The Liberal Democrat leader is going ever further in his objections to the health and social care bill
It would probably be useful if, the next time Nick Clegg shares his views about the health and social care bill, he tells us which of its many proposals he actually agrees with.
It would be far less interesting than watching him explode the verbal hand grenades he keeps tossing into the government's tense and sometimes fractious, but politically very significant, internal debate about how to overhaul the bill. It would, though, save us all having to listen yet again to the deputy prime minister's ever-lengthening list of "things I don't like about Andrew Lansley's NHS plan".
Yet the scope and detail of his concerns matter hugely ? for the NHS, his own position and the coalition's future. His latest speech, at a made-for-TV event at University College hospital's medical education centre, was his most wide-ranging rejection yet of the bill in its current form. Some of his concerns were already known, but others were new, as was his bombshell that the bill will definitely have to be re-examined by a committee of MPs, though exactly when is unclear.
Clegg's interventions may irritate Lansley and backbench Tory MPs. But simple parliamentary arithmetic means that without him and his party's 56 other MPs, the bill will not pass. Buoyed by that, by his concern to ensure the NHS is not damaged by the bill, and possibly by a need for the Lib Dems to be able to claim that they have saved the NHS, he is playing very public hardball.
His promise that "there will be no privatisation of the NHS" was uncontroversial. David Cameron and Lansley have both said the same in big speeches over the last 11 days. Similarly, his statement that "as Andrew Lansley confirmed earlier this week, the duty of Monitor, the health regulator, will not be to push competition" was no surprise. No one who really matters in this high-stakes political game pretends that the health secretary's original plan, for Monitor to become an economic regulator which compels hospitals to compete with each other in his originally envisaged free-market-modelled new NHS, is now the right thing to do, or politically sellable.
But Clegg had not said before that "the secretary of state will continue to be accountable for your health services". That should reassure the British Medical Association and Royal College of GPs, both of which have opposed the bill's proposal to abandon the current situation, whereby the health secretary's legal duty is to provide comprehensive healthcare services. Both key bodies wanted that reinstated; Clegg did what they wanted. His saying that the health secretary "will" continue to have that duty ? not that he should do so ? made it feel like an announcement, not part of a bargaining process.
So, too, his pledge that "there will be no sudden, top-down opening up of all NHS services to any qualified provider". Not "should" not happen, but "will" not. "Any qualified provider", remember, refers to Lansley's plan for letting private healthcare firms, or indeed charities, bid for NHS contracts to treat patients.
Clegg also denounced unidentified "arbitrary deadlines" as "no good to anyone". That may mean that against all the odds, primary care trusts survive beyond their planned abolition in 2013 and the duty on all non-foundation trust hospitals in England to achieve that status by 2014 ? which senior NHS figures believe was totally impractical, but health ministers have defended until recently ? is relaxed too.
And Clegg no longer refers to "GP-led commissioning", the bill's foundation stone. He prefers "clinician-led commissioning", clinicians being doctors in general. That is music to the ears of the Royal College of Physicians, which represents 25,000 hospital doctors. And while family doctors should be "more involved in the way the NHS works", they should not all after all have to join a consortium by 2012.
Clegg's audience listened quietly. But it was hard not to hear, metaphorically at least, the sound of gunfire as he shot Lansley's policy foxes one by one.
So the Lib Dems' red lines on the NHS are now clear. But there is much we still don't know. Does Cameron agree with Clegg, or is this a freelance mission by a desperate deputy PM? If Clegg's concerns do broadly accord with Cameron's, how will the PM sell such a big U-turn to his increasingly anti-Clegg backbenchers? And might ? just might ? we never actually get a Health and Social Care Act at all?
Source: http://www.guardian.co.uk/society/2011/may/26/nick-clegg-scalpel-andrew-lansley-reforms
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