Lansley's bill has killed debate about the future of the NHS

There is a whole lot of politics and very little policy in the war over the government's health refo

Does any of the three main parties actually have a policy for the NHS? It may sound like a peculiar question given that huge stores of energy are currently being spent debating the future of the health service in parliament, but having a big argument in Westminster is not the same as having a coherent agenda.

The Health and Social Care Bill returns to the House of Lords this week and Liberal Democrat peers have some amendments covering the controversial section of the reforms dealing with increased competition between different providers. Crudely, speaking the vital question is how widely market forces will be allowed to operate when, under the new structures created by Andrew Lansley's reforms, GPs are given control over budgets and instructed to purchase the best value care for patients.

Lib Dems in the Lords want to rewrite parts of the Bill that would give the Competition Commission regulatory authority over healthcare. That, it is feared, would amount to a legal mandate for breaking up NHS "monopolies" and, if enough private providers complained about being shut out of contracts, forcing GPs to curtail their use of state services. In terms of the underlying principles of the Lansley project, this argument is pivotal; it is the big one. It is clear from the way the original bill was designed that the Health Secretary wants a radical acceleration of competition to be the main driver of change in the service. The logical extension of the reforms - as initially conceived - is for the NHS label to be, effectively, a kite mark, signalling that care has been paid for by the state and is being carried out by a licensed provider. It should, in theory, be irrelevant whether the people actually doing the caring are public or private sector employees.

It is also clear that the government is too scared to tell the public that this is what Lansley had in mind when he drafted the bill. It sounds and looks a little bit too much like privatisation, which is not a word the Tories want attached to their ambitions for the NHS. That makes it very hard for the government to fight the forthcoming battle in the Lords.

Number 10 is saying it is relaxed about amendments that might "clarify" this crucial section of the bill, but would be unhappy with substantial changes. Does that mean the Prime Minister insists on a level of competition from private providers that forcefully dismantles state monopolies? Or would he be satisfied with a watered down competition clause that amounts, in essence, to an extension of the "internal market" that existed under Labour? Another way of phrasing the question: does Cameron actually want to implement Lansley's vision or is he only pressing ahead with the bill to avoid the humiliation of abandoning a high-profile project in which he has already invested a lot of political capital?

The Lib Dem amendments have been sanctioned by Nick Clegg, largely, it seems, because he is aware of deep dissatisfaction in his party and fearful of being presented, come the next election, as an accomplice in Tory sabotage of a cherished national institution. But does he think a dramatic increase in competition from the private sector - policed by an anti-monopolies regulator - would be a driver of greater efficiency and quality of care in the health service? If the answer is "yes", why is he allowing his peers to sabotage the bill? If the answer is "no", why is he voting for any of this legislation?

As for Ed Miliband, his position is clear enough for an opposition leader. He has written in the Times today calling (again) for the bill to be scrapped. The issue of competition is addressed in passing:

Nor is the cause of integration helped by the Bill's aim to turn the whole NHS into a commercial market explicitly modelled on the privatisation of the utilities in the 1980s. Introducing a free-market model throughout the healthcare system -- quite different from the limited competition currently in place -- will have a chilling effect on the behaviour of those trying to co-ordinate and co-operate.

Another way of putting this might be that market forces are tolerable when Labour allows them to operate in a carefully controlled environment, but destructive and corrosive when unleashed by Tories and Lib Dems. Fair enough, I suppose, but it is a very queasy way of making peace with the Blairite legacy of public service reform. Nowhere else has Miliband dealt explicitly with the question of whether or not he thinks competition is a healthy or a pernicious mechanism for getting value for money in the public sector.

Which brings us back to that initial question. What is the three main parties' health policy? As far as I can make out it is as follows:

Conservatives: secure any version of Lansley's reforms, regardless of what the outcome will actually be for the NHS.

Labour: make sure every problem in the NHS is seen as a consequence of Lansley's reforms; avoid being drawn on alternative plans.

Liberal Democrats: look conspicuously worried about Lansley's reforms; in the event that they are enacted, hide.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Where are the moderate Tories condemning Zac Goldsmith’s campaign?

Conservative MPs are reluctant to criticise the London mayoral candidate’s dogwhistle rhetoric.

Very few Conservative politicians have criticised Zac Goldsmith’s campaign to be elected London mayor. And, amid repeated accusations of racial profiling, Islamophobic undertones, and patronising London’s Indian communities, there has been plenty to criticise.

