Last chance to save the NHS in the House of Lords

A new raft of privatising measures will be voted on tomorrow.

Tomorrow there will be a debate and vote critical to the future of the NHS in England. Labour Lord Philip Hunt has laid a fatal motion to try and kill the "Procurement, Patient Choice and Competition Regulations" that the government have issued under the Health and Social Care Act. The Regulations open up England’s NHS to competition on an unprecedented scale by putting the market at the heart of commissioning decisions.

When the government first released the regulations in February I wrote an article with Dr Lucy Reynolds explaining that they betrayed the political promises and assurances given when the government were struggling to get their Health and Social Care Bill passed. Public feeling against the regulations exploded. 38 Degrees launched a petition against them which now has over 360,000 signatures. This pressure, combined with strong criticism from the medical profession, Labour and even Liberal Democrats, forced the Department of Health to rewrite the regulations.

Unfortunately the revised regulations are little improved. The word "integration" was inserted a few times to address peoples’ fears that competition would increase fragmentation of services. However Regulation 5 dictates that a contract must be advertised for competition unless commissioners are satisfied that there is only one provider capable of providing the service. This is a narrow legal test vulnerable to challenge. Private companies could contest that they are "capable" of providing a service and entitled to bid for that business. Knowing this, commissioners are likely to cautiously avoid the potential for legal challenge by opening services to competition.

The regulations still break the promises given when the government were fighting to push the Health and Social Care Bill through parliament. Andrew Lansley promised prospective Clinical Commissioning Groups that they would decide "when and how competition should be used". Earl Howe promised that commissioners would have a "full range of options" and would not be under any legal obligation to "create new markets, particularly where competition would not be effective in driving high standards and value for patients".

The truth is that it will not be up to commissioners to decide if, when and how to use competition. Far from these reforms freeing GPs to do what’s best for patients, these Regulations bind them to an expensive bureaucratic market system of evaluating commercial tenders as advised by competition lawyers. David Lock QC, commissioned by 38 Degrees to provide a legal opinion on both sets of regulations, said that anyone who insists that they allow commissioners discretion to decide when and how to use competition is parroting "disingenuous nonsense".

"Disingenuous" is an apt word for the politicians here. Liberal Democrat Lord Clement-Jones (who originally opposed the regulations and now supports the new ones) told me that the regulations simply apply EU procurement law and that commissioners are being given the maximum discretion possible within that framework. My contention is that the framework is a straitjacket and, as the politicians always intended EU procurement law to apply, it was thus utterly wrong to pretend that commissioners would have more freedom than this law allows. It makes those promises cynical, misleading and deceptive from the outset, as the necessary caveats would have rendered them meaningless.

The rationale for the reforms is a belief that market competition will drive up standards of care. But as others have pointed out, this faith in the market, like all faiths, lacks evidence. Commercial interests introduce perverse incentives that detract from the focus on duty of care and trust between doctor and patient. This isn’t evidence-based policy-making. This is an ideologically driven experiment being legally enforced before being tried and tested.

If we discover, as many fearfully predict, that these regulations serve to erode and undermine current NHS providers, leading to increasing privatization, rising costs and a reduction in quality of care, then how will we change course? Attempting to undo these reforms is likely to be extremely expensive and politically difficult, giving rise to claims from companies who could sue for compensation. There is a puzzling prioritisation of process here, rather than outcomes. The only guaranteed beneficiaries of this approach are those who will profit from winning new business.

Politicians may say that their hands are tied by EU laws, but make no mistake, this is a choice. Scotland and Wales have made different choices and are organizing their services differently, keeping the market out. There is something profoundly undemocratic about the English case. The NHS reforms were not outlined in the 2010 election, they didn’t appear in any party manifesto and they didn’t even feature in the Coalition agreement. Nobody voted for these changes. The Health and Social Care Act was extremely controversial, pushed through after many political promises were made and these Regulations prove that those promises were highly misleading.

Despairingly for our democracy, all three main parties have played their role in getting us to this point. The last New Labour government laid the path for the current regulations with their Principles and Rules of Cooperation and Competition, though the coalition now go further by turning suggestions into requirements. For all the talk of patient choice, people have been denied the choice that really matters - the choice of a citizen to collectively determine the provision of their national health service. Politicians have pushed through monumental reforms covertly, not by winning the argument openly, honestly and democratically. Peers will have the chance to vote in the Lords chamber tomorrow and the public are telling them how they feel. Will the politicians rise above party political point-scoring and have the big honest debate that all who rely on the NHS deserve?

NHS activists outside Parliament. Photo: Getty Images.

Nicola Cutcher is a freelance journalist and researcher.

Getty Images.
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As long as Jeremy Corbyn's Labour opponents are divided, he will rule

The leader's foes have yet to agree on when and how a challenge should take place.

