Nick Clegg's proposed amendments do not safeguard the NHS against privatisation
The last time a proposition was put to the country with such a slippery argument, the Liberal Democrats made a defiant stand, and said "not in our name". The health and social care bill is not the Iraq war, but the claimed rationale has changed almost as often. At first the big idea was "promoting competition", which was soon softened into "real choice", before giving way to some fuzzier notion of devolving power to professionals – who, by the way, mostly bitterly oppose the whole thing.
The Lib Dems have undoubtedly extracted a few worthwhile concessions on the detail during the bill's turbulent voyage through parliament. But as the final crunch votes loom in the Lords, there is still utter confusion as to the central purpose. The Conservative health secretary, Andrew Lansley, continues to claim that his bill will enable competitive forces to reign as they do in "any other sector", likening the future NHS to the innovative consumer goods markets which gave rise to the MP3 player. The deputy prime minister, in contrast, has just written to all his own parliamentarians to insist that the bill's real agenda is instead preventing private providers from cleaning up at the expense of public hospitals. Ahead of Tuesday's deliberations on the all-important competition chapter, anxious crossbench and Lib Dem peers must decide whose interpretation to trust – the man who penned the original plans, or the man who initially signed off on these without having read them.
Nick Clegg's credibility here is not helped by what happened during the bill's unprecedented pause. No 10 set up the Field review to get itself out of the fix, and when it duly served up fudge Mr Clegg hailed a decisive victory against privatisation. But it was no such thing, and such anxieties persisted in the Lords that the government was forced to bring in dozens of last-minute amendments, some dealing with the foundational role of the secretary of state in the system. Many more changes would be required, however, to turn this legislation into something that any peer committed to the NHS ought to countenance voting for.
Mr Clegg himself suggested five fresh tweaks to persuade the sceptical Shirley Williams to co-sign his pro-bill letter. Some are useful – such as ditching the provision that would drag the marketopian competition commission into play. Others are undeliverable – the prospect of the NHS being ensnared in European competition law is threatened by a complex mix of statute and case law; it cannot be prevented by shoving in a standalone clause proclaiming that this will not come to pass. Others again simply miss the point, such as the promised "safeguards" against abuse of the private patient income cap, when that cap is being raised sixteen-fold, from an average of around 3% of hospital revenue up to 49%.
All told, it is plain that these amendments do not add up to a thoroughgoing safeguard against privatisation. That can be seen by delving into the detail of the bill: it continues to place an unbalanced duty on the regulator to stamp out anti-competitive practices, but not practices which undercut co-operation; and it has been slyly revised to shift the gung-ho order to marketise away from that regulator (where it was so controversial) and shunted on to commissioners instead. But the same verdict is reached if you take a step back and survey the bigger picture. Just as corporate scandals engulf workfare, some excellent reporting by the Mail on Sunday has revealed McKinsey's extraordinary schmoozing of health service bigwigs. Doctors, meanwhile, scratch their heads anxiously when they spot high-paid business consultants stepping into modestly renumerated hospital management roles.
One need not be a conspiracy theorist to suspect ulterior motives here. Fears of corporate takeover chided the traditionally apolitical Royal College of Physicians to lurch towards opposition last week. The envisaged future of the NHS may be replete with thrilling opportunities for business services sector, but that is precisely why parliamentarians – and patients – ought to be worried.