The return of the NHS to being the centre of political debate is overdue. With Jeremy Hunt now in charge we can be sure that Lansleys reforms will be taken up with enthusiasm and an eye on better communication. Hunt is one of those Tories who believe that there is not a lot wrong with the Lansley plan except that people just don’t understand it.
Hunt is wrong, people do understand exactly what Lansley intended – they just don’t like what they see.
In essence Lansley believes he has found the answer the Tories have sought for a long time to the question how best to make healthcare a private business. In the past right wing Tories wanted to make health service provision subject to a commissioning system where a form of social insurance came into play. Lansley instead believes that the service should first begin to move into the private sectors hands through commissioned contracts. Then he believes that the issue of funding through social insurance schemes can be opened up as a secondary set of reforms.
The Health & Social Care Act passed by parliament earlier this year effectively allows for 49% of services both clinical and support to be placed in the private sector. Already we are beginning to see the privatisation of services locally in our hospitals. Staff in the Royal Sussex were told that portering would be subject to competitive bidding with no in house bid permitted. Unions have been advised to expect job losses and changes to work practices. Not long before another contract for occupational rehabilitation was awarded to the private sector.
The NHS will soon begin to resemble a patchwork of services that are supposed to interlock to form into a new competitive health service where cost is more central to planning than care. During the consideration of the bill Labour and a wide ranging alliance of organisations came together to take on the Govt. The Royal Colleges were unanimous along with the BMA in predicting the impact, path and pace of the changes. Much of their argument was played out in parliament and directed at the LibDems who it was thought would block privatisation.
The pause period during which Clegg said he was going to resist privatisation was nothing of the sort. It was merely a period during which the Tories sought to find out how much privatisation the silly and naive LibDems would tolerate. In the end the answer was 49%. Shirley Williams who insisted that she like Clegg opposed privatisation was largely responsible in the Lords for the LibDems capitulation.
In Guardian articles she argued and was pilloried by critics for accepting Lansley word that although in theory the bill could allow 49% of services to be tendered for – in practice it meant less. She maintained that the service remains national because it is provided free at the point of delivery in NHS premises. We said that with 49% as a limit it would become a target leading to poorer quality determined by cost and fragmentation.
Few people understood the brilliant fight being staged by peers in the Lords where we came close several times to derailing the bill completely. We created an alliance of cross bench and Labour peers that meant the bills implementation was delayed by six months and that the Govts main provisions were watered down by amendments they were obliged to put in to get it through.
At the Bills Second Reading we had the biggest ever turnout of Labour peers with 198 voting against the principle of the bill. For Labour our commitment to Bevan’s founding principles is deep and emotional. As chief whip I shan’t ever forget the efforts made by a number of my colleagues – some very ill to be in the Lords to vote. One said to me ‘the NHS has sustained me for two years in my fight against cancer I couldn’t not be here to vote’. Sadly it was the last vote he was able to cast as he passed away not long afterwards.
That collective effort lasted throughout the 90 hours of debates and votes – far more than we sustained in the Commons. Bns Thornton and her team put the Tories and LibDems through the ringer on the bill. For me the bill was the LibDems greatest betrayal of civilised values in our country of which they should be constantly reminded and punished for. They tried unconvincingly to blame the NHS’s problems on Labour.
They said we let privatisation into the service – actually we capped private services at 3%, and during our time the externalisation of support services halted. We recognised the threat of fragmentation, invested in training, invested in a massive new NHS estate, brought in international expertise, expanded nursing services, trained more doctors and grew our reputation as world leaders in health care. Doubling expenditure on health didn’t create the UKs budget deficit, bankers irresponsibility did.
Labour should be proud of what its last government did for the NHS. Labour should also be proud the role played by John Healey, Andy Burnham and Bns Thornton and their teams did in the Commons and the Lords to delay and frustrate the terrible bill. The Lords generated daily bad news for the government on an issue we need to keep in the public mind between now and the election. Andy Burnham has pledged to reverse the effects of the bill. Let’s hope that by campaigning between now and 2015 enough of its ethos is preserved to ensure we can easily restore a genuine NHS to be proud of.
Steve Bassam is Labour Chief Whip of the House of Lords. You can follow him on Twitter @SteveTheQuip