Ever since describing his rival, Sadiq Khan, as having “radical politics” at the end of last year, Goldsmith’s campaign has come under fire for attempting to sound a dogwhistle to voters for whom racial politics – and divisions – are a priority.

You may feel it’s naïve of me to expect Tory MPs to join in the criticism. Presumably most Tory MPs want their party’s candidate to win the mayoralty. So it is unlikely that they would condemn his methods.

But I’d argue that, in this case, we can’t excuse dodged questions and studied silence as good clean tribalism. Granted, Conservatives only want to see their party make electoral gains. And that is understandable. But trickier to explain away is how willing all of the party’s MPs – many of whom are as moderate and “cotton-wool Tory” (in the words of one Labour adviser) as we once assumed Goldsmith was – are to ignore the campaign’s nastier side.

Why aren’t the Cameroons (or neo-Cameroons) who wish to further “detoxify” the party speaking out? There are plenty of them. There is more enthusiasm on the Tory benches for David Cameron than is generally assumed. Many of the 2015 intake are grateful to him; those in marginal seats in particular see him as the reason they won last year. And in spite of the grumbling nature of the 2010-ers, a number of them are keener than appears on Cameron. After all, plenty wouldn’t be in parliament without his A-list and open primaries (a time when the party was supposed to be opening up to candidates of different backgrounds, something Goldsmith’s rhetoric could threaten).

And we know it’s not just Labour whining about Goldsmith’s campaign. It makes Tories uncomfortable too. For example, the Conservative Group Leader at Watford Council Binita Mehta, former Conservative candidate Shazia Awan, and Tory peer and former minister Sayeeda Warsi have spoken out.

And it’s not just non-MPs who are riled by Goldsmith’s rhetoric. Behind the scenes, Conservative MPs have been muttering for weeks about feeling uncomfortable about the campaign.

“There has been a sense that this is a bad dogwhistle, and it’s a bit of a smear,” one Tory MP tells me. “I don’t think Sadiq Khan’s a bad man at all – I think his problem is, which happens to all politicians, is some of the platforms in the past and the people he shared them with, and maybe he didn’t know – I mean, the number of times David Cameron or Gordon Brown or Tony Blair were shown at some fundraising thing, or just visiting somewhere, shaking hands with somebody who turns out to be a crook; that’s the nature of mass politics.”

There is also a mixed view among London’s Tory MPs about the tone of Goldsmith’s campaign generally. Some, who were frustrated in the beginning by his “laidback, slightly disengaged” style, are simply pleased that he finally decided to play dirty with the more energetic Khan. Others saw his initial lighter touch as an asset, and lament that he is trying to emulate Boris Johnson by being outrageous – but, unlike the current London mayor, doesn’t have the personality to get away with it.

One Tory MP describes it as a “cold, Lynton Crosby calculation of the dogwhistle variety”, and reveals that, a couple of weeks ago, there was a sense among some that it was “too much” and had “gone too far and is counterproductive”.

But this sense has apparently dissipated. Since Labour’s antisemitism crisis unfolded last week, moderate Conservative MPs feel more comfortable keeping their mouths shut about Goldsmith’s campaign. This is because racism in Labour has been exposed, even if Khan is not involved. Ironic really, considering they were (rightly) so quick to condemn Ken Livingstone’s comments and call on Jeremy Corbyn and Labour MPs to speak out against such sentiments. It’s worth noting that Labour’s moderates have been significantly less reluctant than their Tory counterparts to call out such problems in their own party.

There is also the EU referendum to consider. Tory MPs see division and infighting ahead, and don’t want to war more than is necessary. One source close to a Tory MP tells me: “[Goldsmith’s campaign] is uncomfortable for all of us – it’s not even considered a Conservative campaign, it’s considered a Zac Goldsmith campaign. But [we can’t complain because] we have to concentrate on Europe.”

So it makes sense politically, in the short term, for Tory moderates to keep quiet. But I expect they know that they have shirked a moral duty to call out such nasty campaign methods. Their calls for Labour’s response to antisemitism, and David Cameron’s outrage about Jeremy Corbyn’s “friends” in Hamas and Hezbollah, are simply hollow attack lines if they can’t hold their own party to higher standards.

Anoosh Chakelian is deputy web editor at the New Statesman.