Health Service) might have seemed populist but it was deeply unwise. GPs don’t seem to want to become NHS financial managers. Neither do they want the NHS to be turned into a system of financing healthcare delivered by a range of private sector providers. It sappears the only supporters of his reforms are the private health providers likely to make billions from the NHS.

If Lansley’s proposals were to go ahead unchecked, the NHS would fragment while private outfits profited handsomely from the public purse. This is the vision of the future I have for years fought against and will continue to fight against. It’s no wonder GPs aren’t going along with the plans – they don’t want to be blamed for the inevitable cuts.

Lib Dem Spring conference expressed concern at the direction the government was taking on health reform, and this has led to Lib Dem MPs taking a stronger stand against Lansley’s ideologically motivated reforms. Strangely, not a single Lib Dem MP voted against the Health and Social Care Bill at its second reading. The mood of conference has changed this indifference and now the Lib Dems are looking to ensure detailed amendments to the bill before it reaches report stage. Evan Harris, Norman Lamb and Shirley Williams (a fierce critic of the reforms) are collaborating to ensure that any proposals are in line with the coalition agreement.

Lansley’s reforms have the potential to destroy the NHS. Senior Lib Dems are now waking up to this reality and are determined to make their objections heard. Norman Lamb, the party’s former health spokesman and now an advisor to Nick Clegg, yesterday spoke out arguing that the plans posed a “financial [and] political risk” and that he would quit his current role unless NHS professionals were brought “on board”. Given the RCN’s position, reiterated at their conference in Liverpool today, the clinical professions are unlikely to be won over easily.

According to the BBC website, Mr Lamb said: "My real concern is the financial risk of doing it too quickly, because then services and patient care suffers...I've said that if it's impossible for me to carry on in my position, I will step down. And I think that it's in the government's interest to get it right in the way that I suggest. Getting the NHS right is the most important thing. And indeed it would be incredibly destabilising politically if we get this reform wrong."

Mr Lamb’s position has already been backed by Dr Peter Carter of the RCN, who referred to him as "someone who knows the NHS". Liberal Democrat activists are also behind Lamb, with Liberal Vision not only heaping praise on his courage but tipping his as future leadership material.

Lansley has opened up a “listening exercise” in response to the criticism but all the evidence so far suggests that Lansley is using this simply as a means of trying to persuade health professionals to listen to him. This is not an approach I would advise the Health Secretary to take, especially as opposition not only comes from health professionals but also members of the Cabinet. Even Danny Alexander is promising “serious, substantive changes to this Bill as a consequence of this process” – something that Lansley simply can not take lightly.

The NHS must continue to evolve and adapt in relation to changing needs and priorities. It is welcome that the coalition government set out plans to empower both communities and health professionals, but there are more effective and less controversial ways of doing this than abolishing PCTs and delegating commissioning powers to one group of professionals – GPs. Similarly, it is useful that the rhetoric from the government is about reducing government interference in the NHS, but Lansley’s decidedly top-down way of doing things suggests he is more interested in enforcing his will onto the NHS than he is in facilitating genuine patient choice and improving health outcomes.

Contrary to what Lansley suggests, the NHS is not in crisis. But it will be if he fails to listen to the concerns of the health professionals he claims to be empowering – or if he is too obstinate to heed the warnings of his Liberal Democrat colleagues.

I am confident that the Liberal Democrats can ensure that the Health and Social Care Bill can be substantially improved on and that government health policy will now more accurately reflect the coalition agreement, as of course it always should have done.

While I am happy to commend Norman Lamb for his principled stance, the real plaudits should go to delegates at the party conference who ensured that Lansley’s bill would not continue to be unopposed by our own MPs. This episode demonstrates the extraordinary influence conference can wield. I am very proud that our party members and activists have played a significant part in questioning the wisdom of the government’s policy and – hopefully – in enforcing a significant climbdown from the Health Secretary.

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