Wednesday, 12 October 2011

The Lords have failed the NHS today.

I am now well and truly off the fence and must record my deep disappointment with the House of Lords vote today.

Like so many associated with the NHS, I judged the Health and Social Care Bill to be a badly constructed piece of legislation – emanating from the world of Andrew Lansley – not a world that most clinicians and healthcare workers understand.

Then as time and debate continued, I started to accept that in spite of coherent and intelligent opposition from literally thousands of highly knowledgeable experts representing millions of people, the Coalition intended to forge forward with the reforms. Ever an optimist, I even believed that the amendments to the reforms could be workable and thought that maybe a point of no return had been passed where maybe it would be better for the NHS to live with this difficult Bill rather than continue to operate in the current no mans land.

But as the House of Lords debate started, like many of us watching this political saga, I began to hope that cometh the day, cometh the Lords. The Lords have the power to send the Bill to a select committee that would further delay the legislation which could have effectively derailed the reforms. 

Despite some excellent argument to the contrary, the learned gentlemen and women took the easy way out. 354 peers voted against an amendment calling for the Bill to be further amended versus 220 who voted for the amendment. It was embarrassing to note that several speakers spoke of Lansley’s ‘good intentions’ with his reform. A bit like saying ‘bless’ as you watch an inadequate and mortifying performance by someone not quite in control of their faculties on The X factor.

As Lord Hutton said ‘Good intentions do not make good legislation…. The white paper has become a white elephant and all we hear is white noise..’

Lord Tugendhat spoke in praise of the managerial staff who have borne the brunt of implementing already challenging budgets as they face their own redundancy. He also made the very good point that the ‘Nicholson Challenge’ (to reduce costs in the NHS by 20 billion over 4 years) was enough of an incentive for reform without cumbersome, complex and expensive legislation. But he felt there was ‘no going back’ as ‘too many eggs have be broken and no omelette made’

One of my Twitter friends (@Scoobydoc) made the very good point that ‘there will be no omelette with these proposals – just mushed egg on the floor’

Another tweet (@mulberrybush) said  ‘what an appalling position – going ahead with the wrong thing just because so much damage already done’

They are right of course.

So… we have 75% of GPs calling for the Health Bill to be withdrawn. We have leading clinicians, medical organisations and Britain’s Royal Colleges of Medicine calling for ‘substantial changes’ to be made to the reforms. Non–politically motivated supporters to this radical reshuffle are as rare as hen’s teeth.

And yet the Health and Social Care Bill has cut a swathe through good sense and expert opinion. Top down re-organisation of the NHS was not part of the Conservative or Lib Dem manifestos. Opposition to this reform is widespread, real and heartfelt.

It’s not just the NHS I fear for today. My belief in democracy is shaken too as a piece of incredibly unpopular legislation comes closer to implementation.


Chairman Chegwin said...

Interestingly, it is the concept of democracy that limits the Lords' powers. The HoL is essentially there to scrutinise and improve legislation - it has no democratic mandate to kill legislation.

The mechanics of the system work like this: if a bill is voted for in the Lords, it is immediately sent for Royal Assent. However, if any amendments are made in the Lords, the bill is returned to the Commons which debates each amendment the Lords have made. The Commons can then accept the amendment, amend the amendment, completely replace a Lords amendment with one of its own or simply reject a Lords amendment.

If any of the last three are done in the Commons, the bill returns to the Lords with an explanation as to why the government has taken the course of action it has. This is a ‘statement of reasons’. The Lords can accept this and pass the bill. However, it can also reject the ‘statement of reasons’. When this happens, the amendments concerned (and therefore the bill itself) goes to and from the Commons and Lords until an acceptable compromise is reached.

If both Houses fail to agree on their differences, the bill dies. This is an extremely rare event and has only happened on very infrequent occasions since 1945.

The bottom line here is that if an elected government decides to pursue a certain policy, an electoral victory gives it the right to do so – and really the Lords have no right to interfere in this process.

You can argue about whether the Coalition itself has the democratic mandate to make these changes to the NHS (working where I do I won't/can't comment either way) but relying on the Lords to kill the legislation was always a non-starter I'm afraid.

Finchers Consulting said...

Thanks Rob - I was working on the basis that if the Bill was further delayed it would eventually fail as it would run out of time? I guess now everyone must just get on with it and make the best of a bad job so to speak.

Chairman Chegwin said...

It can still run out of time. This parliamentary session ends at the end of April I believe so there's still a long way to go - and for opponents, still all to play for.

But noone has constructed a killer argument against reform?

Finchers Consulting said...

You are so right - it's easy to criticise the Bill - not so easy to come up with the magic bullet. Reform is needed but not necessarily restructure. I would prefer to see resources directed towards strong leadership and integration of services instead of all this messing about.

Post a Comment