Simon Hughes MP

Messsage from Simon Hughes MP about the Health and Social Care Act

The White Paper and the Health and Social Care Bill first published by the government

Despite the difficult economic times facing our country the new coalition government has made a commitment to increase the NHS budget over the course of this parliament - in contrast to the view of the former Labour Health Secretary Andy Burnham MP who said this would be irresponsible. But simply raising the budget will not be enough to meet one huge national challenge - how to fund all the care we need when we have a rapidly growing population and in particular greatly increasing numbers of older people who in their later years need more and more health treatment and social care. To do this reform of our health care system is necessary.

The government's 2010 Health White Paper - 'Liberating the NHS' - contained many principles and proposals which were set out either in the Liberal Democrat manifesto or in the Conservative manifesto for the 2010 election. For example commissioning of local health services by general practitioners (GP commissioning) which became one of the key reforms in the Health and Social Care Bill was in the Conservative manifesto, and Health and Wellbeing Boards, which will give local residents and local councils much more influence over health policy in their area, were a key reform proposed in the Liberal Democrat manifesto. Both these proposals were in the first draft of the bill.

But the Bill was drafted by the Conservative Health Secretary following the formation of the Coalition government, and in other major respects, the Bill did not follow the Coalition Agreement (which had been democratically agreed by Liberal Democrat members of parliament and party members) and contained proposals which Liberal Democrats would not have introduced if we had formed the government on our own.

Liberal Democrat opposition to some of the reforms

When the bill was published, given that it contained good and agreed changes as well as more controversial changes promoted by the Conservatives with which we did not agree, it seemed on balance right to give the proposals as a whole support at Second Reading so that parliament could go on to look at the detail, make progress on the changes which I and my colleagues had made commitments to, but have the chance to amend or remove other parts of the bill. I therefore voted for the Bill to have a second reading although I knew immediately that Liberal Democrats would want major changes before we would agree to support the bill through all its further stages to become law.

Once the bill moved to committee stage, and as Liberal Democrat MPs were given the opportunity to scrutinise the bill in much greater detail, it became increasingly clear that there were then clauses in the bill which were damaging to the NHS and which would have resulted in widespread privatisation of NHS services and would have forced hospitals to open up their services to the private sector.

Rightly, this caused a great deal of concern to me and amongst Liberal Democrat activists and the wider public. A decision at the Liberal Democrat conference in Sheffield last March made clear the changes which Liberal Democrats insisted on before we would agree to let the bill go forward. I supported this decision at our conference.

These changes included:

• Complete ruling out of competition based on price
• No private companies able to make decisions on NHS commissioning
• Writing into law the principle that the NHS should be responsive to patients' needs, based on co-operation rather than competition, and promote quality and equity not the market.

The full text of the Liberal Democrat Sheffield motion is at : http://www.libdems.org.uk/latest_news_detail.aspx?title=Motion_carried_with_amendments:_Updating_the_NHS:_Personal_and_Local&pPK=dabf4d29-021d-4366-8891-b38f40d44bc8

As a direct result of this decision by our members the government decided to 'pause' the passage of the bill for two months to listen to the concerns of the NHS professions. The bill was then sent back for its House of Commons committee to make the changes suggested by the professions and initiated by Liberal Democrat members at our conference.

In committee, the government made 175 changes to the bill. It then moved on to report stage in the Commons where I flagged up that further changes would still need to be made to the bill, in particular to make expressly clear the legal duty to parliament and the country for the Health Secretary to provide a comprehensive health service .

Further Liberal Democrat amendments to the Bill

In the House of Lords Liberal Democrats continued to work and amend the bill. By the time the bill came back to the Commons again there had been over 1000 amendments in total made. Many of these had been initiated by Liberal Democrats with the purpose of protecting the NHS from unnecessary 'marketisation' and private sector involvement. Some of the key amendments we made included:

• The removal of the duty of the health regulator to promote competition,
• An express legislative obligation on the Health Secretary always to be politically accountable for the NHS in England (which I had expressly flagged up earlier), and
• The requirement of all members of all clinical commissioning groups to publish a register of all their interests.

Liberal Democrats also insisted that the Bill was amended to make clear that all NHS hospitals must always receive a majority of their income from the public sector (not a rule ever written into legislation before) and that any substantial increase in private sector activity can only be carried out by a hospital if the governors of that hospital agree. The governors must also be satisfied that any such increase will improve the service for NHS patients and take this into account when they make their decision. (Remember too that, by law, all private income has also to go back to the NHS).

