Editorial Thursday 20 October 2011: A deal in the Lords

A deal has been done in the Lords.

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Click here for details of 'NCB chair to give Comrade Sir David a run for his roubles - few Lords a-leaping as the meek shall inherit the Bill', the new issue of subscription-based Health Policy Intelligence.

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Lib Dem peers have an understanding with Conservative peers that they will be allowed to have amendments relating to the Secretary of State's role and accountability for the NHS - specifically the 'duty to promote autonomy' in clause four, which Lib Dem peer Baroness Williams' amendment wants to see removed.

In return for this concession, Lib Dem peers will not vote on certain other amendments - essentially, the ones around Monitor.

It's an interesting approach for the Lib Dems; a party which believes in more representative democracy.

In the past fortnight (and well before the vote last week), Parliamentary staff and other sources reported changes of attitude and approach from Lib Dem erstwhile opponents of the Bill.

In policy conversations about the Bill, the points being raised around SOS accountability are interesting - but probably more symbolic than otherwise.

In political reality, the public is going to carry on considering that the elected politician who has cabinet responsibility for the NHS is the ultimate focus of their ire.

The NHS is not like the BBC, which is permitted to raise its revenue directly via TV Licensing (I didn't realise Capita did their enforcement). We fund it from our taxes, and we expect to have political leaders accountable. We will hold them accountable.

There are vastly more important points of clarification needed regarding the Health Bill.

How is acceptable integration to be distinguished from unacceptable collusion?

How will the certain conflicts of interest with the desire for more primary and community care provision alongside the drive to clinical commissioning be managed?

To market, to market, to buy ... what?

It would be nice to know.

But anyway. A deal has been done.