Falling poll ratings, u-turns and hints of alternative future leadership. Nick Clegg’s position is, yet again, under scrutiny and the Deputy Prime Minister is now looking beyond May 5 and to the major policy challenge facing the Coalition Government – the NHS reforms.
Today the Government has announced an apparent slowdown to the passage of the Health and Social Care Bill with a listening exercise to address concerns. Claim and counterclaim has already been spun across Whitehall on whether this is a full blown retreat on the Government’s reform programme or the “natural break” as the Bill prepares to enter into the Lords.
Whatever the reason, it is clear that the Government hopes the break will offer breathing space for both coalition partners who have been under increasing pressure to heed wide ranging opposition to their health and social care reforms – none more so than from the Deputy Prime Minister’s own party.
In the midst of today’s announcement, the former Liberal Democrat MP and vice-chair of the party’s national policy committee (and former liberal democrat health spokesperson), Dr Evan Harris, has set out the amendments he, and some in his party, would like to see introduced into the Bill. The amendments, which follow the Lib Dem’s spring conference last month, cover four key areas: the role of the Secretary of State; the nature and accountability of commissioning consortia; the functioning of the “market” created by the Bill; and the implementation programme.
Dr Harris, who has been leading the campaign for the changes, has now called for these amendments to be taken on board to “satisfy the requirements of Lib Dem policy”. However, the extent to which this will, or even can, happen remains unanswered.
In early March, Andrew Lansley showed some flexibility and willingness to amend the Bill in order to rule out competition on price, to constrain the role of Monitor and to stop private providers from cherry picking services. However, this has yet to satisfy Dr Harris and some Liberal Democrat colleagues who spoke out today against the Bill’s proposals for full blown “marketisation” of the health service. Nevertheless, the issue of ‘any willing provider’ remains a sticking point for the Lib Dem which, Mike Birtwistle pointed out earlier, represents an ongoing struggle between the two wings of the Lib Dem bird, the pro-health marketeers and the market sceptics.
The suggested amendments also call for the proposed deadline to abolish primary care trusts to now become a goal rather than a commitment, with greater time given to support the transition. However, with many of the new health structures already in place (90% of the population is now covered by GP pathfinder consortia), Andrew Lansley may well argue that further delay could lead to confusion and disparity within the health service. Even the need for greater democratic accountability into the health service has been dismissed by supporters of the reforms who point to the proposed establishment of local health and wellbeing boards under the Bill which will sit within local authorities.
Concessions on key Lib Dem policies and the fear of a ‘no’ vote in this May’s AV referendum has put considerable pressure on Nick Clegg to show that his party is delivering in government. As Andrew Grice of the Independent rightly points out, Nick Clegg has now set his eyes on a big prize to show to his party base, influence over the NHS reforms. With his political capital at an all time low, Nick Clegg, with David Cameron, may be able to deliver on some technical changes to the Bill. However, he may not be able to deliver the ‘big symbolic changes’ which can satisfy his party.
One thing is clear, tweaks or no tweaks, these reforms will go through. Whether the Liberal Democrats can take credit for any substantive changes, continues to look unlikely.