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11 April 2011

Clegg’s adviser threatens resignation over health reform

Norman Lamb has demanded changes to the Health Bill. What is the significance of his intervention?

By Samira Shackle

Norman Lamb, Nick Clegg’s closest adviser, has become the first Liberal Democrat to threaten resignation over the coalition’s proposed NHS reforms.

The former Liberal Democrat health spokesman said the speed at which the plans are to be implemented represents a “real risk of failure”, given growing financial pressure on the service.

Under Andrew Lansley’s Health Care Bill, primary care trusts (PCTs) would be abolished and control of 60 per cent of the NHS budget handed to GP-led consortiums by 2013.

In a humiliating climbdown for the Health Secretary, the bill has been paused for a two-month “listening exercise” following mounting concerns from health professionals and the public.

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While voicing support for the principle of handing greater powers to GPs, Lamb has demanded a series of changes.

What has he demanded?

  • Abandon the 2013 deadline. He argued that the approach should be “evolution, not revolution”.
  • Allow GPs to opt into consortiums, just as schools can opt to be academies.
  • Retain “clusters” of PCTs to monitor the “performance management” of GPs.

Lamb has stressed that his problem is mainly with the speed of change, rather than the principle: “Let’s stick to the principle, which is really good, but let’s not destroy it by getting the process wrong.”

How does this differ from the changes that the Lib Dem spring conference voted for last month?

At the Sheffield conference, the former Oxford MP Dr Evan Harris and the party grandee Shirley Williams tabled an amendment to the bill which was overwhelmingly voted in. These demands include:

  • Ban GP consortiums from taking decisions in private about how to spend NHS money.
  • Totally rule out any competition based on price.
  • Ban private companies from taking over commissioning and allow private health providers in only when it will not damage existing NHS services.
  • Ensure the role of local government in the consortiums.

The central tenet of this is a limitation of the role of the private sector and of the free-market philosophy that underpins the whole bill – arguably a more significant change than the one demanded by Lamb. The amendment says that the government’s aspirations for health “can be achieved without the damaging and unjustified market-based approach that is proposed”.

What impact is this intervention likely to have?

Lamb has indicated that unless his demands are met, the bill will be blocked by Lib Dems when it is revived in June. He has also made it clear that he understands that his position as government whip is “terminal” if his intervention is not heeded.

Clegg appeared on the Today programme this morning. Though he refused to be drawn into discussion of the specifics of the policy – such as the question over the future of PCTs – he stressed that significant changes were expected when the bill is revivived. “There’s no point having a pause unless you’re willing to make substantive changes,” he said.

However, it is likely that the “opt-in” idea will be a step too far for Lansley, who has previously said that giving GPs the option would create a two-tier service.

Quite apart from changes to the policy, this sets down a significant marker for the coalition. If Lamb wins, already disgruntled Conservatives will complain that too many concessions are being granted to the junior coalition partner. But if he is ignored, Lib Dems will complain that they are not listened to.

How have Liberal Democrats and Conservatives reacted?

Public disagreement from such a senior member of the party is embarrassing for the Lib Dem leader, Nick Clegg. In the Today interview, he downplayed the situation, stressing instead that Lamb agrees with “the basic design of giving GPs more financial control and stripping away layers of bureaucracy”. He added: “I couldn’t agree more with Norman: we have to get this right. The NHS is too precious to not get the principle translated properly into practice.”

There is some chagrin from the Tories. Last week (before Lamb’s intervention), Paul Goodman wrote at Conservative Home that the Tories”can’t afford to subcontract compassion to the Liberal Democrats”. Comments on the website’s report of Lamb’s statement show considerable anger from the Tory grass roots about the Lib Dems “holding the government to ransom”.