Health and social care bill: worse than nothing

This is a tale of bad process, bad faith and bad policy, and the result fails the Clegg test.

After being battered in May’s elections, Nick Clegg squared up to the Conservatives on health and declared: “No bill is better than a bad one.” Tomorrow, the legislation returns to the Commons and, for all the real and claimed concessions, the house will consider shambolic plans that ought not to be dignified with the term “reform”. This is a tale of bad process, bad faith and bad policy, and the result fails the Clegg test. It is decidedly worse than nothing.

To recap, Andrew Lansley‘s blueprint for an NHS market was penned in opposition, when expenditure was still rocketing. It was always dubious, but became more so as old Tory research documents were hastily cut and pasted into a command paper, with no adjustment for the reality – the onset of the most sustained financial famine in NHS history. After Mr Clegg breezily agreed to the plans, Lib Dem peers and activists began to realise that the prospective new providers would not be opening glitzy new facilities so much as putting old ones out of business. We then had the extraordinary spectacle of the legislative assembly line halting in full flow, so the bill could be rewritten. Hapless health managers were left steering a ship being rebuilt in line with constantly changing plans. Now MPs – distracted by a whipped-up row and retreat on abortion – are to consider around 1,000 amendments in 12 hours of discussion.

This is no way to make law, and it could be the point where bad process blurs into bad faith. Both Mr Clegg and David Cameron proclaim that there will be “no NHS privatisation”, but of course a Tell Sid-style flotation was never on the cards. Many Lib Dems reasonably took this slogan instead as a promise to avoid wholesale slippage into an unplanned mixed healthcare economy, which is what existed before the NHS, and what Tony Blair recreated around the margins. Tweaks hailed by Mr Clegg, such as the taming of the regulator’s duty to promote competition, appeared to justify their hope.

But now other nips and tucks have come to light which work the other way. Asymmetric restrictions on anti-competitive as opposed to anti-collaborative practices remain, and there has been a sneaky move to strengthen the duty on commissioners to promote choice at the same time as qualifying it for the regulator. In this context leaked emails which show officials discussing handing 10-20 hospitals’ management to the German firm Helios are damning. They suggest Whitehall is working to an agenda which ministers are not frank about, owing to, in the official’s words, “political constraints”.

There are serious arguments for a measure of choice, and the alarm sounded by the British Medical Association, many of whose members already work privately, reflects self-interest as much as values. But the delicate balance between competition and planning ought to be settled by clear arguments, plainly expressed. Instead, lines between purchasers and providers are blurred. Senates and patients’ committees get piled on to an already incomprehensible organogram in a pure political fix. Thick fog surrounds all crucial questions – about the reach of EU competition law, the secretary of state’s duties and his ability to push the commissioning board towards private options.

Already, waiting times are creeping up, and the former NHS chief executive Sir Nigel Crisp last week identified the next challenge: closing hospitals. Nasty work, but, if it is the only way of sustaining tolerable services, ministers would do better to get on with it than to imagine they can leave the dirty work to fuzzy market forces which they dare not describe as such.

This legislation has forced a popular service up the agenda at the very moment it is about to get worse. That has to be bad politics. There is no satisfactory way out of this pass, but by amending or rejecting this bill, Lib Dem MPs can at least turn a plan which was always another party’s idea into another party’s problem.

The Guardian

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