Will the Lib Dems halt Hunt's backdoor NHS privatisation?

Health secretary promises to address "concerns" over Section 75 of the NHS bill after pressure from Lib Dems and Labour.

When the government's Health and Social Care Bill was finally passed by Parliament last year it was on the condition that GPs would not be forced to open up NHS services to private competition.

Andrew Lansley, the-then Health Secretary, told the Commons: "There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector". In a letter to Clinical Commissioning Groups, he wrote:

I know many of you have read that you will be forced to fragment services, or put them out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators – should decide when and how competition should be used to serve your patients interests. 

Having accepted Lansley's assurances, the Lib Dems granted the bill their support. But new regulations published under Section 75 of the act flatly contradict the government's promises. The guidelines state that commissioners may only award a contract without competition if they are "satisfied that the services to which the contract relates are capable of being provided only by that provider". In practice, then, GPs will be forced to open up all NHS services to private companies, regardless of the wishes of local people, with the healthcare regulator Monitor granted the power to block any "unnecessary" restriction of competition. 

Secondary legislation like this is normally nodded through parliament without debate but Labour, smelling a rat, warned that the regulations amounted to an attempt at backdoor privatisation. Jeremy Hunt, Lansley's replacment as health secretary, initially sought to dismiss the opposition's concerns. In response to a question from Jamie Reed, the shadow health minister, he declared: "Who exactly are the section-75 bogeymen [he] hates: Whizz-Kidz, who are supplying services to disabled children in Tower Hamlets? Or Mind, which is supplying psychological therapy to people in Middlesbrough?"

But after the Lib Dems joined Labour in raising concerns, Hunt has been forced to think again. Norman Lamb, the Lib Dem health minister, told his party colleague Andrew George, one of those opposed to the regulations, "We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations."

In reponse, as today's Guardian reports, Hunt has made it clear that he is prepared to rewrite the new guidelines. A source tells the paper: "We are aware that there are concerns over the wording and the way it may be interpreted. We are speaking to the Lib Dem peers to make sure they are happy. We want to make sure everyone is happy."

The shadow health secretary, Andy Burnham, said in response: "The government has been caught out trying to force through privatisation of the NHS by the back door.

"This is another humiliating U-turn to add to the government list, but we believe ministers will stop at nothing to drive through their plans to put the NHS up for sale to the highest bidder."

But will this be anything other than a comestic rewrite? Ahead of the Lib Dems' spring conference next month, this is a key test of the party's nerve. 

Health Secretary Jeremy Hunt speaks at the Conservative conference in Manchester last year. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Cameron in Nuneaton. Photo: Getty
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Why fewer of us want a long-term relationship ... with a political party

In 2015, 38 per cent of voters backed a different party to the one they supported in 2010. So what does the rise of swing voters mean for British politics?

For decades political parties have competed furiously for one of the great prizes of British politics: the affections of the swing voter. It wasn’t that long ago that there were relatively few political swingers: until the 1990s, fewer than a quarter of voters would switch parties from one election to the next.

Yet that once relatively rare breed is becoming increasingly common, which means party campaigners are going to have to come up with new tactical thinking. The British Election Study survey panels, conducted episodically over the last fifty years, are unique in that they are able to track the same voters from one election to the next, unlike more conventional opinion polls that only look at a snapshot of voters at a given time. Using these studies, you can identify the percentage of voters who switch their vote from one party to another between each pair of elections since 1966 when such data was first collected.

In 1966 only around 13 per cent of voters had changed their minds since the previous election in 1964. Since then, the proportion of swingers has been steadily increasing, and by 2015, 38 per cent of voters backed a different party to the one they supported in 2010.

The increase in swing voters is pretty consistent. The only exceptions are between February and October 1974, when (understandably) fewer voters changed their minds in eight months than switched in the preceding four years, and between 1997 and 2001, when the electoral dominance of New Labour under Tony Blair held back the tide for a time. These two exceptions aside, the increase has been constant election-on-election.

A lot of vote shifting can go on even between elections where the overall result remains stable. In 2001, for example, more people switched votes than in any election before 1997, with a surprising level of turmoil beneath the surface stability. While these largely cancelled out on that occasion, it set the stage for more dramatic changes in the parties’ votes later on.

So British voters now seem more likely than ever to jump from party to party. But who exactly are these swingers? Are they disillusioned former party loyalists? Or have British voters simply stopped getting into a serious relationship with the parties in the first place? We can get some insight into this using data from the yearly British Social Attitudes Survey, looking at the number of respondents who say that they do not identify with any of the political parties (party identifiers tend to switch much less often) when they are asked ‘Generally speaking, do you think of yourself as a supporter of any one political party?’ and then ‘Do you think of yourself as a little closer to one political party than to the others?’ if they say no to the first question. The graph below combines data from 1984 to 2013. Each line represents people who were born in a different year. Higher lines mean that there are more people who do not identify with a political party. So, for instance, voters born in 1955 started with very low levels of non-identification (22 per cent), which have gradually risen to 44 per cent in the latest survey. Most of the lines on the graph go up over time, which shows that almost all generations are falling out of love with the parties.

However, an acquired taste in swinging among the older generations is dwarfed by the promiscuous younger generations – shown by the dashed lines – most of whom never form an attachment to a party at all. Each generation in the data has been less committed to the parties than the previous generation was at the same age, with around 60 per cent of the youngest generation – those born since 1985 – expressing no attachment to any political party.

Since most of this change has been a generational shift, it may be a long road back for the parties. Loyalty to parties is often handed down in families, with children inheriting their parents’ commitment to a party. Now that this process has broken down, and younger generations have lost their attachment to parties, they may in turn pass on this political detachment to their children.

The majority of younger voters have simply never grown up with the idea of getting into a long-term relationship with a political party, so they may never settle down. Many Labour MPs were outraged when it turned out that lots of the new members who joined up to vote for Jeremy Corbyn had voted for the Green Party just a few months before, but this may simply reflect the political approach of a generation who see parties as needing to earn their vote each time rather than commanding lasting, even unconditional loyalty.

If Britain’s newfound taste for swinging isn’t going to disappear any time soon, what does it mean for party competition? In the past most people had settled partisan views, which seldom changed. General elections could be won by attracting the relatively small group of voters who hadn’t made up their minds and could very easily vote for either of the two main parties, so political parties based their strategies around mobilising their core voters and targeting the few waverers. While they worried about traditional loyalists not turning up to the polls, the parties could be assured of their supporters’ votes as long as they got them to the voting booth.

Nowadays, swing voters are no longer a small section of the electorate who are being pulled back and forth by the parties, but a substantial chunk of all voters. This helps to explain why politicians have been so surprised by the sudden rise of new parties competing for groups previously thought to be reliable supporters. The new parties that have entered British politics have also allowed voters to express their views on issues that don’t fall neatly into traditional left– right politics such as immigration (UKIP) or Scottish independence (the SNP). This in turn has posed a dilemma for the traditional parties, who are pulled in multiple directions trying to stop their voters being tempted away.

This may just be the start. If the number of swing voters stays this high, the parties will have to get used to defending themselves on multiple fronts.

This is an extract from More Sex, Lies and the Ballot Box, edited by Philip Cowley and Robert Ford.