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.

Getty Images.
Show Hide image

Scottish Labour's defeat to the Tories confirms a political transformation

The defining divide is no longer between left and right but between unionist and nationalist.

It was Scotland where Labour's recovery was supposed to begin. Jeremy Corbyn's allies predicted that his brand of left-wing, anti-austerity politics would dent the SNP's hegemony. After becoming leader, Corbyn pledged that winning north of the border would be one of his greatest priorities. 

But in the first major elections of his leadership, it has proved to be Labour's greatest failure. A result that was long thought unthinkable has come to pass: the Conservatives have finished second (winning 31 seats). For the first time since the 1910 election, Labour has finished third (winning 24). Scottish Labour leader Kezia Dugdale stood on a left-wing platform, outflanking the SNP on tax (pledging to raise the top rate to 50p and increase the basic rate by 1p), promising to spend more on public services and opposing the renewal of Trident. But rather than advancing, the party merely retreated.

Its fate confirms how Scottish politics has been realigned. The defining divide is no longer between left and right but between unionist and nationalist. With the SNP as the only major pro-independence party, the Tories, led by the pugnacious Ruth Davidson, framed themselves as the pro-UK alternative - and prospered. In contrast, Dugdale refused to rule out supporting a second referendum and suggested that MPs and MSPs would be free to campaign for secession. The result was that Scottish Labour was left looking dangerously irrelevant. "Identity politics. Labour doesn't get it," a shadow minister told me. Its socialist pitch counted for little in a country that remains ideologically closer to England than thought. The SNP has lost its majority (denying it a mandate for a second referendum) - an outcome that the electoral system was always designed to make impossible. But its rule remains unthreatened. 

Corbyn's critics will seek to pin the baleful result on him. "We turned left and followed Jeremy's politics in Scotland, which far from solving our problems, pushed us into third," a senior opponent told me. But others will contend that a still more left-wing leader, such as Neil Findlay, is needed. Dugdale is personally supportive of Trident and was critical of Corbyn before his election. Should she be displaced, the party will be forced to elect its sixth leader in less than five years. But no one is so short-sighted as to believe that one person can revive the party's fortunes. Some Corbyn critics believe that a UK-wide recovery is a precondition of recovery north of the border. At this juncture, they say, SNP defectors would look anew at the party as they contemplate the role that Scottish MPs could play in a Westminster government. But under Corbyn, having become the first opposition to lose local election seats since 1985, it is yet further from power. 

In Scotland, the question now haunting Labour is not merely how it recovers - but whether it ever can. 

George Eaton is political editor of the New Statesman.