Lib Dems on collision course with ‘market-based’ NHS reforms

By Ian Quinn

The Government's NHS reforms face their biggest challenge yet, after Liberal Democrats at their party's spring conference voted to oppose key parts of the health bill.

In a motion passed in Sheffield on Saturday, the party committed to demand new safeguards are written into the bill to limit the role of private firms and effectively return to the previous Government's policy of the NHS as the 'preferred provider'.

The motion was an embarrassment to Liberal Democrat health minister Paul Burstow, whose original motion overwhelmingly supported the reforms, and leaves health secretary Andrew Lansley now facing having to re-negotiate the terms of the bill, or see Liberal Democrats vote against them.

With the bill continuing its committee stage this week, Liberal Democrat MPs are now vowing to ignore pressure to vote with the Government, after angry MPs hit out at their treatment at the hands of the party whips.

While the Liberal Democrat motion said the party welcomed ‘much' of the vision in the bill, such as giving more power to clinicians and the move to outcome measures, it warned that they could be achieved ‘without the damaging and unjustified market-based approach that is proposed.'

The motion also attacks the coalition for proposing reforms which ‘have never been Liberal Democrat policy' and ‘did not feature in our manifesto or in the agreed coalition programme which instead called for an end to large top-down re-organisations.'

It calls for an NHS ‘based on co-operation rather than competition', putting the party on a collision course with the Conservatives over the 'any willing provider' strategy.

Under the party's proposed amendments to the bill, new providers would be allowed ‘only where there is no risk of cherry picking which would destabilise or undermine the existing NHS service.'

Among other demands the Liberal Democrats are making include a proposal that local councillors should make up half of the board membership of commissioning consortia, with members angry that the bill has not gone far enough to ensure local democracy.

Mr Burstow promised there would be no 'US-style privatisation of the health service on our watch' and that he would listen to Liberal Democrat concerns.

‘The party has shown its mettle by setting out areas for improvement in the Bill. I can assure you we are listening to the party's concerns and I will be taking those concerns back to the Government,' he said.

The vote comes in a tough week for the Government's reforms, with the BMA's Special Representative Meeting in London tomorrow set to debate a raft of motions attacking plans for competition and GPs also debating a vote of no confidence in the health secretary and the possibility of industrial action.

In an interview yesterday, Mr Lansley hinted the wording of the bill may change, but not substantially, saying: ‘This is not about significant changes to the policy but about reassuring people as the Bill goes through the House.'

Conference therefore calls on Liberal Democrats in Parliament to amend the Health Bill to provide for:

I) More democratically accountable commissioning.

II) A much greater degree of co-terminously between local authorities and commissioning areas.

III) No decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed GP consortia.

IV) The complete ruling out of any competition based on price to prevent loss-leading corporate providers under-cutting NHS tariffs, and to ensure that healthcare providers ‘compete' on quality of care.

V) New private providers to be allowed only where there is no risk of ‘cherry picking' which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases, and where the needs of equity, research and training are met.

VI) NHS commissioning being retained as a public function in full compliance with the Human Rights Act and Freedom of Information laws, using the skills and experience of existing NHS staff rather than the sub-contracting of commissioning to private companies.

VII) The continued separation of the commissioning and provision of services to prevent conflicts of interests.

VIII) An NHS, responsive to patients' needs, based on co-operation rather than competition, and which promotes quality and equity not the market.