Crunch time for the Liberal Democrats –The NHS Bill and electoral oblivion

The tuition fee debacle was bad. But at least there was a reason, if not an excuse. Neither major party was committed to removing tuition fees. So whoever the Liberal Democrats ended up in Coalition with it was unlikely that the party was going to be able to honour its pledge. The hand was no doubt badly played, but the outcome was going to be nothing other than politically damaging.

This time there is no excuse. The Conservatives may claim that their manifesto refers to extending GP commissioning. But this passing reference is a threadbare justification for the enormous changes being proposed. And how many electors actually read the manifesto? If they bought the story at election time then it was more likely to be Cameron the compassionate Conservative reassuring them that the NHS was his top priority, that it was safe in his hands, that there would be no top down reorganisation, that it wouldn’t be privatised, etc., etc., etc. That these reassurances were not worth the breath required to produce them seems increasingly apparent. Significant chunks of the electorate have interpreted the Government’s plans as taking an axe to their beloved NHS.

We can quibble about whether the plans being rushed through the Commons this week actually constitute privatisation. But that is largely irrelevant. The PFI was not technically privatisation. But it has resulted in commercial interests taking large amounts of money from taxpayers in the good times, while leaving the taxpayers to pick up the bill when things don’t work out. And, in many cases, for the provision of a poorer service. That is what people object to.

Liberal Democrats may well consider a version of the GP commissioning approach – including stronger local democratic accountability – to be desirable. The party may well have a model of commissioning that would be both democratically acceptable and prevents commercial interests running rampant. But attempts to graft that on to Andrew Lansley’s original proposals have resulted in a dogs’ breakfast of a proposal. Many informed observers think is unwieldy and inefficient. The chances of these precipitous reforms delivering the sort of cost savings the Government promised were always miniscule. If these proposals go ahead then the prospects look vanishingly small.

Shirley Williams’ intervention over the weekend will further fuel concerns that buried in the 1,000 pages of this Bill are provisions that are going to lead to the progressive privatisation of the NHS. That may be through bad drafting and inadvertence – the protections needed to stop it are not there. But the evidence, brought to light by Spinwatch through FoI requests, that talks are already well underway between the Department of Health and multinational providers rather suggest that this is intentional.

Andrew Lansley might seek to write off this evidence as scaremongering. There have been comments from senior politicians, including Liberal Democrats, that continuing to debate these issues is creating uncertainty and delaying the cost savings that need to be made. The time has come to move on, it is suggested. I am reminded of some of Bob Diamond’s comments that the time for remorse over the banks’ role in the global financial crisis is over and we should get back to business. Only the bankers think that is the case.

These manoeuvres which attempt to silence critics of the NHS reforms are similarly crass. I hope that backbench Liberal Democrat MPs will be having none of it. The changes proposed to the NHS are momentous. They deserve as much scrutiny as possible and they need to be given as much Parliamentary time as possible, rather than being railroaded through Parliament in time for conference season.

Among the Liberal Democrat membership there are significant differences over whether introducing commercial providers into the NHS is desirable. Those who start from a stronger economic liberal orientation seek to separate means from ends and argue that as long as the service is free at the point of use and taxpayer funded there isn’t a problem. The full force of domestic and EU competition law will be a welcome spur to efficiency. Those with a stronger social liberal orientation argue that means are important if you want to achieve the ends of equality and cohesion – that pushing for privatisation and marketisation will have negative effects on access that will fall differentially upon the least advantaged. Attempts to counteract this tendency will require systems of targets and regulation which not only tend to set up distortionary incentives but also can absorb all the resources that are “saved” by introducing competition in the first place.

But these are technical discussions. They are largely irrelevant to the electoral consequences of the next few days.And being against these reforms is not to be against reform per se.

The NHS reforms will be constructed by their opponents as privatisation. The Coalition is the government that killed the NHS. And this is how large chunks of the electorate will interpret them. It may not be rational. But that doesn’t mean it isn’t the case. The killing the NHS will be the part of the legacy that enters the history books, as much as its success or otherwise in taming the budget deficit.

Many people did not vote Liberal Democrat seeking or expecting that outcome. Indeed, many voted Liberal Democrat for precisely the opposite reason. The NHS was a Liberal creation. Surely its future would be safer with the Liberal Democrats than with the Tories? Supporting this Bill in its current form will be seen by many as betrayal too far. And, unlike tuition fees, this time there will be no excuse. If we take that direction then electoral oblivion awaits.