BMA: Lansley’s Health Bill may need to be dropped

As the government’s listening exercise winds down, a consensus on competition in the NHS is no close

The government's health plans for the NHS in England require such substantial changes that the entire bill may have to be dropped, according to the British Medical Association.

The doctors' union called for a series of changes in its submission to the government's six-week listening exercise, which was called in response to mounting criticism of the Health and Social Care Bill. In particular, doctors demand that the regulator's new duty to promote competition be dropped. They also want to see timetables relaxed and the net of responsibilities that the bill places on GP consortiums spread to involve other clinical staff.

The Deputy Prime Minister, Nick Clegg, is due to deliver a speech on health reform that will be closely watched, given his tough rhetoric on NHS reform in recent weeks.

Although he will call for substantial changes, he is expected to echo David Cameron's speech last week on the need for reform. The Liberal Democrats share their main concern about the bill with the BMA: that competition clause. The BMA wants a greater emphasis on collaboration; the Liberal Democrats endorsed this at their spring conference. To this end, Clegg will say:

People want choice – over their GP, where to give birth, which hospital to use. But providing that choice isn't the same as allowing private companies to cherry-pick NHS services.

As the listening exercise – essentially a second consultation period – draws to a close, it seems a consensus is no closer.

The government has repeatedly promised substantial change and rethinking of the bill (while reiterating the need for reform), but the question is how far it is willing to go with watering down the competition clause. Given that a free-market philosophy permeates Andrew Lansley's entire bill, and it has the support of many Conservatives, this will prove problematic.

Among the groups that have backed the government's plans for greater competition are Reform, a pro-market think tank, and the NHS Confederation, which represents managers. Doctors on one side and managers on the other: whose advice would you rather take?

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

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Forget the progressive alliance - it was the voters wot won it in Richmond

The Labour candidate on how voters have acted tactically for decades.

The Richmond Park by-election is both a triumph and a setback for the concept of an anti-Tory progressive alliance. As the Labour candidate, I was bombarded with emails and tweets saying I ought to stand down to prevent Zac Goldsmith being re-elected long after it was technically impossible for me to do so even if I had wanted to. I was harangued at a meeting organised by Compass, at which I found myself the lonely voice defending Labour's decision to put up a candidate.

I was slightly taken aback by the anger of some of those proposing the idea, but I did not stand for office expecting an easy ride. I told the meeting that while I liked the concept of a progressive alliance, I did not think that should mean standing down in favour of a completely unknown and inexperienced Lib Dem candidate, who had been selected without any reference to other parties. 

The Greens, relative newbies to the political scene, had less to lose than Labour, which still wants to be a national political party. Consequently, they told people to support the Lib Dems. This all passed off smoothly for a while, but when Caroline Lucas, the co-leader of the Greens came to Richmond to actively support the Lib Dems, it was more than some of her local party members could stomach. 

They wrote to the Guardian expressing support for my campaign, pointing out that I had a far better, long-established reputation as an environmentalist than the Lib Dem candidate. While clearly that ultimately did little to boost my vote, this episode highlighted one of the key problems about creating a progressive alliance. Keeping the various wings of the Labour party together, especially given the undisciplined approach of the leader who, as a backbencher, voted 428 times during the 13 years of Labour government in the 1990s and 2000s, is hard enough. Then consider trying to unite the left of the Greens with the right of the Lib Dems. That is not to include various others in this rainbow coalition such as nationalists and ultra-left groups. Herding cats seems easy by contrast.

In the end, however, the irony was that the people decided all by themselves. They left Labour in droves to vote out Goldsmith and express their opposition to Brexit. It was very noticeable in the last few days on the doorstep that the Lib Dems' relentless campaign was paying dividends. All credit to them for playing a good hand well. But it will not be easy for them to repeat this trick in other constituencies. 

The Lib Dems, therefore, did not need the progressive alliance. Labour supporters in Richmond have been voting tactically for decades. I lost count of the number of people who said to me that their instincts and values were to support Labour, but "around here it is a wasted vote". The most revealing statistic is that in the mayoral campaign, Sadiq Khan received 24 per cent of first preferences while Caroline Pidgeon, the Lib Dem candidate got just 7 per cent. If one discounts the fact that Khan was higher profile and had some personal support, this does still suggest that Labour’s real support in the area is around 20 per cent, enough to give the party second place in a good year and certainly to get some councillors elected.

There is also a complicating factor in the election process. I campaigned strongly on opposing Brexit and attacked Goldsmith over his support for welfare cuts, the bedroom tax and his outrageous mayoral campaign. By raising those issues, I helped undermine his support. If I had not stood for election, then perhaps a few voters may have kept on supporting him. One of my concerns about the idea of a progressive alliance is that it involves treating voters with disdain. The implication is that they are not clever enough to make up their mind or to understand the restrictions of the first past the post system. They are given less choice and less information, in a way that seems patronising, and smacks of the worst aspects of old-fashioned Fabianism.

Supporters of the progressive alliance will, therefore, have to overcome all these objections - in addition to practical ones such as negotiating the agreement of all the parties - before being able to implement the concept. 

Christian Wolmar is an award winning writer and broadcaster specialising in transport. He was shortlisted as a Labour mayoral candidate in the 2016 London election, and stood as Labour's candidate in the Richmond Park by-election in December 2016.