NHS reforms now a battle over politics, not patients

Deputy Prime Minister Nick Clegg is demanding a re-think over the NHS reforms, particularly on issues affecting competition in the health service. He is concerned that the body which will regulate the NHS under the new system, Monitor, will be overly focussed on competition rather than the interests of patients.

This is only the beginning of Liberal Democrat rebellion over the NHS, according to Channel 4 News Social Affairs Correspondent Victoria Macdonald.

Nick Clegg is expected to propose further amendments over the next few weeks as he seeks to differentiate the Liberal Democrats from their Coalition partners, the Conservatives – despite voting down Labour-led amendments earlier in the Bill’s progress.

But, as health policy expert Roy Lilley told Channel 4 News, it is too late to go back now, so there will have to be some kind of compromise.

You can’t let competition loose in the NHS. There will be tears before teatime. NHS expert Roy Lilley

He said: “The NHS has been so emasculated – 45 per cent of its managers lost, Primary Care Trusts all huddled together. You can’t go back, it would be horrendous. What are you going to say to an NHS manager who has been made redundant – oh sorry, here’s your job back?”

He said he expected elements of the Bill to be changed substantially as a result of parliamentary wrangling – and then the Bill to pass into law.

But there are at least three major issues before this can happen, he suggested.

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Competition concerns in NHS reforms

Mr Lilley agreed with Nick Clegg that competition was a key issue under the NHS reform plans.

He explained: “There are lots of services in a hospital like hip operations and hernias. These could be done in the private sector. But the revenue from these cross-subsidises expensive and tricky things, like paediatrics, A and E, pathology.

“But if you take hip operations away, you carve out huge chunks of money from the NHS, and destabilise the system. You can’t let competition loose in the NHS. There will be tears before teatime.”

The Health Bill says that, in exercising its role to “protect and promote the interests of people who use health care services”, Monitor should be “promoting competition where possible”.

This is what concerns the Liberal Democrats, and Mr Lilley.

Lansley will fight tooth and nail to keep it, but it is in the hands of politics now. NHS expert Roy Lilley

He said: “I think there’ll be some alteration of Monitor’s role. Rather than stimulating competition we might get overseeing it, managing the market.”

The other two key issues which will see reform before the Bill is acceptable politically, he suggested, are around the Secretary of State’s “duty” to provide a comprehensive health care system, and the transparency of the system itself – meaning GP consortia may have to hold public meetings rather than conduct their business privately.

But he said there could be a fight on the cards, particularly regarding Monitor’s role.

“Lansley will fight tooth and nail to keep it, but it is in the hands of politics now,” he said.

“With these comments, Clegg is either pushing at an open door or preparing himself for one hell of a fight. The Bill could theoretically be voted down at a third reading in the House of Commons if Labour and the Liberal Democrats line up together.

“But the Tories will not want the embarrassment of losing on the floor of the house. So I think there will be some compromise. But this is not a battle over Monitor. It’s a battle between Cameron and Tory backbenchers over his credibility – when they think he has given Clegg enough. It’s in the hands of politicians now.”