Tag Archives: nhs

Liberal Democrats should continue to debate whether to support the Health and Social Care Bill

Despite the welcome and significant changes to the Health & Social Care Bill that Lib Dem parliamentarians have secured, there remain serious concerns both within the party, Parliament and the medical profession about the impact and timing of the reforms.

As the House of Lords prepares for report stage, it is right and proper for the party, from grassroots to leadership, to debate whether the damaging elements of the Bill have been sufficiently tamed, and whether further amendments can be sought in the Lords, to bring the reforms back in line with the Coalition Agreement and party policy as determined at spring conference last year.

The party needs to debate whether in the absence of such further changes, and considering the substantial changes already underway on the NHS front-line, the Bill can retain Lib Dem support – the Social Liberal Forum will continue to support the likes of Graham Winyard, Charles West, Evan Harris and Shirley Williams as they seek to secure that debate.

for further information, please contact prateek.buch@socialliberal.net

Lord Smith of Clifton writes: trends and tendencies in contemporary UK politics and the future of the Lib Dems

(Preamble: Trevor Smith joined the Liberal Party in 1955 when it had five MPs; he fears he may die with the LibDems having the same number!)

The Lib Dems are in a very serious state, possibly facing meltdown of the kind experienced by the Canadian Conservatives some time ago (though they managed a spectacular come back), or the Canadian Liberals in last year’s elections. The burning question is how, at the very minimum, to limit the electoral damage and hopefully to revive the party’s fortunes.

A starting point is to recognise the turbulent condition that has characterised most party systems in the western democracies for some time. Voter alienation resulted from the dramatic loss of public confidence in the ability/integrity of political elites. This has prompted a perceptible lurch to the Right in many countries, including such notable social democracies as Holland. The UK has not been immune to this. New Labour was the most obvious symptom, encapsulated in Mandelson’s phrase – “we are intensely relaxed about people getting filthy rich”, as Blair has succeeded in unashamedly doing for himself since leaving office. New Labour also presided over the continuing growing gap between rich and poor. The drift Rightwards was also seen in the thrust of much of the argumentation in the Orange Book, written by influential LD MPs. The Tories, of course, have always had a significant number of far-Right MPs, – especially the ‘Flag, Faith, Family’ brigade – whose influence waxes and wanes over time, but who are currently becoming more vociferous in the light of the Eurozone crisis.

Where does this place the future of the LDs? We must undertake a tally of our strengths and weaknesses and must not flinch from doing so. The LD Leadership should not seek to stifle this – not least because it can’t. The Labour and Tory parties are engaged in public debates about policy, which are neither particularly convincing nor edifying. But the high rhetoric/low substance surrounding Cameron’s ‘Big Society’ (but no Big Deal!) musings and the oxymoronic (pun intended) nature of the advocacy for ‘Blue Labour’ should not detract LDs from arguing robustly among themselves about the future direction of the party. Such a debate is essential if we are to prepare for the future.

First, at the outset, we must fully recognise the toxic effect of the U-turn on tuition fees: it is as indelible a stain on us as Iraq was on Blair/New Labour or as the treatment of miners was on Thatcherism. There are no mitigating arguments that can be prayed in aid to dispel the sense of public betrayal over tuition fees. Compounding the situation is the stark fact that the new fees system is too complicated to convey easily for general consumption – and in itself that is bad politics.

Second, in Coalition, LDs have allowed the Tories to assume too much of the initiative especially in policy areas where we had earlier set the pace. Prior to 2010, for example, Vince Cable had established his unassailable authority on a whole range of economic issues: unsustainable public and private debt levels; excessive remuneration packages in the big corporations; the inadequacy of banking regulation; and the monopolistic position enjoyed by Rupert Murdoch in the mass media. That considerable advantage has been allowed to be largely squandered. Tackling fat cat pay has now been adopted by Cameron and Osborne and by Ed Miliband. They are all ‘Johnny-come-latelys’ to the problem: the Tories are unconvincing converts, while the Blair/Brown governments positively refused to address the issue, which had become increasingly blatant during their watch. We’ve let both pinch our clothes and it will be difficult to recover our previous unique position. Cameron’s latest proposal to give shareholders more control over remuneration is far too weak; the boards of the institutional shareholders, who control the votes, are as steeped in fat cat greed as elsewhere in commerce and their record (e.g. insurance companies successive pension scandals) is not unblemished.

