Much has been made of the implications of last week’s local election results for the future of the coalition government. The Liberal Democrats, who have previously fared well in local elections, received only 15% of the local election vote and made a net loss of 695 council seats – the worst local election showing they have experienced for decades.
Alongside the losses in Scotland and Wales, as well as the ‘No’ vote in the AV referendum, Nick Clegg and his party have, in his own words, suffered a “real knock”. This knock has led Clegg to promise that there will be a louder Lib Dem voice in Government, and one of the first areas where he plans to demonstrate this is around the now much debated NHS reforms.Clegg will likely have support from his party on this pledge – activists at the Liberal Democrat spring conference in March voted against the proposed reforms, with former MP Evan Harris and others compiling a list of 23 ‘essential amendments’ which would need to be made before the party would back the Health and Social Care Bill.
These 23 amendments may well be used to benchmark the effect that the Liberal Democrats are able to have over NHS reform policy in the coming months, and one evident theme among them is the party’s long held commitment to localism and devolving power in the NHS. Two key amendments call for:
Membership of local commissioning bodies to include a substantial proportion of elected councillors as per the Coalition Agreement in order to improve transparency and accountability
Unless commissioning bodies have a majority of councillors, there must be scrutiny of all commissioning decisions by local elected councillors either through the local authority, overview and scrutiny committees, or health and wellbeing boards (which must have a majority of councillors to fulfill this role)
And there is nothing new about this focus on localism. It was central to the Liberal Democrat manifesto last year, and in an interview with the HSJ ahead of the 2010 General Election, the then Liberal Democrat shadow health spokesperson Norman Lamb (who now works closely with Nick Clegg) argued that in the circumstances of a hung parliament his party would not compromise on the policy to turn primary care trusts into directly elected health boards. This was reiterated in the Coalition Agreement which made a commitment to ensuring a stronger voice for patients locally through directly elected individuals on the boards of their local PCT, and the planned introduction of health and wellbeing boards in the Bill has been pointed to by some as already one concession to the Liberal Democrats.
The question now is whether the loss of nearly 700 council seats will affect the strength of feeling among Liberal Democrats on this key policy. Will they be so enthusiastic about the role of locally elected councillors on commissioning boards when the number of locally elected Liberal Democrat councillors has just taken a nose dive?
The answer may come down to the struggle between ideology and pragmatism that all political parties face. Having waited so long for national power, Liberal Democrat pragmatists may be reluctant to devolve responsibility to a tier of government increasingly run by their political foes.