The Health and Social Care Bill

As the Liberal Democrats meet in Gateshead today, I have emailed my Liberal Democrat MP Mr Stephen Williams (MP for Bristol West). I have never met him, but I believe that he is a decent fellow. My message to him was as follows:

Dear Stephen,

I’m writing to let you know that I am not reassured by the reassurances that you and Nick Clegg have offered over the NHS and Social Care Bill. The professional bodies, trade unions and a range of experts are far more convincing (I’m afraid) than politicians whose party interests are supported by mere commercial enterprises rather than by dedicated membership bodies with personal commitments to service.

I am hoping, of course, that you will be one of those Liberal Democrat MPs who vote with the hostile motion at Gateshead. I would be delighted to share my delight with everyone I met that “my MP voted to stop the Bill at conference.”

To put it another way, this weekend could definitely be the end of the credibility the Liberal Democrats have had in previous Parliaments. The chance that any LibDems would remain as Bristol MPs at the next election would have to be close to zero.

I hope you use the remaining time to oppose the Bill. Its “thousands” of changes guarantee that if passed it would still need another major Bill in three or four years time, and all the agony would start all over again. The waste of resources and good will is a shocking prospect. It’s a truly wretched piece of legislation, and I suspect that most Liberal Democrats are of the same mind,
Yours sincerely

Sam Saunders

Fingers crossed, eh?

A Letter From A Member Of Parliament

After Thursday’s division on the Third Reading of the Health And Social Care Bill in the House of Commons this week I got a copy of the generic letter that Stephen Williams MP sent to all those who had contacted him about the Bill. He wrote:


Dear Sam Saunders,


Health and Social Care Bill


Thank you for your recent correspondence regarding the Health and Social Care Bill. A great many Bristol West residents have contacted me about this Bill and my intention is that this reply will cover all of the main points that have been raised.


Most of the Bills discussed by Parliament are non-contentious and arouse limited debate. It comes as no surprise that a Bill reforming the NHS and social care has received a great deal of attention, both within Parliament and from external commentators. This particular Bill has now been under discussion for more than 6 months. Quite apart from the many representations received by MPs from constituents and lobby groups, the Bill has been the subject of major debate between the two governing parties in the Coalition Government. The Liberal Democrat spring Party Conference in March 2011 debated this issue and called for changes to the original Bill. Nick Clegg and Andrew Lansley agreed to “pause” the detailed Parliamentary scrutiny of the Bill in order to allow for more external consultation. The Bill considered by MPs over the last two days (6th-7thSeptember) is much changed from the original version as a direct result of this further discussion.


On Wednesday the Bill received its approval by the majority of MPs, including myself. It now passes to the House of Lords for further debate and possible amendment.  Whatever your opinion of the final outcome I hope you will agree that this long and detailed consideration by the Coalition government is a great improvement on the many examples of contentious legislation being rail-roaded through by a single party, which was my experience during the time of the previous government. I will now turn to the detailed points raised in the letters and emails that I have received.


Firstly, there has been the spectre of “privatisation” or “break up” of the NHS into some model resembling health care in the USA or many EU states. I am clear that there was never any intention that this was the purpose (or an unintended consequence) of the Bill. There was never a chance that I and my Lib Dem colleagues would have allowed that to happen; I can emphatically assert that there will be no “privatisation” of the NHS and no special concessions (i.e. “cherry picking” or favourable tariffs) to private sector providers of health care. The NHS will remain free at the point of need and treatments will be paid for by our taxes.


It is important to note that this does not mean that there is no role for non state owned providers of health care. Ever since its inception in 1948, the NHS has commissioned care from private doctors and companies. The vast majority of family doctors in Bristol West are essentially private professional practices which derive most of their income from the NHS. There always has and there will continue to be a mixture of providers of health care. The important point for each patient is that the treatment is paid for by the NHS, no matter from whom it has been commissioned.