Third, Nick Clegg fought the last Election promoting the notion of “Fairness” as an operating political principle. The Coalition’s adoption of steadily raising the income tax threshold and pupil premium is consistent with this, but they have to be seen alongside the Government’s fiscal policies that bear most heavily on the poorest and particularly women and thus will have far greater general impact.

I could go on but these examples are enough by way of illustration.

In our stocktaking, we should ask what effect have individual LD ministers had on policy-making of a distinctive LD kind. We have not resisted Michael Gove’s emaciation of local authorities’ involvement in education in England with the quangoisation of schools through a massive expansion in the number of Academies. Andrew Lansley (if we are foolish enough to let him) will have poisoned the NHS with a massive injection of private marketisation. When Lib Dem ministers demit office, what foot prints will have been left of which they can be proud? In these two policy areas LD ministers seem to have exercised little or no clout.

Since May 2010, the position of women has deteriorated both in terms of lower-end job prospects and representation on the boards of major corporations. Lynne Featherstone, the LD minister for women, should say what, if any, policies have been initiated to deal with these two problems.

We should ask ourselves what the noticeable Lib Dem impact has been on broad areas of Government policy not covered in the Coalition Agreement, and in too many areas it is clear that we have been out-manoeuvred by our Tory partners in Government. True, we are the junior partners but we should not be pushovers – too much has been conceded to date.

For example, in the areas of Defence and Foreign Affairs – where we have ministers – there is no public evidence of any obvious LD influence in the conduct of policies; indeed, quite the reverse as in the case of the employment of Cameron’s EU veto. At best, there has been acquiescence. And, yet again as with the economy, our internationalism has been squandered – a unique selling- point over decades. How can we recover this?

What steps should now be taken to protect/re-assert our profile/ratings?

First, we should acknowledge the tuition fee debacle, and demonstrate that our remorse over fees is not as fragile as our original commitment against them. To this end, we should fight for a substantial reduction in fees now and, very importantly, ensure this happens before the 2015 general election. A post general election reduction could be met from the savings from abandoning Trident. (We assume that’s still LD policy but wouldn’t bank on it!).

Secondly, LDs should make a firm commitment significantly to reduce the gap between rich and poor that has been growing under successive governments over the past three decades. This Government is reforming welfare payments to save public funds, reducing welfare dependency, as well as “idleness” among the poor. Any future government with formal Lib Dem involvement or support must address the other end of the spectrum – the idle rich, to which end the ‘mansion tax’ or some variant should be re-visited.

Thirdly, we must also state LDs will tackle three other glaring inequalities: gender, ethnic and regional.

As we’ve said, the position of women continues to deteriorate and this must be reversed. For example, there must be much more childcare provision for working parents, while consideration of the introduction of quotas on the boards of major corporations as has been successfully accomplished in Norway. It’s clear the recommendations of the Davies’ Report, that called for FTSE 350 boards to have 25% women membership by 2015, are not being taken seriously enough by business generally, and neither the ratio nor the date look like being achieved.

Similarly, it is abundantly clear, in view of the appalling slowness to date, ethnic recruiting quotas must be introduced for a defined period of, say, ten years for the police services; this policy has worked very well in remedying the Catholic/Protestant imbalance in the Police Service of Northern Ireland and should be emulated in Great Britain. Quotas are a very effective method of remedying ingrained institutionalised bigotry, bias and prejudice.

Regional inequalities: the North/South prosperity divide continues to widen. Are the recent Enterprise Zones, part of a policy of “managed decline” or an earnest attempt to promote authentic economic growth in the Regions? The Barnett Formula should be applied to the English Regions with full transparency; in a way previous governments have shied away from doing.

