This weekend has certainly been interesting. For the record, I’m relatively pleased with the outcome of the votes at conference on the NHS bill this weekend. It is one of a whole range of possibilities about what might have happened, and we don’t fully know what the fallout will be yet. No, technically, we have not given any particularly clear instruction to our parliamentarians on how to vote. And yes, technically, the amended form of “The Shirley Williams Motion” (ahem) says almost nothing of any consequence. But since conference has never been in the business of telling our parliamentarians how to vote, that’s probably OK. The act of deleting the clause which asked our parliamentarians to vote for the bill at 3rd reading seems to have sent the right message to the media.
Did Conference Achieve the Right Outcome?
In any case, what the best outcome for conference would have been is a rather complex question. It’s complex because there are a number of objectives which in an ideal world would all be achieved:
1. Kill the Health and Social Care (HSC) Bill.
2. …but leave open the possibility of implementing some of the uncontroversial elements of the plans, like joining up the delivery of health care, social care and public health.
3. Preserve the coalition government, and the goodwill of our coalition partners within it (tricky to reconcile with point 1!).
4. Preserve the sovereignty, democracy and credibility of conference as a policy-making body.
How best to achieve a balance between these objectives, and which ones are more important, is not a straightforward question. For instance, had we passed the motion calling for the withdrawal of the bill, only to find that it made not the slightest difference to the progress of the bill, conference (and by extension the party) would have been utterly emasculated. Had we passed the withdrawal motion and subsequently seen the withdrawal of the bill, I’d be pretty happy, but I would be concerned that the Tories would be on the lookout for some piece of Lib Dem-favoured policy which they could hole below the waterline in retaliation. As it is, we’ve stopped short of passing a (possibly unenforceable) motion calling on our peers and MPs to vote against the bill, but made it fairly clear, in the balance of speeches this morning and in the result of the vote, that we are really not comfortable with this bill and would rather it died. If the bill subsequently does die, the Tories can’t lay the blame squarely at our feet, but we have nevertheless contributed to the momentum of the anti-bill forces. Somehow I don’t think we’ve heard the last of this row yet. So, whilst I was willing to support the Withdrawal motion in the Emergency Motions Ballot, I don’t think it is by any means straightforwardly obvious that what happened today will not have better outcomes than that would have had.
The above may sound rather slippery, or seem to display a warped sense of priorities. How can I put the party and the stability of the government alongside protecting the NHS? I must be some kind of traitor, no? Well, if I believed much of the hyperbole about the effects of this bill, then yes, I’d agree, the reasoning I’ve laid out above would be disgraceful. But I have to say that although I don’t support the HSC Bill and want it dropped, I really don’t buy the idea that it’s going to lead to the end of a comprehensive, free NHS in the way that some of the anti-bill folks have been suggesting. Whilst good impartial information on this issue is scarce, from what I’ve been able to make out this is not a reasonable expectation to have of the effects of the bill. Nor do I think it will result in the wholesale privatisation of the NHS. I just don’t happen to think it’s a good enough revision of the model for running the NHS to justify the disruption which the re-organisation will cause.
What Is Actually Wrong With The HSC Bill?
I believe the use of private providers within the NHS can be destabilising to the viablity of NHS services, and that it has led to an ever more fragmented service for the last 10 years or more. I do not like the one-size-fits-all way that the “choice” – or competition, as it is more honestly known – agenda has been clumsily grafted onto the NHS, but we should not pretend that this bill introduces that agenda, or that without this bill that agenda would not continue to drive much of the way the NHS is run. What this bill does do, so far as I can see, is transfer who is doing the commissioning from PCTs to CCGs, and remove some brakes on Foundation Trusts’ involvement in the private sector. I’m not saying that isn’t problematic*, but at root the stuff I most dislike about the Lansley vision for the NHS is not actually new. Marketisation and competition has been the dominant idea behind NHS reform throughout Labour’s time in office. If those of us who are deeply uncomfortable with it don’t like it, we need a coherent vision of our own. Meanwhile, I am satisfied that my party’s representatives in the Lords have secured some valuable safeguards, such that in some ways this might be an improvement on the 2006 Act which Labour left us.
So what is the problem? The problem is, in other ways, it’s worse than the 2006 act, and in any case the reorganisation of the NHS is simply massively unhelpful at a time when the NHS is already under budgetary pressure. The problem is that the apparent safeguards about conflicts of interest for CCGs (and any private companies which they might look to enlist in support of their commissioning work) over the services they commission have barely scratched the surface. The problem is that setting tariffs which reflect the “clinical complexity” of work does not prevent “cherry-picking”, it merely quantifies it. The problem is that there are simply too many doubts about this bill, and too many people in the medical professions themselves who oppose it. It is not a very good idea, and it will not improve the NHS, in my estimation. There are just too many pitfalls.
But let’s be honest. It is not going to result in everyone having to get private medical insurance. It is not going to mean that the NHS is privatised. It is not a “US style” health system. And the people who are shrieking hysterically that it is all of these things are doing their case no favours. And since I don’t buy the apocalyptic visions of what will happen if the bill passes, I am prepared to entertain the possibility that it will pass, and I don’t think that every single other one of the objectives I listed above is worth sacrificing because we might – might – be able to stop it.
