The Health and Social Care Bill is currently at the report stage in the House of Lords. The Lords’ amendments are going to bounce the bill back to the House of Commons and the bill will find itself in a game of Parliamentary ping-pong between the two houses as further amendments are debated and agreed (or not).
This means that both MPs and peers are likely to have further chances to amend or vote out this bill, and if you’re a Liberal Democrat parliamentarian (which I’m assuming most of you are) you really should be making use of those chances. Here’s why:
1. It ain’t broke…
Sometimes we need to take a step back and remind ourselves what an incredible achievement the NHS is. Comprehensive healthcare, free at the point of access, provided to everyone dependent on clinical need with no regard to ability to pay. That’s an impressive goal and one which the service largely delivers. It’s not perfect – outcomes are better for some areas of disease than others, and as a country we could still do more in the area of preventative medicine (particularly relating to alcohol and obesity), but actually it’s pretty damn good.
Looking at the OECD‘s figures on health we can see that our health system stands up pretty well to comparison to other countries. We spend approximately half as much per head of population on healthcare as America, and, on average, live for two years longer. Taking a couple of examples from within Europe, we also spend less than Ireland and Denmark, and enjoy higher life expectancies. The only country that enjoys significantly higher average life expectancy (83 compared to our 80.4) whilst also spending less per head on healthcare is Japan. That’s not all down to healthcare – Japan has very low rates of obesity and places a high cultural importance on health and wellbeing. There’s a quick overview of how the Japanese health system works here. What’s interesting is that, although the Japanese system includes some private funding, all the competition has been removed from the market – more on that point later.
So, our health system isn’t perfect, but neither is it fundamentally broken. This bill proposes high level change to the way the system is organised and delivered – to put through that level of change I’d suggest you need to be pretty sure that what you’re doing at the moment isn’t working. Actually, the evidence we have suggests that it works pretty well.
2. …and this won’t fix it.
The list of groups who actively support this bill is tiny-wee. The against list is almost overwheming. The Health Select Committee, for example, think the change will be too disruptive on top of the current tightening of funding. The BMA, who initially supported the idea of health care being commissioned by clinicians, now say that “the positive vision of clinician-led, patient-focused, locally sensitive and accountable commissioning is being lost in the huge amount of often chaotic change taking place.”
The key elements to the bill that create this feeling of chaos are the shift towards healthcare being commissoned by local groups of GPs and the introduction of a requirement for competition in the provision of some services. For me, it’s this competition that’s the real problem. Competition is a market concept – it works where there is a clear market and a consumer that can choose between different products or services based on quality, price, convenience etc. A good way of thinking about how competition will work in a given situation is to ask yourself two questions. “Who’s the customer?” and “What’s the product?”
If you go to a store to buy a loaf of bread it’s easy. You’re the customer. The bread is the product. You choose the type of bread you want – white, granary etc. – you might also look at the size and price of the loaves, and then you buy your selected product. It looks simple in a healthcare situation as well, but actually it’s not. At face value, you might think that the patient is the customer and the medical care is the product, but that’s not quite right. The medical care is the product, but the customer is whoever is paying for/commissoning that medical care, whether that’s central government, local Primary Care Trusts or groups of GPs. The seller of the healthcare, whether that’s an NHS hospital or a private provider, has to make their offering the most attractive to the commissoning group, not the most beneficial to the patient. The market is skewed, so that the individual receiving the product isn’t the person it’s been tailored towards. Going back to the shop analogy, the patient isn’t the product or the seller or the customer. The patient is the carrier bag.
3. … and the arguments in favour of the bill are stupid
Now I know that this isn’t actually how parliamentary democracy works, but in principle the group that make the best arguments and provide the strongest evidence should win the debate. I understand that actually the party (or parties) that hold a parliamentary majority and whose Whips’ office work most effectively win the day, but let’s just pretend that the debates might influence someone.
Firstly, the fact that the Health Select Committee oppose the Bill should be a fairly big reason to vote against it. Otherwise what’s the point of the committee stage in the passage of any bill? The idea is that, at the committee stage, a smaller group of MPs examine bills more closely, identify any major problems and iron out the kinks. In this case the relevant committee has come back and essentially advised that this bill just won’t work at the moment. That’s strike 1.
Secondly, your own deputy leader wants the Health Secretary to move on. Simon Hughes suggested that Andrew Lansley should move on after the bill was passed on the Andrew Marr Show. This is a very odd thing to suggest. Hughes isn’t saying that the bill shoudn’t be passed, but he’s suggesting that the architect of the bill should lose his job. I don’t see any other way of interpreting this other than that Hughes is saying, “Yes. It’s a terrible idea, but we have to put up with it, and then do everything we can to try to forget…” Well, you don’t have to put up with it. There is no inevitability about the passage of this bill. You could vote against it. Then Andrew Lansley would almost certainly lose his job as Health Secretary. It’s a win:win. That’s strike 2.
Thirdly, the government’s main argument in favour of the bill is now that the changes just need to be voted through as soon as possible to give people as long as possible to forget before the next general election. It’s not really a position marked by huge idealogical commitment to a vision. “Let’s just get it over with…” is a legitimate position if you’re talking about ripping off a band aid, but not if you’re planning to pull out the underpinnings of one of the most effective public healthcare systems in the world. Strike 3.
4. It’s technically the right thing to do
Ok, so you’re a Lib Dem MP. You might not like this bill, but you are in coalition with the Tories and part of coalition is accepting things that might not have been your first preference for the greater good. Well, you don’t have to accept this. It wasn’t in the Tory manifesto at the last general election. It’s not in the coalition agreement. In fact the coalition agreement says that the government will “stop the top-down reorganisations of the NHS that have got in the way of patient care.” So there you go. It’s not that you personally want to scupper this bill. It’s that you have to. It’s in the coalition agreement. Voting against this bill is what you signed up for. Technically, you have no choice.
5. It’s politically the right thing to do.
Now, you do understand that the Liberal Democrat vote is going to evaporate at the next election, don’t you? Those of us to the left of the party are going to follow the boy wizard over to Labour in punishment for your buddying up with Dave and his massive shiny forehead. Anyone towards the right of the party has got a Conservative government anyway, so they might as well actually vote for them next time.
You need to set yourself apart from your coalition peers, and this is the issue to do it on. Nigel Lawson viewed the NHS as the closest thing the British have to a religion, and he wasn’t far wrong. We moan about it but suggest that we might change it, suggest, horror of horrors, that we might have to pay directly for health care, and all of a sudden we are unquestioning believers in the one true way. Positioning your party as the protectors of the NHS might be your best bet to stave off electoral ruin next time around.
So there we go, five reasons for any Lib Dem parliamentarians to get behind the opposition to the Health and Social Care Bill. You can pick whatever reason works for you – ethical, intellectual, technical or self-interested. I don’t really care why you vote against it, just make sure you do.
And that’s me done getting my politics on for this week. Apologies for the lack of recent bloggage – my work life went a bit manic for a while, but normal(ish) service should now be resumed, so, as ever, if you like please subscribe and you’ll get a lovely email letting you know when there’s something new to read. The plan is that if you come back at the end of the week there should be some lovely crime fiction reviews here waiting for you all. Happy days.