A MASSIVELY important debate will take place in Parliament next week and, no, we are not talking about Chancellor George Osborne’s Budget statement on Wednesday.
The really important battleground will be in the House of Lords on Monday when Earl Howe will stand to present the final Third Reading of the Health and Social Care Bill to fellow peers.
The vote is being seen as the last real obstacle for a range of health reforms that would transform the NHS in England forever.
On a purely political level, the Bill – which has already undergone more than 1,000 amendments since it was first drafted as a White Paper nearly two years ago – has caused huge divisions among MPs. Labour, which founded the NHS, as we now know it, in 1948, has argued the Bill would cause “fragmentation and privatisation” within the NHS and has consistently voted against it.
But the real fight has been within the coalition itself where rebel Lib Dems have repeatedly tried and failed to get the proposals thrown out.
The Lib Dem leader, Nick Clegg, had a difficult time standing in for his boss at Prime Minister’s Questions on Wednesday, when Harriet Harman mercilessly stuck the stiletto in on the Lib Dems, whose coalition support for the Tories has stayed intact enough to push the Bill this far. One exchange summarised the divisions pretty well, with Harman asking Mr Clegg: “Can you explain why you have failed to persuade the doctors, the nurses, the midwives, the paediatricians, the physicians, the physiotherapists and the patients?” To which Clegg replied: “The Labour Party used to believe in reform. Now they believe in starving the NHS of cash.”
And so on and so on.
If the Third Reading is approved on Monday it will go back to the Commons where it will almost certainly nudge a step nearer to going on the statute book.
So what of the reforms? Speak to health professionals – GPs, surgeons, midwives and so on – and they are well up to speed on what it could mean to them, but to those of us at the receiving end – the millions of patients who are treated every year – the changes can seem very complex and clouded by a public debate that has been characterised by some trenchant and totally polarised views.
Among the changes we would see primary care trusts (PCTs such as NHS Northamptonshire) replaced by so-called clinical commissioning groups (CCGs, before long it’ll be tripping off the tongue) constituted by GPs who would, in time, manage tens of billions of pounds of NHS funds. The sceptics fear it will undermine the traditional doctor-patient relationship. The CCGs will, in turn, be overseen by an NHS Commissioning Board that would, in theory at least, cut some of the political meddling that characterises the NHS now.
Meanwhile, Northamptonshire County Council, for example, would be handed the specific remit of dealing with local public health issues, an area they have some involvement in through social care provision at the moment. However, the chief executive may soon have smoking, alcohol abuse and obesity dropping into his in-tray too, among other things.
The Conservatives – and for the record all three Northampton MPs, Michael Ellis, Brian Binley and Andrea Leadsom, are loyal on this – have an ideological inclination to open up the market to competition (think the energy sector in the 1980s and the railways in the 1990s).
This will also be in evidence with the NHS as hospitals bid for treatment contracts from the NHS while the amount of private work an individual hospital can do will rise from 1.5 per cent to 49 per cent. This is red rag to a bull for the critics who say it will create a two-tier NHS where those with money will get treated first. Critics also claim that opening the market up will see unrealistic bids to deliver services and fail patients in the process.
It’s a complex debate and one that stirred up strong emotions on both sides among people working in the NHS, between those who hold as sacrosanct the view that it should be free at the point of use and those who, in an ever more challenging world where people are living longer and being treated at enormous cost, believe the present system is creaking and in desperate need of reform.
What unfolds on Monday – a Lords rebellion on the part of the Lib Dems or a timid surrender to the inevitable – will be fascinating to watch.
The outcome could be very far-reaching indeed.