Editorial Monday 23 January 2012: The politics of protest

It's been an interesting few days for the Health And Social Care Bill's tortuous progress through Parliament.

A leaked draft of the Commons Health Select Committee's forthcoming report on NHS expenditure found its way to Toby Helm and Denis Campbell of The Observer.

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Click here for details of 'Taking the pith out of the Health & Social Care Bill - “Integrate my chutzpah”, says Andrew ‘Not Looking For  A Fight’ Lansley', the new issue of subscription-based Health Policy Intelligence.

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The document is reported to say, "The reorganisation process continues to complicate the push for efficiency gains. Although it may have facilitated savings in some cases we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings".

The select committee is said to focus in part on community provision of integrated health and social care services to prevent hospitalisation of the frail elderly, concluding that committee members found "precious little evidence of the urgency which it believes this issue demands – on both quality and efficiency grounds".

Deputy Prime Minister Nick Clegg was wheeled out on the Andrew Marr Show to present NHS reform as a must-do. This is quite a bold move, given Mr Clegg's opinion poll ratings.

Fortunately the epic Health-Secretary-In-Waiting that is Simon Burns was on hand to throw his weight behind the reforms.

The select committee report (which is on public expenditure on the NHS, and not specifically about the Bill) will be un-embargoed at midnight, and I'll write about it tomorrow. But these events came in the wake of the announcements last week that both the RCN and RCM joined the BMA in calling for the Bill to be withdrawn.

Meanwhile, Labour's Lords team announced on Twitter that the appeal on the release of the Risk Register has been brought forward from April to 5th & 6th March. (Earl Howe's reluctance to reveal the risk register means we can be assured the document is an uncomfortable read for the Government).

The opposition of politics
The politics of opposition are straightforward. Labour opposes the Bill, and has been consistent in doing so. (The People's Party doesn't particularly have policy proposals of their own, as a) opposing the Bill has been a fairly full-time preoccupation, and b) it's been too early in the Parliamentary cycle to be heard. They'll need to be getting on with forming the outlines of a health policy over 2012.)

At the same time, new-intake Conservative MPs are starting to feel more buoyed-up by their position in opinion polling. Health Bill committee member Nick De Bois wrote this interesting bell-weather piece for Conservative Home on the need for the Conservatives to be bold in claiming leadership of the Coalition Government.

The Lib Dem position on the Bill remains essentially the same: a quiet split between the left of the party and the Orange Book tendency among the leadership. Andrew George MP remains the sole Commons MP who has spoken out for the Bill to be withdrawn and voted against it.

The Lib Dem peers have so far proved broadly quiescent in the Bill's progress. Its report stage in the Lords begins on 8 February. The Third Reading

Kill Bill?
I have said for some time now that the Health Bill (while not primarily about NHS privatisation) remains the biggest example of the Yes, Minister politician's syllogism:
1. Something must be done
2. This is something.
3. Therefore this must be done.

While the communication to make the case for the Bill has struggled to reach the giddy heights of the appalling, I also disagree with those who think that the main problem is the presentation of the Bill. (There's a nice joke in Westminster circles about this: 'What's the difference between Chris Huhne and Andrew Lansley? Chris Huhne can get his points across'.)

The evident centralisation of power in the Nicholson Commissioning Board (which is even starting to alienate the few core supporters of clinical commissioning, such as NHS Alliance) and the schizophrenic nature of Monitor as FT system manager and economic regulator are issues I have written about on here many times.

Added to these is the sheer un-necessity of a top-down system-wide structural reorganisation with the attendant opportunity costs, loss of corporate memory and staff - to say nothing of the loss of agency that can do major and long-needed reconfiguration of maternity and A&E services. (This is of course central planning, with which the Bill's philosophy is inimical.)

So, we can expect more protest against the Bill. There will be pressure for further concessions.

Labour will be boosted by a fresh chance to get shouty and oppositional, but will also know the numbers do not stack up for a defeat without a big shift in the position of left-leaning Lib Dems, which currently looks unlikely.

Left-leaning Lib Dems will be torn between a fear of splitting their party and doing the wrong thing.

Orange Book Lib Dems support these reforms, and simply hope the NHS will go away as an issue (which it won't).

Mainstream Conservatives support these reforms, perhaps with some resentment about the toning-down to date of the competition and market rhetoric. There are a few left-of-centre Conservatives, and a few Daniel-Hannan-was-right types on the dingbat fringe, but not enough of either to worry party managers or aid Bill opponents.

The NHS is not going to go away as an issue. There are real and huge issues that require action: acute over-stretch in A&E and maternity as currently configured, and ever-emerging challenges from long-term conditions. There are real reforms to be made in clinical performance measurement and in developing self-care, co-production and perhaps even some preventative care. Evidence-based care is still too variably delivered (albeit the NHS Atlas is beginning to be a big help in showing this).

The Health Bill reforms promise an implausible route to liberation via tight Stalinist controls.  They do not address the urgent need to shut unsafe A&E and maternity services, and thus have been dishonestly silent on the certainty of greater medical unemployment that would follow this.

Those responsible for the Health Bill will not have created every ill that besets the NHS over this and coming years, although their opponents will claim the contrary. They will, however, be guilty of profoundly incompetent communication; a fatal strategic error in deciding that reform equals structural reorganisation; and syllogistic political remedies that do not look likely to address the real issues.

I have written before that it's time to fasten your seatbelts.

It's now time to check your airbag, tyres and brakes as well.