Round-up of initial reactions to the Lib Dem conference NHS Bill vote

by Stephen Tall on March 11, 2012

There’s been no shortage of reaction to the vote by the Lib Dem conference this morning to vote by 317-270 to approve an amendment which implicitly calls on the party leadership to drop its support for the NHS Bill.

I say “implicitly” because the motion as passed — pasted at the foot of this post — does not call on Lib Dems to ‘Kill the Bill’. However, conference did vote (albeit narrowly) to remove the call for Lib Dem peers to support the Bill. This follows yesterday’s pre-debate conference vote (again narrowly) to choose not to debate the motion which would explicitly have called for the party to ‘Kill the Bill’ if approved.

Unsurprisingly, this rather confusing picture has left the Lib Dems open to accusations of a political fudge. Here’s PoliticsHome.com’s Paul Waugh, for example:

Dr Evan Harris, the former Lib Dem MP who moved the amendment, issued the following statement on the Social Liberal Forum website, stating his view that conference had clearly called for further substantial amendments to be made to the Bill before the party could support it:

“The Liberal Democrats have clearly and democratically told their ministers and their leaders that they do not support the bill. This can not be ignored. Although many wish to see no bill at all – for good reason – a significant number would support a bill which was amended to comply with what the the Sheffield conference called for last year, so that the bill is more in line with the Coalition Agreement. Most Liberal Democrats are applied [sic] that the Government is defying the Information Commissioner and the appeal tribunal over the Risk Register. The requirement from March have been published and it is time for Liberal Democrat ministers to engage with what we have called for. The party will not stand for its views to be ignored as we have supported the Coalition and Coalition Agreement but can not this Bill in this form.”

The right-leaning Spectator’s James Forsyth meanwhile has interpreted the conference vote as being more ambiguous:

This is a blow to the leadership who were confident last night of winning the vote this morning. But it is nowhere near as bad as the conference — which, remember, still has the power to make party policy — deciding that the bill should be dropped. It is, though, another sign of how deeply this bill has divided the Liberal Democrats.

Nick Clegg declined to let his speech be distracted by this morning’s vote and the NHS controversy which dominated the conference, making only a brief, passing reference to the health reforms:

Take NHS reform. Controversial, yes. Difficult, yes. But the value of coalition has been proven because this is a coalition Government. The health bill was stopped in its tracks and rewritten because this is a coalition Government. Competition will be the servant of health care, not the master because this is a coalition government. This is a bill for patients not profits. It is not a Liberal Democrat health bill but it is a better bill because of the Liberal Democrats, a better bill because of you. A better bill because of Shirley Williams – Shirley: thank you.

And the Guardian’s Andrew Sparrow has given his take on the downsides and upsides to Nick Clegg of the vote:

On the down side

• Clegg asked his party to support the Shirley Williams motion in full – and they refused. That makes him look weak.

• The debate has shown that Clegg has failed to persuade his party that he has significantly improved the health bill. If Lib Dems don’t believe him on this, why should the public?

• David Cameron may be increasingly wondering whether the Lib Dems will be reliable coalition partners for the next three years.

• The Lib Dem “left” is looking stronger than it was. That’s awkward for Clegg, because people normally place him on the Lib Dem “right”.

• Shirley Williams may be feeling tarnished. The leadership effectively used her as a human shield. In her speech (see 10.03am) she suggested she was not entirely happy about all this.

On the up side

• Clegg wants to persuade the public that the Lib Dems are not the same as the Tories – and today’s vote will help him make that case.

• Today’s vote won’t stop the health bill becoming law.

• Although Clegg lost on a key narrow vote, he still managed to avoid the nightmare scenario of having the Lib Dem conference voting for the bill to be withdrawn. Lib Dem MPs and peers would almost certainly have ignored a vote of that kind, but that would have provoked an internal party crisis and cast doubt on the Lib Dems’ much-prized boast that they are a proper democratic party.

• Clegg may find it easier to extract concessions from Cameron in the future, because he will be able to cite this vote as evidence of the real party management problem that he is having as a result of being in coalition.

And here are my thoughts, from the vantage of not being at conference this year:

Passion trumped pragmatism

There’s been an inevitable problem with the Lib Dem leadership’s position — indeed in the Coalition’s position — on the Health & Social Care Bill: few are passionately in favour of it, and those who are appear unable to articulate why it’s a good thing. Nick Clegg’s position has been “This is a bad bill which we Lib Dems have improved”. Unfortunately for him this leaves open an obvious line of attack: that Lib Dems should not support a Conservative Bill just because it’s not as bad as it was. The ‘We must defend the NHS’ position is a far stronger line than ‘We have made a bad Bill less worse’.

