The coalition is now split over national health policy

NHS reform becomes first public division as Lib Dem conference votes in favour of radical rewrite of

Controversial proposals to reform the National Health Service in England has become the first public split on policy between the two coalition parties, after the Liberal Democrat spring conference voted overwhelmingly in favour of an extensive rewrite of the bill.

While there have been numerous backbench revolts on certain issues, such as tuition fees, and areas in which the parties have codified their disagreement, such as voting reform, this is the first public division on policy.

Nick Clegg, who said yesterday he was "very relaxed and very positive" about the NHS debate, narrowly averted defeat by accepting two "rebel" amendments when it became obvious that they were going to pass.

The two amendments centre on limiting the role of the private sector in the NHS. The party votes for banning GP consortiums from taking decisions in private about spending NHS money, totally ruling out any competition based on price, banning private companies from taking over commissioning, allowing private health providers in only when it will not damage existing NHS services, and ensuring the role of local government in the consortiums.

This vote is a major development: it means that Clegg's party is formally committed to changing the Health Bill. Evan Harris, the former Oxford MP campaigning on the motion, said that the party expected Clegg and the health minister Paul Burstow to be bound by the vote. In a clear challenge to the leadership, Evans said: "We expect Liberal Democrats in government to follow what we overwhelmingly vote for."

This will pose problems for Clegg with his Conservative cabinet colleagues, as the proposed changes will not beaccepted happily by the Health Secretary, Andrew Lansley (who has also attracted the anger of doctors). Indeed, the whole bill – which proposes giving control of 80 per cent of the NHS budget to GP consortiums – is underpinned by a market-based philosophy.

This opens up an easy fault line for Labour, which can exploit the motion passed today by proposing amendments to the bill and challenging Lib Dem MPs to stay consistent with the decisions passed today and vote against the government.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Why are boundary changes bad for Labour?

New boundaries, a smaller House of Commons and the shift to individual electoral registration all tilt the electoral battlefield further towards the Conservatives. Why?

The government has confirmed it will push ahead with plans to reduce the House of Commons to 600 seats from 650.  Why is that such bad news for the Labour Party? 

The damage is twofold. The switch to individual electoral registration will hurt Labour more than its rivals. . Constituency boundaries in Britain are drawn on registered electors, not by population - the average seat has around 70,000 voters but a population of 90,000, although there are significant variations within that. On the whole, at present, Labour MPs tend to have seats with fewer voters than their Conservative counterparts. These changes were halted by the Liberal Democrats in the coalition years but are now back on course.

The new, 600-member constituencies will all but eliminate those variations on mainland Britain, although the Isle of Wight, and the Scottish island constituencies will remain special cases. The net effect will be to reduce the number of Labour seats - and to make the remaining seats more marginal. (Of the 50 seats that would have been eradicated had the 2013 review taken place, 35 were held by Labour, including deputy leader Tom Watson's seat of West Bromwich East.)

Why will Labour seats become more marginal? For the most part, as seats expand, they will take on increasing numbers of suburban and rural voters, who tend to vote Conservative. The city of Leicester is a good example: currently the city sends three Labour MPs to Westminster, each with large majorities. Under boundary changes, all three could become more marginal as they take on more wards from the surrounding county. Liz Kendall's Leicester West seat is likely to have a particularly large influx of Tory voters, turning the seat - a Labour stronghold since 1945 - into a marginal. 

The pattern is fairly consistent throughout the United Kingdom - Labour safe seats either vanishing or becoming marginal or even Tory seats. On Merseyside, three seats - Frank Field's Birkenhead, a Labour seat since 1950, and two marginal Labour held seats, Wirral South and Wirral West - will become two: a safe Labour seat, and a safe Conservative seat on the Wirral. Lillian Greenwood, the Shadow Transport Secretary, would see her Nottingham seat take more of the Nottinghamshire countryside, becoming a Conservative-held marginal. 

The traffic - at least in the 2013 review - was not entirely one-way. Jane Ellison, the Tory MP for Battersea, would find herself fighting a seat with a notional Labour majority of just under 3,000, as opposed to her current majority of close to 8,000. 

But the net effect of the boundary review and the shrinking of the size of the House of Commons would be to the advantage of the Conservatives. If the 2015 election had been held using the 2013 boundaries, the Tories would have a majority of 22 – and Labour would have just 216 seats against 232 now.

It may be, however, that Labour dodges a bullet – because while the boundary changes would have given the Conservatives a bigger majority, they would have significantly fewer MPs – down to 311 from 330, a loss of 19 members of Parliament. Although the whips are attempting to steady the nerves of backbenchers about the potential loss of their seats, that the number of Conservative MPs who face involuntary retirement due to boundary changes is bigger than the party’s parliamentary majority may force a U-Turn.

That said, Labour’s relatively weak electoral showing may calm jittery Tory MPs. Two months into Ed Miliband’s leadership, Labour averaged 39 per cent in the polls. They got 31 per cent of the vote in 2015. Two months into Tony Blair’s leadership, Labour were on 53 per cent of the vote. They got 43 per cent of the vote. A month and a half into Jeremy Corbyn’s leadership, Labour is on 31 per cent of the vote.  A Blair-style drop of ten points would see the Tories net 388 seats under the new boundaries, with Labour on 131. A smaller Miliband-style drop would give the Conservatives 364, and leave Labour with 153 MPs.  

On Labour’s current trajectory, Tory MPs who lose out due to boundary changes may feel comfortable in their chances of picking up a seat elsewhere. 

Stephen Bush is editor of the Staggers, the New Statesman’s political blog. He usually writes about politics.