Finally, for the moment, but very importantly, there remains the question of the future of the NHS. How it develops is vitally concerning for England (NI, Scotland, and Wales are distinct) and no less so for the LDs. There needs to be some very serious intra-party discussions if ruptures are to be avoided or at least contained.

In terms of LD party management, the NHS issue is symptomatic of a growing authoritarian tendency amongst the Leadership. Party Conferences are becoming too stage-managed. Tom McNally, LD leader in the Lords, has written in Liberal Democrat News suggesting they should be held less frequently! The provision for membership participation in policy-making distinguishes the LDs from the Tories and Labour. It should be lauded, defended and not diluted.

Trevor Smith is a Liberal Democrat working peer.

Better a localist NHS than a nationalist one

Yesterday, Health Secretary Andy Burnham wrote an article for the Guardian aiming to set out the clear blue water between Labour and the Conservatives on the National Health Service. In doing so, he inadvertantly demonstrated quite how vapid Labour’s vision for the NHS really is. It was summed up in one sentence:

For Labour, it all comes down to defending the N in NHS.

You read that right. Given the choice between “national”, “health” and “service” the word that Burnham considers most key to the Labour approach is the former. Ignore “health”, never mind “service” – who needs a bandage when you can wrap yourself in a flag?

Think I’m being unfair? Burnham is of course a repeat offender. His response to Dan Hannan’s American adventure last week was to attack Hannan for being “unpatriotic.” With Labour floundering in the polls, never has Samuel Johnson’s adage that “Patriotism is the last refuge of a scoundrel” seemed so apt.

Burnham goes on to set out three specific examples of what he means:

Labour’s job is to speak up for the N in NHS – for national standards, national pay and national accountability

Let’s take these in turn. It is certainly the case that Labour has focused on national standards and it would be churlish to deny that over the past 12 years we have seen significant improvements. But it is foolish to suggest that mere regulation of health standards is a significant dividing line; even the US is pretty strict in this respect. And all too often Labour’s achievements have been bought by throwing money at the problem and by entrenching a target culture. Certain things, such as hospital hygiene, seem to have escaped them entirely.

But standards don’t automatically lead to results and the experience of healthcare around the country varies enormously. After writing about it last week, I am loathe to use the phrase “postcode lottery” but what is clear is that all the national standards in the world can’t get you an equal level of standard at a local level. Labour has tried everything – short of localism – to tackle this problem and after twelve years it has comprehensively failed. Burnham offers nothing new, merely that the Tories would have fewer national standards. This displacement activity fools no-one.

His second dividing line, unbelievably, is pay. Whatever the rights and wrongs of national pay bargaining, it is frankly gobsmacking that a Secretary of State considers this to be one of the crucial dividing lines in health on which Labour will fight the election. And you could argue with some force that its approach to national pay bargaining has been one of Labour’s biggest screw ups in recent years, driving the epitome of a soft bargain. Is Burnham serious about his desire to fight the next election on this record? Or is this more a case of deference to Labour’s paymasters, the unions?

Finally, somewhere below pay, comes the piffling issue of accountability. Here we are told we have two options: Labour’s centralised health service or a Tory quango. If ever there was a false choice, it is this.

The problem with the Tory’s policies on health are not that they are localist but that they aren’t localist enough. As we saw with IVF, at the first sniff of controversy they tend to reach for the national comfort blanket. They have nothing to say about the most important tool at a localist’s disposal: tax. They might support democratic administration of health services at a local level but the decision making will continue to be made centrally.

The social liberal alternative is spelt out on this website in Richard Grayson’s chapter on the NHS from Reinventing the State. Current Liberal Democrat policy is broadly along these lines. Far from leading to a decline in standards, the experience of continental Europe is that devolving decision making is key to ensuring them. The lesson learned is that accountability and standards are inter-dependent.