Another concern that many constituents have highlighted has been the role of the Secretary of State for Health. The original 1947 Act that established the NHS made the Minister for Health responsible for the provision of a comprehensive system of health care. Reforms of the NHS by successive governments have amended that duty, essentially reflecting that fact that government is usually an enabler rather than a direct provider or commissioner of services. Indeed, the current situation is that Secretary of State delegates the commissioning of health care to a network of Primary Care Trusts (NHS Bristol in our case), each with their own Board and Chief Executive. Those trusts commission health care from GPs, Hospital Trusts (mainly, but not all, state owned) and a variety of other businesses, including the private sector. Some doubt was expressed as to whether this duty of the Secretary of State was being weakened under the Bill. I have read carefully the Department of Health’s legal advice and received direct assurance yesterday from Paul Burstow MP (Lib Dem Minister of State for Health and Social Care) that the Health Secretary will retain ultimate responsibility for the provision of health care.


Indeed, the duties of the Health Secretary have been widened by the Bill. Firstly, the Health Secretary must ensure that the Government is actively attempting to reduce health inequality. As Chair of Parliament’s cross party committee on Smoking and Public Health I very much welcome this new duty. Public health and the shocking disparities in life expectancies between different social groups has not been given the attention it deserves in the past.  Secondly, the Health Secretary will also have a new legal responsibility to make sure that the NHS is an active participant in medical research. Bristol is of course a major national centre of excellence for several areas of medical research.


Aside from the corporate status of the NHS and the duties of the Health Secretary, many people have cited “competition” and “EU regulations” as a concern. The Bill does not make any substantive change to the levels of competition for health care already in existence. The NHS has a massive procurement budget and a large number of suppliers. As such it has always had to abide by competition rules (both UK and EU wide depending on the size and nature of the contract) when it contracts out for services. The Health and Social Care Bill will not alter this longstanding situation. I would also refute the assertion that competition is an alien or evil concept in health care. Competition is about maximising patient choice and also value for money for the taxpayer.


However, I do understand and agree with concerns that businesses should not make unfair levels of profit from health care. The Coalition government intends that this Bill will place important limitations on the applicability of competition law so that those charities or private firms who do bid to provide treatments should not be allowed to “cherry-pick” or undercut on matters of price. Where competition is present it will be in areas such as quality and alternative treatments, not on price for specific treatments as these come under a set NHS tariff. Furthermore, unlike the previous government, the Coalition is determined that it will not simply promise payment to such organisations regardless of whether those organisations have seen NHS patients. The last government encouraged the setting up on Independent Sector Treatment Providers, specifically to compete with NHS Trust Hospitals. There is one in Bristol, at Emersons Green.


The Government believes that any disputes which occur between organisations which are involved in seeing and treating NHS patients, regardless of whether these bodies are public or private, should be dealt with by a regulator which is specifically devoted to health matters (known as Monitor), rather than the Office of Fair Trading (OFT). This is an important enhancement under the Bill, as the remit of the OFT is arguably too broad to deal with such disputes and a specific health sector regulator is welcome.


Throughout the consultation on this Bill, the Liberal Democrats have sought to emphasise the importance of properly integrating local health services and ensuring their sustainability, and enhancing local as well as Parliamentary accountability. As well as confirming existing and introducing new duties for the Health Secretary, the Bill also gives much more scope for decision making and scrutiny in Bristol. A new Health and Well Being Board will be set up in Bristol and the City Council will also have new duties in public health. I believe that we will be able to build an NHS that has a strong set of legal duties on the national government, but where local health care professionals and politicians will be able to design and commission health care services that address local needs.


The Liberal Democrats have made valuable changes to the Health and Social Care Bill which I believe will not only secure the future of a comprehensive system of health care but also lead to improved levels of service. The very nature of health care means that we cannot have a template of provision that can never be subject to reform or innovation. Advances in medical research and demographic change mean that we must make sure that our system of health care matches contemporary needs and circumstances.


Finally, a personal note. Rest assured that I greatly value the NHS and I fully understand that many people in Bristol regard it as our greatest national institution. I have a direct personal interest in the NHS as a long term patient at one of Bristol’s main hospitals. The issues discussed in this note are as important to me as they are to you and I have given them a great deal of thought over many months. No piece of legislation can ever satisfy everyone and no doubt there is a scope for further improvement and clarification as the House of Lords now considers the Bill. I thank you for your interest in the Bill and hope that this reply has reassured you.