If you doubt that the changes made by Liberal Democrats to the bill were both substantive and substantial then you can read this briefing note produced by the independent House of Commons Library: http://www.parliament.uk/briefing-papers/SN06252
All these changes have now been included in the final version of the legislation.

And this is the reason why I did not oppose the many improvements made in the Lords but supported them when they came back to the Commons for approval. You can read details of all my contributions to the final debates on the bill on 20^th March here: http://www.publications.parliament.uk/pa/cm201212/cmhansrd/cm120320/debtext/120320-0003.htm

The last Labour government and the NHS

Much of the opposition to the Health and Social Care Act has been coordinated by the Labour Party. Of course I understand that the principal duty of the official opposition is to oppose, but much of Labour opposition has been entirely opportunistic and artificial. When in government Labour pursued a privatisation agenda in the NHS with a zeal greater than any previous Tory government . So desperate was the Labour party under Tony Blair to bring the private sector into the NHS that they even paid private suppliers a premium. It was also the last Labour government which introduced the Independent Sector Treatment Centres, which guaranteed the private sector NHS work and paid the private sector 11% more than the NHS for doing it, and paid £250 million to the private sector for operations which never happened.

One of the great achievements of the Health and Social Care Act is that it ends and prevents these abuses from happening again - and has therefore outlawed completely the excesses of the Blairite privatisation agenda. As a direct result of this bill, there can be no more premiums for private providers and competition will be on the basis of quality only. And when the private sector is involved they will only be paid for jobs which have actually been done.

Moving forward

I repeat that although this new Health Act included proposals for changes in the law which a Liberal Democrat Health Secretary would never have introduced, Liberal Democrats insisted on many changes and improvements to the bill because we are determined to prevent this country moving any further towards a national health service for profit of the kind promoted by Labour in government and championed by the Tories.

So, given the safeguards against privatisation which I and my Liberal Democrat colleagues insisted on in the Commons and the Lords, including the closing off of the preferential treatment of private sector providers introduced by Labour, I supported the bill in its final form because I believe that the changes as a package will deliver benefits to the NHS, as well as to people in Southwark and throughout the rest of England.

In all of my conversations in recent months with NHS professionals and other workers, as well as lay people like me who are the NHS patients of yesterday, today and tomorrow, what has mattered most is not structure but that our national government's health policy will provide the best treatment and outcomes for patients in England.

I understand that for many people there is a fear that whatever the safeguards against privatisation put into the Act by Liberal Democrats and others, Conservative and some Labour politicians will continue to push their privatisation agendas. I hope that this letter has demonstrated that Liberal Democrats have always resisted this tendency. We will definitely continue to do so.

As the local MP in Bermondsey and Old Southwark, which are areas which include the world famous Guy's Hospital and with the strongest of commitments to a public national health service, my job is to continue to listen to and work with local doctors, hospitals, patients and others with an interest in health issues to make sure that the outcomes many still fear do not happen. Through the reforms introduced by the bill which increase the democratic accountability of our health service, there are also now far more opportunities for local residents and local representatives to engage in formulating health policy and help to shape our local health services.

As a political grandson of William Beveridge , the author of the NHS, and as a Liberal who has for over 40 years been a member of a party which from the beginning and throughout its history has fully backed the NHS, I am not now going to stand by if anybody else attempts to undermine it. Locally and nationally I shall continue to work and campaign for an improved NHS paid for by the taxpayer - and free to use whenever people need it. And I know from all my local work over many years that although the NHS is often the very best of public services, there are certainly still many improvements yet to achieve.

How you can help defend and support the NHS

As I have outlined above many of the reforms in the Health and Social Care Act introduce a far greater degree of democratic control over the health service. That means that people like you who care about the future of our health service can become involved at a local level in setting the priorities for the health service and overseeing their delivery. If we do not want to see some of the outcomes we fear, it needs people like you to take up the opportunity to take part in the local governance of our health service. I will certainly continue the fight and I hope you will join me in this too.

Thank you once again for contacting me on this important issue. Over the next few months and as events relating to both national and local health policy develop I would like to email or write to you again to keep you informed. If you do not want to receive any more emails or letters on this subject please unsubscribe by clicking on the link below.

If you would like to be more involved in local decision-making on health and social care, then also please let me know and I will point you in the directions where you may be able to be most influential. And if you would like to come to one of the next meetings I hold on these issues, then please indicate, and I will make sure you are invited.

Thank you very much again for your interest. I hope that I have addressed at least some of your concerns.

Yours Sincerely,

Simon Hughes MP