4 April 2011

Social Liberal Forum lose the plot

I received an email this morning from a supporter of the Social Liberal Forum asking me to back their campaign calling for the government's health policy to be amended in four specific ways.

Two of which are sensible and uncontroversial - providing more local democratic accountability and slowing down the pace of change to help the NHS through its toughest settlement for decades and avoiding another massive reorganisation.

The third is some fairly meaningless waffle about market reform and cherrypicking profitable services (surely impossible unless the NHS charged market rates for its services), so can probably be safely ignored.

But the fourth is frankly crazy - and sadly is what party reps voted for at the recent spring assembly. It calls on the party to 'ensure the Health Secretary had a duty to provide a fully comprehensive and free health service, with no gaps and no new charges'

Fully comprehensive and no gaps - really? This means that every NHS facility in every part of the country should offer the same fully comprehensive service - so leafy Surrey should have the same facilities to fight alcohol and drug related disease as Glasgow council schemes. Diseases of affluence should be taken as seriously in Hull as is Havant. Its clearly either prohibitively expensive and wasteful or egalitarian nonsense and should be opposed by liberals and anyone who believes in localism.

Needless to say I won't be signing it - but if anyone wants to either sign it or find out more the link is here: Forward to a better yesterday


  1. Er - I think you're the one who's lost the plot. Your interpretation of "fully comprehensive health service with no gaps" is at best idiosyncratic and at worst completely unrelated to the words actually used.
    Of course, if you're objecting to the very idea that there should be "facilities to fight alcohol and drug related disease" in "leafy Surrey", then you'd have a hint of a point (but why would you think that? Do you think that alcoholics and drug addicts who are surrounded by rich people don't deserve treatment as much as those on council estates?); but assuming that by "the same facilities" you mean "exactly the same level of each type of service in each building that has "NHS" on the door", which seems to be the way your rhetoric is heading - well, then we're way past straw men. You're taking on soap-bubble elephants there.

  2. Unrelated to the words actually used?

    Here is what the SLF email (signed by Drs Evan Harris, Charles West and Graham Winyard)says:

    Liberal Democrat members and activists – Demanding changes to the Health and Social Care Bill

    Our Federal Party Conference last month overwhelmingly backed a call from Shirley Williams, Dr Evan Harris and 150 others, calling for Andrew Lansley’s health reforms to be significantly amended to bring the policy back in line with the agreed Coalition Agreement and with Lib Dem principles.
    Specifically we seek amendments to:
    a. ensure the Health Secretary had a duty to provide a fully comprehensive and free health service, with no gaps and no new charges
    b. provide more local democratic accountability for the health service
    c. curb the market obsession of the proposed reforms to prevent quality being relegated behind price and prevent the cherry-picking of profitable services by the private sector undermining and fragmenting existing provision
    d. slow down the pace of change so that the NHS, facing its toughest settlement for decades, does not implode from the stress of another massive reorganisation

    The changes to the health bill required by conference are set out in full here. They do not preclude other changes that may be needed but which were not covered by the conference motion as amended.

    We are calling on our party’s leadership to fully respect the declared view of the Party on this matter and insist on all these changes in the health policy in any discussions with the Conservatives.

    We believe it would be unacceptable for Liberal Democrat MPs and peers to be whipped to vote against conference policy and to vote in support of Tory policies that were not included the coalition agreement and that we have democratically rejected.

    So in what way have I misinterpreted SLF's intention? What can 'fully comprehensive and no gaps mean' otherwise?

    Why are the SLF trying to mandate Lib Dem parliamentarians to go further than the conference motion? What to they mean by 'They do not preclude other changes that may be needed but which were not covered by the conference motion as amended', if not to agree to everything they say - even if it is not covered by the motion?

  3. "What can 'fully comprehensive and no gaps mean' otherwise?"

    It can mean what any rational person would understand it to mean: that anywhere you go in the country you can receive all the health services that a reasonable person would consider to be essential in the modern world. And no, "anywhere" doesn't mean in every single NHS 'facility'; that would be silly. And interpreting language as if it were being used stupidly is not valid debate.

  4. Well, the footsloggers seem to think that the changes called for are welcome, and that they take a lot of the wind out of the protesters' sails.......which has got to be one of our functions as LibDems, hasn't it? And the government seems to be putting a brave enough face on it to be convincing so, yes, I've signed.

  5. So Malcolm what are 'all the health services a reasonable person would consider essential be'? How do you find out? How does this square with local accountability?

    Surely if local people don't want to provide health care for foreign nationals, elective plastic surgery or under 16 contraception, that would be OK under clause b, but not ok under clause a (and your reasonableness test)?

    You can't have it both ways - a national uniform service and local accountability?

    I am quite happy for the NHS to provide different levels of health care in different localities and I hope that whatever comes out of the revised NHS proposals focuses on local control not national uniformity.

    Because it is the national uniformity that has led to the stultifying bureaucracy and waste that has been the hallmark of the NHS since its creation.

  6. No, the hallmark of the NHS since its creation has been a quite phenomenal level of care available to everyone regardless of means or status.
    Certainly, there is a constant battle against stultifying bureaucracy and waste, as in any very large, hydra-headed organisation. But they are not the most remarkable things about the NHS.

  7. I'm not very impressed by your post Dan. You seem not to understand the dangers posed by marketisation of the NHS. There's a lot of thoughtless genuflection to marketisation in some sectors of the Party. I note this comment:

    "A 2010 review of the effects of these [Labour] reforms documented many improvements, including reduced waiting times; increased access to general practitioners, better outcomes for cancer and heart disease, and improved patient satisfaction with the NHS; many analysts, however, believe these improvements owed more to the introduction of performance targets, improved public reporting, and strong performance management than to enhanced operation of the market."

    The New England Journal of Medicine, 7 April 2011 here http://www.nejm.org/doi/full/10.1056/NEJMhpr1009757

  8. Thanks for you post KK. But you rather miss my point - which is about the contradiction of the SLF trying to impose a national one size fits all policy on the NHS and increase local accountability.

    I'm sceptical about marketisation too - but given there is no market in any traditional sense I don't believe much of the scaremongering about cherrypicking profitable services and the like.

    The pause announced by the coalition is welcome - but I hope it is used to break up the megalith that is the NHS and allow local people more say on their local health service.