As a party, we have rejected social insurance as a funding model. Chris Huhne, who chaired the party’s public services working group in 2002 gives three reasons for doing so (pdf):

The first is that insurance schemes usually insist on co-payment. Thus patients pay nearly a third of primary care themselves in France, and in Germany the sick pay charges for the first period they spend in hospital, rather like an insurance excess in this country. The result is inevitably to exclude some of the poor. These schemes do not ensure universal access to health care when and where people need it.

The second problem is that social insurance schemes are surprisingly bureaucratic. Far from abolishing NHS administration, insurance schemes require more paperwork by both GPs and hospitals so that they can ensure proper reimbursement of insured costs, but no more. This is the flip side of the patient knowing how much operations cost, but it is itself costly and timeconsuming for the health professionals.

The third difficulty is that they also involve a separate and often expensive premium collection system, and even supposedly universal schemes based around employment suffer holes. Although much more comprehensive than the United States reliance on private health insurance – where some 45 million people currently have no health insurance at all – the safety net is not universal.

Moreover, if people are allowed to top up either spending or insurance payments, there can be the rapid development of a two-tier service. There would be choice and quality for the well-off, but a rump service for the rest.

Instead, we party has generally favoured the Danish model, a model which – as Richard explains – has been further reformed in recent years and could be emulated in the UK.

After twelve years, the model that Labour has demonstrated it is most comfortable with involves inconsistently applied standards and virtually no accountability. Andy Burnham’s comfort with such a patchy record is quite galling. If he thinks it is an election-winning position to hold, he is quite wrong.

We love the NHS

The debate in the us about healthcare seems to be getting increasingly insane, with Obama being compared to Hitler, Sarah Palin spreading lies about “death panels” and assorted nonsense. A repeat of the debate in the early 1990s when the Clintons attempted to introduce healthcare reforms of their own was to be expected, but this debate is decidely more wacky.

One interesting side aspect of this debate has been how the UK has been dragged into it. When Sarah Palin is talking about “death panels” it turns out that she is referring to NICE. Stephen Hawking, having been cited as the sort of American who the NHS would kill, has intervened pointing out that, erm, he’s British and dependent on the NHS. Meanwhile Tory goldenboy Dan Hannan has been touring the US espousing how terrible the NHS is and why they are so much better off without it. What’s all the more remarkable is that the Obama proposals are actually closer to the sort of systems we find in mainland Europe – indeed the sort of proposals that in the UK we normally associate with the right. What passes for “socialism” in the US, the Lib Dems would more closely associate with the Orange Book.

Hannan appears to be blissfully unaware of the fact that despite the fact that the US healthcare system tops the OECD league table in terms of cost as a proportion of GDP, it leaves 25% of its citizens without cover. As well as the most expensive healthcare system it also has the worst outcomes. We can all come up with our criticisms of the NHS, but at half the cost (per capita) it remains one of the best value for money systems in the world.

In politics, it is all too easy to criticise public services. There is no question that the NHS could be improved and Liberal Democrats have plenty of ideas of how to do this. The central concern we have is ensuring that the system is more democratic and responsive to patient needs. There is also growing evidence that this is linked to levels of inequality where the UK does only marginally better than the US.

But with the system under attack on the other side of the Atlantic, it is perhaps a good time to reflect on what a tremendous achievement the NHS has been over the past 60 years. One of the most heartening aspects of the US debate has been the rise of the #welovethenhs meme on Twitter. A spontaneous reaction to the bile coming over from the States, thousands of ordinary people have been spreading their own stories of how the NHS has helped them and their families. Currently this is one of the top “trending” items on twitter meaning that thousands of Americans, in turn, are likely to read about how a better funded health system could help them. Neither the US or UK governments could have bought this kind of publicity.

At the Social Liberal Forum we’d like to do our own small bit as well, which is why we’ve set up our own We Love The NHS group on our new Social Network. Why not join the group and add your story there?

See also: http://www.libdemvoice.org/here-at-ldv-welovethenhs-15891.html