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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Benn vs McDonnell: how Brexit has exposed the fight over Labour's party machine

In the wake of Brexit, should Labour MPs listen more closely to voters, or their own party members?

Two Labour MPs on primetime TV. Two prominent politicians ruling themselves out of a Labour leadership contest. But that was as far as the similarity went.

Hilary Benn was speaking hours after he resigned - or was sacked - from the Shadow Cabinet. He described Jeremy Corbyn as a "good and decent man" but not a leader.

Framing his overnight removal as a matter of conscience, Benn told the BBC's Andrew Marr: "I no longer have confidence in him [Corbyn] and I think the right thing to do would be for him to take that decision."

In Benn's view, diehard leftie pin ups do not go down well in the real world, or on the ballot papers of middle England. 

But while Benn may be drawing on a New Labour truism, this in turn rests on the assumption that voters matter more than the party members when it comes to winning elections.

That assumption was contested moments later by Shadow Chancellor John McDonnell.

Dismissive of the personal appeal of Shadow Cabinet ministers - "we can replace them" - McDonnell's message was that Labour under Corbyn had rejuvenated its electoral machine.

Pointing to success in by-elections and the London mayoral election, McDonnell warned would-be rebels: "Who is sovereign in our party? The people who are soverign are the party members. 

"I'm saying respect the party members. And in that way we can hold together and win the next election."

Indeed, nearly a year on from Corbyn's surprise election to the Labour leadership, it is worth remembering he captured nearly 60% of the 400,000 votes cast. Momentum, the grassroots organisation formed in the wake of his success, now has more than 50 branches around the country.

Come the next election, it will be these grassroots members who will knock on doors, hand out leaflets and perhaps even threaten to deselect MPs.

The question for wavering Labour MPs will be whether what they trust more - their own connection with voters, or this potentially unbiddable party machine.