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Editor's blog Thursday 26 May 2011: The Battle Of The Bill: Conservative backbenches fight back

Hats off to Nick Watt, Guardian political editor, for obtaining an email from wholly sane Conservative backbencher Nick DeBois MP setting out some Conservative red lines on the changes to the Bill.


Click here for details of 'Lansley: the NHS is not a mobile phone; I am not Henry V', via subscription-based Health Policy Intelligence.


DeBois's email to his Conservative colleagues reads as follows:

As you are no doubt aware, there has been widespread media coverage during the 'pause' about the Government's NHS reforms. Coverage has suggested rather concerning change, coming not from within our own ranks but from amongst our coalition partners. I have been closely involved with the Bill at Committee stage and in public, and many colleagues have shared with me their concern that their views need to be counted.

The recent 1922 meeting demonstrated widespread support for the Bill. It is absolutely vital that Conservative backbenchers are able to input into this process, and that our views are not ignored. Thus far, critics of this Bill have made their voices the loudest, but we still have an opportunity to set out clearly Conservative backbenchers' 'red lines' on NHS reform, the principles on which we will not budge.

1. Core 'red lines'
The Conservative Party manifesto – on which we were all elected – does the job of setting out some key red lines from which we should not retreat. These are:

• We must nail the myth about so-called 'privatisation' of the NHS. Our commitment is that the NHS must continue to be free at the point of use, available to all, funded from general taxation, and based on need and not ability to pay. We have always supported this fundamental principle of the NHS and we will not yield on this principle.

• Patients should be able to be treated at any qualified provider. Patients should have every right to be treated at the best possible service, free of charge, on the NHS, if that service meets NHS standards and NHS costs. If a provider is qualified to deliver NHS standards at NHS costs – and a patient, together with their doctor, wants them to be treated there – the Government should do nothing that stands in their way.

• Patients, together with their doctors, should have a choice over where to be treated. Without such a choice, there can never be an incentive to drive up standards in the NHS. However, vested interests will fight to restrict patients' right to choose. Therefore, Monitor must be retained as a regulator to ensure that patients' choices are not being restricted and ensure that their interests are not being harmed.

• There must be no top-down bureaucracy and political micro-management of the NHS. Making clear that responsibility lies with doctors and nurses on the frontline in itself makes clear that responsibility does not lie with the top-down NHS bureaucracy or with Whitehall. Without the clear division of responsibility, the top-down hierarchy will remain empowered and more money will continue to be spent on bureaucracy rather than on patient care. We have been clear about the date – April 2013 – when statutory responsibility must transfer from the top-down bureaucracy to GP consortia. Contrary to what is being said in public by others, this is a very reasonable period of time. Not to proceed with this division of responsibility puts at risk our aim of releasing £5 billion from NHS administration savings during this Parliament and being able to reinvest it all back into patient care.

• There must be no two-tier NHS. GPs should take charge of commissioning budgets, through consortia, everywhere in the country. To do otherwise would repeat the mistake of GP fundholding – where some areas of the country benefitted from GP commissioning but other areas fell behind. GPs must be given support where they are unable to commission the full range of services, but the network of GP commissioning consortia must be in place by April 2013. The statutory responsibility for ensuring that NHS services are delivered to patients is too important to be fudged.

2. Next Steps
I am keen that our views are heard at the top of government so that the debate is not monopolised by others, and would be grateful for your feedback on the red lines - and invite you also to share your views on the following if you wish:

• Are there any other red lines which have been omitted from the list?

• What could be included in the Health and Social Care Bill to make sure that future governments cannot undermine the principle of a universal, tax payer-funded NHS without consulting Parliament first?

• Do we need to strengthen mechanisms to ensure that unfair subsidies paid to providers – such as Labour's Independent Sector Treatment Centre programme – cannot be allowed?

• How can we ensure patients have the information they need to make an informed choice?

• What measures can be developed to ensure GPs are fully supported following the transfer of commissioning responsibility in April 2013?

I apologise for the length of this email, but I am determined that we reclaim the debate over the future of the National Health Service from those who seek to use the Bill as a political tool. I intend to share these views as part of the current listening exercise and I look forward to your input.

Kind regards,

Nick de Bois