Tories wobbling over health bill

As Camreron attempts to push through his disastrous Health and Social Care Bill cracks have opened up in the government, Peter Manson examines the issue.

Using the argument that there is “too much decision-making led by bureaucracy rather than clinicians”, David Cameron insists he will ride the opposition and stay the course on the government’s Health and Social Care Bill. The bill will further undermine the national health service through introducing more competition, outsourcing and private facilities within the NHS itself.

Cynically claiming he wants to give “power to doctors and nurses”, Cameron points to the new right granted to general practitioners to commission services. But it will be the patients who will be told to choose between rival ‘service providers’ - GPs will not be permitted to advise them, as this could “distort competition”. So, instead of doctors pulling together with other healthworkers to provide the best possible treatment, their role will be to watch impotently while ill-informed patients flounder between various (perhaps unsatisfactory) options.

No wonder that GPs are up in arms - just like every organisation representing those who work in the NHS. For the unions and professional associations it will mean less control by their members over the way they do their job. It is true that organisations like the British Medical Association can be described as “vested interests” - part of the “medical establishment”, as Conservative supporters of the bill like to point out. But their leaders and most members are hardly radicals - many are natural Tory voters. They do, however, have professional pride, yet they know that the proposals will severely compromise healthcare, weaken the NHS and compromise their ability to do their job.

Much as health secretary Andrew Lansley denies that the bill is about privatisation, that is exactly what it foresees. NHS wards and even hospitals will close, allowing private competitors to take over. According to the pro-NHS Health Emergency campaign, “A group of general practitioners in Yorkshire has already pre-empted the enactment of the bill by deciding, unilaterally, that certain minor surgical procedures will no longer be covered by the NHS, then offering to provide the treatment privately through a company they own.”[1] Clearly there are some GPs who have decided they might as well see what is in it for them.

Another campaign, Keep Our NHS Public, has publicised the example of US consultancy firm McKinsey, which helped draft the ‘reforms’. McKinsey has taken advantage of its role to share the information it has gathered with private health providers. No doubt additional information was gleaned from senior staff at Monitor, the NHS regulator, who were entertained and even sent on junkets abroad at McKinsey’s expense.

Meanwhile the department of health is sitting on the ‘risk register’ it compiled, which apparently warns of longer waiting lists and patient deaths should the bill pass. The elimination of ‘bureaucratic layers’ will also entail the merger (and closure) of services. Although it is claimed that it is mainly management that will no longer be required, many of those made redundant will be clerical workers, while large numbers of front-line clinicians will be forced to relocate.

The Tories are deeply divided over the bill in view of the resentment it has generated among professionals and sections of the middle class. This has been reflected in several setbacks in the Lords, where no fewer than 130 changes have been voted through - although the bill’s central trajectory remains intact. It has also been reflected on the Conservative Home website, which declared: “The NHS was long the Conservative Party’s Achilles heel. David Cameron’s greatest political achievement as leader of the opposition was to neutralise health as an issue. The greatest mistake of his time as prime minister has been to put it back at the centre of political debate.”[2]

The conclusion? The “bill could cost the Conservative Party the next election. Cameron must kill it.” Or at least so says Tim Montgomerie. It was Conservative Home that revealed the fact that three cabinet ministers have been giving briefings calling for Lansley to be replaced. One Downing Street source was quoted as saying he should be “taken out and shot”.

There is no doubt that Lansley is in big trouble, with Tory MPs accusing him of failing to “sell” his ‘reforms’ adequately - as if it was all just a matter of PR. It is said that Conservatives in marginal seats have been among those pressing him to stay away from local hospitals. They fear that any hint of association with the beleaguered health secretary might cost them their seats.

And it goes without saying that the Liberal Democrats are more than concerned. Deputy leader Simon Hughes called for Lansley to be replaced. Referring to leader Nick Clegg, one Lib Dem insider is widely quoted as saying: “Nick is simply not going to be able to keep the party on side.”

There has been talk of a cabinet reshuffle, with health being handed over to a Lib Dem (who would no doubt ‘modify’ the Health and Social Care Bill out of existence) in exchange for Vince Cable being replaced by a Tory as business secretary. But to do as Tim Montgomerie demands would be a humiliation for Cameron, who has come out four-square behind both the bill and the minister responsible for it. However, if Tory grumbles become outright rebellion, he may well have no choice. If that happens, it will be the tensions within his own party, more than ructions among the Lib Dems, that will force his hand.

The Weekly Worker has strongly disagreed with the continual statements of, for example, the Socialist Workers Party that the coalition government is “weak”, simply because it is made up of two parties traditionally proposing different priorities within British capitalism. But the fact that they have come together in defence of their common interests at a time of crisis is not only presented as a strength, but actually is.

That is reinforced when you examine the forces at work within the coalition. Short of a miracle, the Liberal Democrats are facing wipe-out at the next election, because a huge proportion of their voters have deserted them in disgust following the Lib Dems’ adoption of diametrically opposite policies to those they promised before the 2010 election - particularly in regard to cuts and tuition fees. Which means that the Lib Dems have no alternative but to stick it out. They cannot risk a government defeat and the calling of an early election. Better to hang on and hope that - somehow - things will turn around.

The leaders are, of course, more clear in this than some of their backbenchers, who perhaps have less to lose and for whom the health bill is viewed as a betrayal too far. With the Lib Dem spring conference coming up, there will be no letting up on the pressure on Clegg. After all, if even Conservatives are expressing disquiet about the bill ...

The Lansley bill undoubtedly represents a devastating attack on the NHS. Yet our determination to defeat it should not lead us to pretend that the health service is just fine. The Tories’ identification of a bureaucracy that gobbles up resources, and results in patient care and treatment that is tardy and inefficient, is not exactly inaccurate. All publicly owned services and industries under capitalism tend to be characterised by those failings. That is why Health Emergency, whose campaign director is John Lister of Socialist Resistance, can be criticised for its tendency to defend the NHS as it is. It is probably true that “the NHS delivers very well in comparisons with other health services” and the UK’s record on, for example, diabetes is “among the best in the world”.[3] But should we be satisfied with that?

While the Tories’ ‘solution’ of replacing bureaucracy with the market is such an obvious non-starter that it needs no further comment, that does not mean we should just leave well alone. The NHS needs to be brought under the direct, democratic control of its workers and users - yes, “power to doctors and nurses”, as well as porters, cleaners, secretaries …

That really would be a way to overcome bureaucracy.



1. www.healthemergency.org.uk/pdf/FAQ-HASCB-090112.pdf.

2. http://conservativehome.blogs.com/thetorydiary/2012/02/the-unnecessary-and-unpopular-nhs-bill-could-cost-the-conservative-party-the-next-election-cameron-m.html.

3. www.healthemergency.org.uk/pdf/FAQ-HASCB-090112.pdf.