Editor's blog Wednesday 30 March 2011 EXCLUSIVE - Lord Owen: PM Cameron must sack health ministers; Health Bill "fatally flawed"

A Health Policy Insight exclusive.

Lord Owen:
- Health And Social Care Bill “fatally flawed”
- PM must sack his health ministers - Lansley, Howe, Burns, Milton and Lib Dem Burstow
- Without major changes, House Of Lords have Parliamentary route to kill the Bill
- Threat of statutory year-long delay if Bill not agreed between Houses

Lord Owen - 'The Prime Minister will hopefully ... replace the existing health ministers in the House of Commons and allow for fresh thinking, and much less dogmatism'.

In a dramatic intervention at a time of political horse-trading between the Coalition parties over changes to the Health And Social Care Bill, Health Policy Insight can exclusively reveal that cross-bench peer and SDP founder Lord Owen says that PM David Cameron must sack his health ministers.

Owen also writes that Parliamentary procedure will enable the Lords to amend the Bill substantially, thus effectively killing it off as it was originally conceived.

Lord Owen (a former Labour Cabinet Minister under James Callaghan) is known for his independence of approach. As a crossbench peer, he does not take the Lib Dem whip, and so Conservatives are unlikely to associate his views strongly with those of the Lib Dem team of Nick Clegg and Norman Lamb leading the negotiations.

However, Owen's analytical mind is respected around much of the House.

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Click here for details of 'Andrew Lansley's Millwall Tendency', via subscription-based Health Policy Intelligence.

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Lord Owen will tomorrow publish a new pamphlet on NHS reform, whose title, 'Fatally Flawed', gives its perspective on the proposed legislation. Its author concludes that "a mindset is developing that ensures that this Bill should not be enacted in anything like its present shape and form".

No evidence; much to criticise

Lord Owen - 'This Bill focuses on means, with little concept of ends. Perhaps the Government are deliberately hiding the ends because they know if they did not do so it would make its health policy even more unpopular and incoherent'.

Lord Owen echoes many critics of the Bill's lack of an evidence base, with his comments that "this legislation towards an external market in health care puts this proven balance (of good quality care with universal coverage) in jeopardy. It warrants very careful thought, before being voted onto the Statute Book, particularly since close scrutiny of the experience and evidence accumulated from the internal market of the past 20 years does not justify such a revolution".

He continues, "decentralisation and patient choice are welcome as the direction in which to travel, but we need more honesty that they are more costly, while creating a wider range of local health services, and ensuring a greater variety of provision across England. This variety ... requires more planning and debate".

Lord Owen's criticisms continue: "The Bill promotes too much cherry-picking and does not provide a fair, let alone a level, playing field. Introducing evidence-based GP commissioning can be beneficial, but the Coalition has not made the case for its changes, nor defined their purpose ... What this Bill does is focus on means with little concept of ends. Perhaps the Government are deliberately hiding the ends because they know if they did not do so it would make its health policy even more unpopular and incoherent".

(It's not quite what you might call understated, is it?)

The Salisbury Convention

Lord Owen - 'The Coalition lacks a mandate for many of the policies set out in this Bill'.

Lord Owen cites the Salisbury Convention of the House of Lords (AKA the Salisbury Doctrine), of which he says, "There was no mention in either the Conservative or Liberal Democrat party manifestos at the 2010 General Election of an intention to carry forward anything like this revolutionary change. Under the Salisbury Convention the House of Lords is entitled therefore to make substantial amendments to this Health and Social Care Bill.

"In the Summer of 2011 the House of Lords may be faced with an important task if the Bill is not substantially changed in May at the Report Stage in the House of Commons. The House of Lords traditionally does not vote against the Second Reading of Bills. Yet the surprise at the scale of the reforms in the Health and Social Care Bill, and the shocked response of so many in the health sector to some of its provisions is but a demonstration that the Coalition lacks a mandate for many of the policies set out in this Bill.

"At the very least, these substantial proposals that affect the founding principles of the NHS must be given the time and consideration they deserve. Referral to a Select Committee of the House of Lords, as part of an acceptance of its Second Reading, is a very realistic possibility rather than subjecting this Bill immediately to an ad hoc battle of amendments between the Lords and the Commons.

"At the Second Reading of the Public Bodies Bill referral to a Lords Select Committee went to the vote and the Government only had a majority of 30 against referral (HL Deb, 9 Nov 2010)

"I believe that a referral motion to a Select Committee of the Health and Social Care Bill would be carried in the Lords, particularly if there was a time limit attached to the motion, giving a date when the Select Committee would have to finish, and envisaged working in part through the Summer recess.

"Even after such a Select Committee had reported there would still be a necessity for substantive amendments to be passed by the House of Lords. If these are passed and then rejected by the House of Commons, an amendment “ping-pong” follows between both Houses. The Lords, however, are entitled to hold out and let the Coalition government decide whether to accept an amended bill or to delay the Bill’s introduction for the statutory period of a year or more when there has been no agreement.

"The Prime Minister will hopefully act long before this happens in the summer and replace the existing health ministers in the House of Commons and allow for fresh thinking, and much less dogmatism. Such a decision would allow the Coalition Government to return to their primary task of helping the NHS deliver the large efficiency savings that they have already quantified as part of the necessary reduction in the UK’s structural fiscal deficit".

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Editor's note - journalist colleagues got in touch since this story was published last night, to query our description of this piece as an exclusive, and saying that they had received copies of Lord Owen's pamphlet under embargo until 11 am today.

The document was sent to editorial AT healthpolicyinsight.com as a Microsoft Word file by email from a clearly pseudonymous email account, and came with no details of the embargo. (We do respect embargos, but did not receive this document officially). After making some checks, we decided to publish on the basis that this was a deliberate leak.

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Click here for details of 'Andrew Lansley's Millwall Tendency', via subscription-based Health Policy Intelligence.

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