The party leadership played its hand badly

The moment I read Nick Clegg’s conference rally speech — calling on Lib Dems to ‘tear off the rear-view mirror’ — I thought he was in danger of misjudging the mood of party members. My sense, backed up by LibDemVoice’s survey of party members, has been that the membership split roughly into three camps: 15-20% who broadly backed the Bill as it stands; 30-35% who were pretty implacably opposed to it; and about half the membership open to persuasion one way or the other based on the quality of the arguments. Unfortunately the party leadership decided to make this a test of strength — but in the weakest way possible, by deploying Shirley Williams as a human shield. The result was that Baroness Williams, who is clearly conflicted on the NHS reforms — supporting the improvements she’s helped bring about, but still only half-heartedly in favour of the Bill itself — was left to carry the argument. While this came close to working (the vote this morning was a narrow one, after all), it gave the appearance of the Lib Dem leadership not wishing to put its own head above the parapet for fear of the resulting headlines if the vote were lost.

A failure of proper debate

I’m not talking about the debate in the conference hall — which I followed here on LibDemVoice — but about the dire level of debate in the media and (inevitably) on Twitter. Like almost everyone else who’s commented on the NHS reforms to date, I’ve not read the Bill. I would, however, like to try and understand it. For anyone hoping to find out objective facts about the NHS Bill in the newspapers or online all I can say is: good luck. The claims (on both sides) have become ludicrously overblown: I am as sceptical that the Bill will genuinely improve patient choice as I am of the claim that it will privatise health-care. I do not like the leadership framing the debate as a choice between supporting Andy Burnham or Shirley Williams; and I am struck that the Bill’s opponents, while saying they support NHS reform and innovation, seem shy of defining, let alone advocating, what positive proposals they would be in favour of. Pretty much all I’ve seen and heard in the past weeks has been shallow slogans and prophesies of apocalyptic disaster that discredit genuine debate.

Text of the NHS motion (as amended) passed by Lib Dem conference today (with thanks to Paul Walter’s blog):

Conference notes:

A. That during the Lords Report Stage of the Health and Social Care Bill in February and March 2012 Liberal Democrats, in conjunction with peers from other benches, have achieved significant changes to the Conservative Health Secretary’s original Health and Social Care Bill.

B. Taking the lead from the motion passed at Spring Conference 2011 Liberal Democrats in the House of Lords have worked successfully to:

i) Guarantee the Secretary of State’s responsibility for a comprehensive health service, his power to intervene if things go wrong and his accountability to Parliament.

ii) Ensure that competition in the NHS is in the interests of patients, based on quality not price.

iii) Secure the commissioning process against damaging conflicts of interest.

iv) Ensure that any profits from treating private patients in Foundation Trust hospitals are invested in the NHS.

v) Underpin the independence of public health.

vi) Place a duty on the National Commissioning Board and CCGs to address and report on progress in reducing health inequalities as part of how their performance is assessed.

vii) Place on all service providers an equal duty to provide NHS education and training; and

viii) Put the NHS in the vanguard of medical research.

Conference further:

1. Confirms the commitment of Liberal Democrats to a comprehensive national health service accessible to all and free at the point of need.

2. Welcomes the changes made to the Bill, which meet the main demands made by Conference at Sheffield, including:

a) Making Monitor’s top priority the interests of NHS patients, not competition.

b) Ending Labour’s policy of giving preferential terms to the private sector.

3. Supports the Liberal Democrat team in the House of Lords in its endeavours to ensure that the Bill is further amended to:

a) Remove reviews by the Competition Commission from the Bill.

b) Retain Monitor’s regulation of Foundation Trusts after 2016.

c) Ensure that individual Foundation Trusts have to justify in advance any substantial increase in their private income.

4. Calls on Liberal Democrat peers to support the Third Reading of the Bill provided such further amendments are achieved.

5. Calls (on) Liberal Democrats nationally and locally to work with Royal Colleges, NHS staff, patients and carers groups and local authorities in the interests of upholding the NHS as a public service, ensuring its ability to meet the challenges of an ageing society despite constrained financial circumstances, and securing better health outcomes for all.

* Stephen Tall is Co-Editor of Liberal Democrat Voice, and also writes at his own site, The Collected Stephen Tall.