Labour MPs began plotting to remove Jeremy Corbyn as leader before he even held the position. They have not stopped since. From the outset, most regarded him as electorally and morally defective. Nothing has caused them to relinquish this view.

A week before the first major elections of this parliament, Labour found itself conducting a debate normally confined to far-right internet forums: was Hitler a Zionist? For some MPs, the distress lay in how unsurprised they were by all this. Since Corbyn’s election last September, the party has become a mainstream venue for hitherto fringe discussions.

Many MPs believe that Labour will be incapable of rebuilding its standing among the Jewish community as long as Corbyn remains leader. In the 1930s, Jewish support for the party was as high as 80 per cent. “They handed you your . . . membership just after your circumcision,” quipped the father in the 1976 television play Bar Mitzvah Boy. By the time of the last general election, a poll found that support had fallen to a mere 22 per cent. It now stands at just 8.5 per cent.

Corbyn’s critics cite his rejection of anti-Semitism and "all forms of racism" (as if unable to condemn the former in isolation), his defence of a tweet sent by his brother, Piers (“Zionists can’t cope with anyone supporting rights for Palestine”), and his description of Hamas and Hezbollah as “friends”. The Lab­our leader dismissed the latter remark as a diplomatic nicety but such courtesy was not displayed when he addressed Labour Friends of Israel and failed to mention the country’s name. When challenged on his record of combating anti-Semitism, Corbyn frequently invokes his parents’ presence at the Battle of Cable Street, a reference that does not provide the reassurance intended. The Jewish community does not doubt that Labour has stood with it in the past. It questions whether it is prepared to stand with it in the present.

MPs say that Labour’s inept response to anti-Semitism has strengthened the moral case for challenging Corbyn. One shadow cabinet minister spoke of how the fear of “enormous reputational damage” had pushed him to the brink of resignation. As the New Statesman went to press, Corbyn’s first electoral test was looming. Every forecast showed the party on course to become the first opposition to lose council seats in a non-general-election year since 1985. Yet Corbyn appeared to insist on 3 May that this would not happen, gifting his opponents a benchmark by which to judge him.

Sadiq Khan was projected to become the party’s first successful London mayoral candidate since 2004. But having distanced himself from Corbyn throughout the race, he intends to deny him any credit if he wins. Regardless of the results on 5 May, there will be no challenge to the Labour leader before the EU referendum on 23 June. Many of the party’s most Corbyn-phobic MPs are also among its most Europhile. No cause, they stress, should distract from the defence of the UK’s 43-year EU membership.

Whether Corbyn should be challenged in the four weeks between the referendum and the summer recess is a matter of dispute among even his most committed opponents. Some contend that MPs have nothing to lose from trying and should be prepared to “grind him down” through multiple attempts, if necessary. Others fear that he would be empowered by winning a larger mandate than he did last September and argue that he must be given “longer to fail”. Still more hope that Corbyn will instigate a midterm handover to the shadow chancellor, John McDonnell, his closest ally, whom they regard as a beatable opponent.

Those who are familiar with members’ thinking describe many as “anxious” and in need of “reassurance” but determined that Corbyn receives adequate time to “set out his stall”. One shadow cabinet minister spoke of being “caught between Scylla and Charybdis” – that is, “a Labour Party membership which is ardently Corbynista and a British electorate which is ardently anti-Corbynista”. In their most pessimistic moments, some MPs gloomily wonder which group will deselect them first. The possibility that a new Conservative leader could trigger an early general election is cited by some as cause for haste and by others as the only means by which Corbynism can be definitively discredited.

The enduring debate over whether the Labour leader would automatically make the ballot if challenged (the party’s rules are ambiguous) is dismissed by most as irrelevant. Shadow cabinet members believe that Corbyn would achieve the requisite nominations. Momentum, the Labour leader’s praetorian guard, has privately instructed its members to be prepared to lobby MPs for this purpose.

There is no agreement on who should face Corbyn if his removal is attempted. The veteran MP Margaret Hodge has been touted as a “stalking horse” to lead the charge before making way for a figure such as the former paratrooper Dan Jarvis or the shadow business secretary, Angela Eagle. But in the view of a large number of shadow cabinet members, no challenge will materialise. They cite the high bar for putative leaders – the endorsement of 20 per cent of Labour MPs and MEPs – and the likelihood of failure. Many have long regarded mass front-bench resignations and trade union support as ­essential preconditions for a successful challenge, conditions they believe will not be met less than a year after Corbyn’s victory.

When Tony Blair resigned as Labour leader in 2007, he had already agreed not to fight the next general election and faced a pre-eminent rival in Gordon Brown. Neither situation exists today. The last Labour leader to be constitutionally deposed was J R Clynes in 1922 – when MPs, not members, were sovereign. Politics past and present militate against Corbyn’s opponents. There is but one man who can remove the leader: himself.

George Eaton is political editor of the New Statesman.

This article first appeared in the 06 April 2016 issue of the New Statesman, The longest hatred