Yours sincerely

Stephen Williams MP


In summary he says:


  1. We have made a lot of changes to the first attempt to change the NHS.
  2. There will now be no privatisation and no easy profits for suppliers. Patients won’t be asked to pay for their treatment.
  3. The NHS has always bought supplies and services from private companies.
  4. GPs in Bristol West are mostly private practitioners who work for the NHS.
  5. In a largely devolved system the Secretary of State for Health will retain overall responsibility for the provision of health care.
  6. The responsibility will include a duty to reduce inequality in health care and to require the NHS to support research.
  7. There are no important changes to the role of competition in health care provision.
  8. Profiteering and market abuse in the competitive aspects of health provision will not be allowed.
  9. A Monitor for the NHS will ensure that such profiteering will not go unchecked.
  10. Local politics will still have a role to play in NHS provision.
  11. The Liberal Democrats have helped by making changes to the first proposals.

Stephen Williams MP has been an NHS patient himself, with long term treatment in a Bristol hospital.
I think this is all very optimistic and I sincerely hope he is right is the implicit suggestion that the Tories have now abandoned the idea of dismantling public health provision. The Tory Election promise to do no centrally managed reform has clearly been abandoned and it is good to see that despite claims of financial crisis large sums of money can be found to provide a job creation scheme for health managers to open new offices and to move people from one desk to another.


The outcomes of chaotic events can never be known – but as long as nurses and doctors and other health professionals have the will to do their best for patients (whatever nonsense is poured on them from above) we might avoid the outright scandal of US health provision and the gradual decay of the co-operative ethic.


Fingers crossed eh? I’m also with Mr Williams in hoping that the House of Lords (so recently packed with Cameron’s Chums) can remedy some of the nonsense that is still in the Bill. A Bill, let us not forget, that no one voted for in the last election, for which there is no immediate need and which will soak up large sums of money that could have gone to direct use in health care itself. It is and always was, a vanity bill intended to further the libertarian cause of Big Business and the self interest of rich people. The Liberal Democrats (if what Stephen Williams says here turns out to be true) will have saved the Tories from a humiliating defeat and kept the hopes of the private health lobbyists alive.



A Letter To A Member Of Parliament

This morning, having skimmed my Twitter messages, I came upon an article in the British Medical Journal. All of a sudden it seemed urgent to say something to someone about what I thought. So I wrote to Mr Stephen Williams, MP for Bristol West – the constituency in which I now live and where I am registered to vote. This is what I wrote:

Dear Mr Williams,

Of all the damage being done by the Tories at the moment there is nothing as fundamental and nothing as contrary to British post-war consensus as the Bill that is about to damage the foundations of the health service.

In my opinion your article on the subject ( is timid and lacks the sense of urgency or vision that I would have hoped for. It seems to accept that you are going to vote in favour of something that most of your constituents would be against. The Bill as it stands is driven by a mixture of libertarian (not liberal) idealism, the financial self interest of pharmaceutical and insurance businesses, and the individualistic ambition of some health professionals. Once it is enacted, the remaining checks and balances that you seem to want to trust will sooner or later be washed away by the power of “market” forces. The National Health Service will not be able to remain a genuine public service once the new dispensation has started running. Cameron wants “NHS” to be no more than a brand and is keen to remove the difficult questions of resource allocation away from the realm of public debate and democratic decision.

The National Health Service was started as, and in many hearts remains, a deeply held moral principle and practice. I was born a year after the NHS began, and I look forward to my grandchildren being able to enjoy it as I have done and as my children have done.

I am asking you to re-read the BMJ article by Pollock and Price and to be visionary in how you vote in Parliament. The full text is here:

With best wishes

Sam Saunders

We are, I believe, not “customers” of the NHS, we are partners and participants. We need to cherish, support and understand it. The Tories want it to be the McDonalds of the health industry – just another glass-fronted outlet where we can browse for the least unattractive offering in a high street full of more expensive options.