5 min read

Editor's blog Wednesday 7th September 2011: Humpty Dumpty, centaurs and Alan Partridge in yesterday's Commons Health Bill debate

I don't really know what to say about yesterday's debate on the recommitted Health And Social Care Bill. It may be that I have been staring at it for too long, and the wood-for-trees confusion has set in, like rigor mortis. I hope not. It remains important stuff.


Click here for details of 'PM Cameron: “whole health profession on board for what’s now being done”. Why do they call August the silly season?’, the new issue of subscription-based Health Policy Intelligence.


It is, however, clear that any Lib Dem rebellion will be small. The Bill will pass comfortably to the House of Lords, who will cheerfully kick it to pieces.

It will then make the return journey to the Commons for some Humpty-Dumpty surgey by all the King's horses and men.

And if that means the front-bench Health team, then images of a centaur  crowd in on the consciousness.

Yesterday was the 59th birthday of the legend who is Health Minister Simon Burns. Sadly, we were not favoured with a his trademark battle cry of "Nye Bevan", intended to wind up the Opposition.

We did, however, have the brilliant spectacle of The Burns Unit's Alan Partridge impersonation. As Secretary Of State Andrew Lansley (saviour, liberator) read out a list of Labour manifesto health policies from the last general election - yes, the one they lost under Gordon Brown - Burns marked the end of each line with a Partridgesque "A-Ha!"

It was the highlight of a not-great debate. Much was (inevitably) the rehearsal ad nauseam of well-entrenched positions. The opposition were not able to conjure a result from the recently-FOI'd DH-McKinsey-Helios emails, courtesy of Spinwathch and The Guardian. Our Saviour And Liberator Lansley was able to blandly answer, "we are not transferring foundation trusts or NHS trusts into the private sector. We are not planning to do that. The particular case to which the hon. Member for Easington (Grahame M. Morris) referred was misrepresented as a proposal to transfer the ownership of NHS organisations. There is no such proposal; we are not planning to do that".

No plans or proposals. Clearly it was only a scoping exercise.

The Conservatives' best gun was (unsurprisingly) health select committee chair Stephen Dorrell, who will have heartened his fellow backbenchers (and probably quite a few Lib Dems) with his assurance that "many of those observations about the supposed role of Monitor have been based on a misunderstanding, whether deliberate or otherwise, of the intention behind the Bill when it was first introduced. Whether the misunderstanding was deliberate or accidental, the Government are responding to virtually all those points in order to make it clear that, in the context of the Bill, the central purpose of Monitor is not to be a blind economic regulator based on the assumption that the health service is simply another utility. Various loose words have been used that bear that construction—but never by Ministers, and the implications of those observations have never been accepted by Ministers. As I have understood it—this is why I have supported the Bill throughout its passage—the Government’s intention has always been to ensure that the new NHS envisaged by the Bill gives effect to the basic commitment on which the Government were elected to ensure that the health service secures equitable access to high-quality health care for all patients regardless of their ability to pay".

Dorrell also addressed the privatisation attack, noting that in the past two decades, all health secretaries bar Frank Dobson's "legislative and other proposals to introduce more flexible and patient and standards-oriented structures in the health service were opposed by somebody or other on the grounds that they were going to privatise the health service. If that was the purpose of those policy initiatives, the one thing that they all have in common is that they have been singularly unsuccessful. If it is the policy purpose of this Bill to privatise the health service—which I do not for one moment believe it is—it will, I am sure, be as unsuccessful as all the other measures that went before it".

Dobson (self-dubbed "heritage Labour") roused himself to some witty lines - "To ask the essentially collaborative health care system in this country to turn over to being competitive is a bit like asking the Meat and Livestock Commission to promote vegetarianism".

He also made a salient point on the likely lawyerisation of the NHS: "if we are to have contract-based provision of services, a huge amount of lawyer effort will be put into trying to draw up watertight contracts. What one lawyer thinks is a watertight contract, another lawyer will make a leaky contract by puncturing a hole in it, and we will go over to the system in the United States, where zillions of dollars are spent on court challenges or settlements with the providers of health care".

Lib Dem doubter John Pugh, meanwhile, has a nice line that "The choice for the House is not between Aneurin Bevan’s NHS and the Bill, but between Blair’s NHS and Secretary of State’s version. If I were to sum it up neatly, I would say that the Secretary of State’s version most closely resembled Blairism with clearer and more equitable rules".

Labour health select committee member Grahame Morris made an effective, softly-spoken speech, again touching on the above-mentioned DH-McKinsey emails, which prompted Simon 'Partridge' Burns to retort, "the e-mails were not there to discuss these bodies taking over NHS hospitals; the e-mails were about discussing what their views are on hospitals that are struggling. The e-mails were part of an information-gathering mechanism to find out how policy in the NHS could be improved to deal, within the NHS, with hospitals that might be struggling as part of the foundation trust pipeline".

Mmmmm. The slight problem being that isn't what they say.

Morris's fellow Labour health committee member Rosie Cooper also had some effective lines of attack: "The reforms do not address the financial challenges, especially the Nicholson challenge. This is costly—making people redundant, throwing organisations into disarray and telling people, “You don’t have a future, you might have a future,” “Let’s have a cluster, let’s not have a cluster,” “Where are you going to work?”, “It’s all going to disappear by 2013,” “There are no PCTs—well, they’re there really, but clusters will do the work,” “No, we don’t have strategic health authorities—well, okay, we’ll keep four of them.” The Marx brothers would be proud of the stops, turns, U-turns, pauses and muddle that there have been. But the bottom line is that the great British public have to watch those antics and are worried about their health service.

" ... In all such situations I always say, “Follow the money.” What is actually going to happen? If this is costing a lot of money—there is a lot of muddle—it has to be really clear that the driver of the reforms cannot be, as the Secretary of State has previously said, the idea that the NHS is unaffordable; we seem to be able to afford a lot of other things. If the reason is not financial efficiency, it has to be purely ideological".

Cooper added, "As the economic regulator, Monitor is given a whole series of powers that ultimately focus on enforcing competition in the NHS. There are still fundamental gaps in how that organisation will be held to account. There is a lack of clarity about how health services can engage with and influence the work of Monitor. Having been chair of a foundation trust hospital, albeit only for a month—because I stood for Parliament and had to resign—I can say that Monitor was a law unto itself. And before the Health Committee, Monitor likened the NHS to utility companies, which does not give me any confidence whatever.

"I want to talk about Monitor not consulting commissioners on changes to enhance tariff. Private providers can apply to Monitor for an enhanced tariff to preserve the services that they, as private businesses, are providing to the NHS".

Liz Kendall rounded up effectively for the Labour front bench, and Andrew Lansley (saviour, liberator) told the House there is nothing to worry about in the reforms. The vote went broadly on party lines, save a handful of Lib Dem abstentions.