Powered by Guardian.co.ukThis article titled “NHS reforms hide ‘new threats’, warns leading Lib Dem” was written by Allegra Stratton and Patrick Wintour, for The Guardian on Saturday 18th June 2011 00.00 Europe/London

A leading Liberal Democrat has warned there are “new threats” hidden within the reworked NHS plans that have been drawn up for the coalition.

The former MP Dr Evan Harris, who led the first Lib Dem rebellion which forced the government to “pause” its reforms and think again, has told the Guardian he can’t rule out another Lib Dem rebellion if the coalition doesn’t move to ameliorate three new problems in its proposals.

Harris has concerns regarding competition, commissioning of private firms, and the level of responsibility for the NHS held by the health secretary.

On Tuesday last week the group of professionals assigned to working out the compromise – the Future Forum – delivered their report, and the government is due to issue its response on Monday.

Harris believes “there are new threats to the NHS emerging as the Conservatives appear to try to bring in competition and privatisation through another route”.

He hopes the government will register they agree with his concerns when they issue their formal response on Monday.

The former party health spokesman is speaking about the health reforms to 250 Liberal Democrat activists at the Social Liberal Forum (SLF) conference “Liberalism, Equality and the State” – a group that represents social democrats within the Lib Dems that have increasingly been concerned at the direction the coalition is taking.

Lib Dems say there remain ways in which they can register their unhappiness if concerns are not reflected in the government’s response. The bill is only due to enter the House of Lords just after the autumn party conference season, and a rebellion when their party convenes for its conference could see amendments put down in the Lords.

Harris is a vice-chair of the Lib Dems Federal Policy Committee and a former health spokesman for the party. He spearheaded the rebellion at the Lib dem’s party conference in March when activists voted in favour of deputy leader Nick Clegg blocking the coalition’s reform plans.

He told the Guardian: “Liberal Democrats and healthcare professionals have largely succeeded in preventing Monitor [the proposed independent regulator] being used to marketise the health service but there’s a real danger the new health bill, or the government’s ‘instructions’ to the NHS Commissioning Board will force competition on local health services through a different route.”

Harris highlighted the danger of essential NHS services being undermined by large numbers of cases, and the income that goes with them being farmed out, to private or third sector providers leaving an A&E, or intensive care unit unviable.

“The NHS doesn’t need any favours on a level playing field but in the end it has to provide these emergency and rescue services and it can’t do that in a free market.”

A second area identified by Harris was the potential for clinical commissioning groups to outsource most work to private companies with vested interests, beyond the scope of full public scrutiny.

“Commissioning healthcare is a key public function and we need to use the skills and experience of public health doctors and existing NHS staff to do it, rather than sharp-suited executives from private companies with their own agendas of simply making money.”

Harris is also concerned that the government is still only placing a responsibility on to the secretary of state of the “duty to promote” rather than the stronger duty to “provide or secure the provision of” a comprehensive NHS service.

Harris said he had received advice from public interest lawyer Peter Roderick demonstrating that was now in doubt.

“If the government doesn’t want the secretary of state to have a duty to provide a comprehensive NHS then they should say so and see it voted down by the Liberal Democrats. If they accept that the secretary of state cannot shrink from that responsibility they should make it clear.”

Party grandees business secretary Vince Cable, deputy party leader Simon Hughes and energy secretary Chris Huhne will all address the SLF conference. Before the SLF’s battle over the NHS the group was regarded by party managers as obscure, but it has now grown significantly in stature. It is expected attendees at the conference will discuss the pace of deficit reduction, with a proportion of Lib Dems feeling it needs to be recalibrated. Harris’s comments came as Labour attacked plans by a GP commissioner in Leicester to ration NHS care.

Shadow health minister Liz Kendall highlighted comments left on website Conservative Home in which Dr Teck Khong said: “The government must not flinch from setting out an explicit list of services available and excluded from state provision.”

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