Editorial Friday 10 February 2012: With friends like this, the Health Bill doesn't need enemies

The Health And Social Care Bill now looks more likely to be put out of its misery than it ever has before.

The Bill has struggled to buy a friend, and been the subject of perhaps more negative discussion than any legislation since the Community Charge - better known as the Poll Tax.


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This week, the Financial Times editorial said the Bill should be withdrawn. The Bill also gave Labour leader Ed Miliband a clear and easy win at Prime Minister's Questions.

This morning, the influential Conservative Home website agrees - and according to The Guardian, was urged by three Cabinet Ministers to do so.

Conservative Home is owned by Lord Ashcroft (about whose polling we have previously written). Its editor Tim Montgomerie will well-regarded across the political spectrum. He senses the degree to which the Bill has become politically toxic.

The FT has been sceptical of the reforms for some time. For Conservative Home to join in the attack is startling. (The Telegraph and Spectator also join the fray. So has pro-Tory Westminister correspondent and blogger Iain Martin.

And the Government are duly startled, getting Conservative Party Chair Baroness Warsi to offer this rapid rebuttal attempt.

The remarkability of the online forum for the Conservative Party's activitsts and thinkers joining the 'Kill Bill' faction is considerable, and one would expect it to produce a decent rebuttal.

But oops! Baroness Warsi's effort will not calm many fears of those who have actually been paying any attention. A few key lines, and responses:

"The Health and Social Care Bill represents the most radical decentralisation of power that the NHS has witnessed in its history"

Ahem. The uber-Quango £60 billion NHS Commissioning Board, of which even keen supporters of clinical commissioning are wary?

"The Bill underpins a patients’ right to choose".

Ahem-ahem. ([cough]Bullshit[/cough]). Have a look at the NHS Constitution, introduced by Labour in 2008.  There is no legally enforceable right there, just as there will be no legally enforceable right now. NICE's commissioning outcomes framework will set a certain amount down as must-do.

"The Bill enshrines in law the power that frontline staff should have the ultimate say in where NHS resources are spent."

Oh, I can't ahem any more: this is just crap. No. It doesn't. The national tariff, set by Monitor and NICE and the commissionign outcomes framework set by the NHSCB and NICE will do most of that.

"It gives NHS organsations the freedom they once had to organise themselves as they see fit".

Utterly wrong. Couldn't be more wrong. NHS foundation trusts have had substantial freedoms since 2003, including to vary national terms and conditions (which only one did). CCGs are not being allowed to organise themselves as they see fit: they are havong to be co-terminous, and the bottom-of-promised-range management cost allowance is forcing them into a certain scale. Commissioning support organisations have no choice but to be hosted by the NHS Commissioning Board.

"The first argument against the Bill is that we don’t need legislation. Those who articulate this argument all of a sudden should be asked why, then, do they oppose it?"

Oh sweet Jesus. To achieve the aims of this Bill, some legislation is needed (i.e. for CCGs to become statutory bodies in themselves). Sensible opponents of the Bill think that significant portions of it are deeply incoherent (Monitor's economic regulator / FT overseer conflict being the most obvious); wildly unclear (failure regime); and plain contradictory (delayering by adding two new management layers;  liberating the front live through a vastly powerful national Quango).

They don't oppose it because they think legislation (and indeed change) isn't necessary; they oppose it because they think this legislation and this change isn't necessary.

"The second argument against the Bill is that it introduces a free market free for all."

Another straw man. The current Bill does not explicitly do that (although its original iteration was pointing strongly in that direction in terms of provision).

The arguments made are so incompetent that it's hard not to wonder if Baroness Warsi is hoping to increase the chances the Bill will be withdrawn. With friends like this, the Health Bill doesn't need enemies.

UPDATE: The Guardian's splendid Michael White has a different take, and sees both Andrew Lansley and the Bill as here to stay. He also speculates on the identities of The Cabinet Three.