Party must decide whether or not it wants to own the hideous headaches to come – it is still not too late
The Liberal Democrats' federal committees must today allow for an unrestricted debate on the health bill at the party's spring conference – and the delegates assembling in Gateshead must then seize their final chance to demand that this dire legislation be scrapped.
It was the same spring conference in 2011 which forced the unprecedented parliamentary pause. Delegates might have liked to kill the bill back then, but they rightly took their collectively responsibility seriously, and so instead demanded specific changes to bring it into line with the coalition agreement. That document had, after all, followed Lib Dem policy in proposing to democratise the primary care trusts which Andrew Lansley later moved unilaterally to abolish. It had referred to the regulator, Monitor, the engine which will drive marketisation, in somewhat oblique terms – not specifying the lopsided obligation later put on it to "promote competition" above all else. And although this drive to privatise was evident in obscure Conservative party documents in early 2010, it was conspicuous by its absence in David Cameron's reassuring manifesto. This, therefore, was not merely a bill that the Lib Dems had not agreed to, but a bill that nobody had voted for. That gave the party a powerful negotiating position, and – for a time – it appeared to be playing it well at Westminster. The whole rhetoric of the reforms was recast so that competition was no longer an end in itself, but a means to be applied only where it would benefit patients.
But the party must now recognise that the other side has ratted on the deal that it reasonably thought it had done. There have been worthy advances on public health, but the welcome change of tone on markets was not satisfactorily reflected in the bill. Yes, there was some widening of Monitor's remit, and more recently the restoration of the legal duties on the secretary of state. On closer reading, however, many changes were not what they seemed. Rather like a pompous individual who says "not unlike" when "like" would do, the bill's new mandate for Monitor to "prevent anti-competitive practices" adds syntax without changing the underlying thought. If you doubt the basic continuity, just read the defiant defence of the competitive thrust of the reforms which Mr Lansley recently penned for Health Service Journal; there he compared the nascent market in medicine to that in electronic goods. Lib Dems may half-believe and half-hope that they have changed the design, but the architect himself smiles on with satisfaction as he watches the foundation stones fall into place, exactly where he wants them.
The party's president now fingers Labour for letting the market rip. There is something to that: Tony Blair did sign off on some appalling private contracts. But this is utterly beside the point now. Those duff deals were done in the NHS good times when a little money could be squandered without jeopardising benign public perceptions. The new Tory drive to privatise comes in the form of a hated bill, amid a botched reorganisation and at the start of the longest spending squeeze in NHS history. Lib Dems must decide whether or not they want to own the hideous headaches to come.
Delegates may be told that the tweaked bill represents the best deal they could get. Contemptuous Tories, who mutter that with a sixth of the MPs their partners are ripe for cutting down to size, will be thrilled by such talk. The truth is that there were two Lib Dem voters for every three Conservatives in 2010, and the Tories cannot rule alone. If the Lib Dem voice speaks loud and clear, it will count. There may also be claims that it is simply too late say no. Don't believe it. Officials know it's not done until it hits the statute book, so have developed plans B and C. It may even be said that the Lords cannot halt a bill on third reading. In fact, though it has not been done for a while, it is perfectly allowed.
The one real difficulty with changing course is that the prime minister has made this a virility test. The Liberal Democrats will neuter themselves if they indulge him in that.