*”Problematic” might be the understatement of the year if it turns out that this shift does, in fact, lay the commissioning process open to all sorts of legal challenge by the private sector when they don’t like the outcome of a tendering process. This is one area in which I genuinely have no idea who is right, both because I have read contradictory advice from different respectable sources, but also because the HSC Bill is such a moving target, with many ammendments still only existing in potentia as undertakings by the government.
The State of the Party and of the Leadership
So, what of the way that the leadership behaved in this whole matter? Well, I think it’s pretty undeniable that the tactics of using Shirley Williams in the way they did displayed some serious desperation. The stony silences during the Q&A session with Cleggy during the questions about the NHS were telling, as was the fact that during his speech today he didn’t feel confident in trying to make us clap anything about the HSC bill stronger than thanking Shirley for her work on it. It is unfortunate that at a time when the shine was always going to be coming off Nick, as the party started to grow tired of the more unpalatable elements of coalition, he is having to use up extra capital with members (and make no mistake, that’s what he’s doing, burning through it at quite a rate at the moment) to sell something to us which wasn’t even in the coalition agreement, and which actually directly contradicts it (“no top-down reorganisations…” may be over-familiar by now, but it’s still worth remembering: this is a direct breach of the coalition agreement).
To see Clegg at conference nowadays, it’s pretty clear that he’s an increasingly remote figure in the party. That’s not to say he can’t recover, but I’m sure someone with the emotional intelligence that Nick has cannot have failed to notice that he is not trading from a position of strength at conference these days.
So what can the leadership do about the growing gulf with the wider membership of the party? Well, in the immediate terms of the HSC Bill, not much, other than hope that the Tories find the guts to kill a bill that many of them are clearly uneasy about, and which has been an unmitigated disaster for them in terms of re-toxifying their brand on the NHS. But in terms of preventing this from happening again, I think it’s worth considering how they can bring the party along with them on issues which fall outside of the coalition agreement. Let’s ignore for a moment that the HSC Bill contradicts the agreement, what if it was just a “matter arising” which is not adressed by the agreement? Currently the procedure, we are told, is that it goes to the “Coalition Committee”. For some issues, that’s fine. But I would argue that on an issue as large as reforming the NHS, they really should have moved to get conference on side before pressing ahead with the reforms, in the same way they did with the coalition agreement itself. This would, of course, have strengthened their hand in rejecting excessive Tory demands, on the grounds that they couldn’t get them past conference.
One could argue that the leadership tried to do just this with the original Burstow motion at conference last spring. However, that doesn’t quite hold water. Burstow’s motion being selected instead of the anti-bill motion it was competing with made it virtually impossible for conference to reject the bill outright. Since we’re not allowed to move wrecking ammendments at conference, as soon as Burstow’s motion was on the agenda we could do nothing stronger than reject his motion outright. That’s fine, but it wouldn’t have stopped anything, since doing so doesn’t say anything definitive – defeating a motion is the absence of a policy, not a decisive policy against. The likely outcome would have been that the government plowed on regardless. In the event, the people who were concerned about the bill went for a more constructive approach, moving an ammendment which listed the things they disliked about the HSC Bill (then White Paper). This attempt to be constructive has since been thrown back in their face; the fact that they didn’t delete the first sentence of Burstow’s motion (“conference welcomes much of [the white paper]“) has since been used to suggest that they were actually endorsing the Lansley plan, with a few quibbles. Yes, seriously.
Meanwhile, since conference doesn’t, by convention, discuss the same issue twice in two consecutive conferences, the fact that a motion had been discussed at the spring conference about the white paper meant that conference could not react to the bill as it became draft legislation by moving any motion at all at autumn conference – the attempt to suspend standing orders didn’t get the two thirds majority it needed. By the time this year’s spring conference rolled around it was almost too late to stop the bill, but nonetheless the leadership still clearly feared the embarassment of the withdrawal motion passing enough to go to the desperate lengths of wheeling out Shirley’s name, as I’ve already mentioned. In this light, the leadership’s (and FCC’s) behaviour at successive conferences looks less like an attempt to seek conference’s blessing for the bill in any meaningful way, and more like an attempt to prevent conference from making any decisive and timely call for the bill to be dropped.
The sad thing about this whole process is that it seems to have forgotten what we know about the strengths of our democratic structures. Repeatedly in David Laws’s book about the formation of the coalition, it is mentioned explicitly that the threat of having to get something past the membership strengthened our negotiating position. A strong, independent minded conference is one of the key buffers we have against Tory domination of the coalition. And yet for whatever reason, the leadership of this party seems to have been willing to actively frustrate members’ attempts to intervene in the case of the NHS bill. Ultimately, the result is that a bill which is now an albatross around the government’s neck has been allowed to progress past the point when it could have been quietly sidelined.
What could the leadership do about it? They could stop playing the kind of pathetic procedural games at conference which would make a student union trot blush.