Reflecting on the exchanges in last week’s Opposition Day debate on the Health and Social Care Bill, I found it difficult to discern precisely what Labour’s opposition to the Bill was based on.
Lurching wildly from listing the number of amendments to the bill, to reiterating supposed public or Royal College opposition, and finally trying to square the circle of opposition to the bill but support for GP-led commissioning, Labour have not worked out what they are actually opposing.
I want to tackle some of the arguments that have been put by the Opposition over the past couple of days and suggest that the empty rhetoric coming from the Labour benches is simply not constructive.
Opinion polls as exclusive guide to policy-making
Public opinion polls have never been a sufficient or exclusive guide to effective policy-making. The detail of every reform cannot be set out in a General Election campaign (though the Conservative party committed in our manifesto to opening up the NHS to private and voluntary sector provision), and much less can the technical intricacies of reform in a large public body be debated effectively in a national debate.
The supposed opposition of the Royal Colleges (many of which, as effective trade union bodies, may well have an ideological opposition to competitive structures within the NHS) is similarly overstated. It has been well-documented that despite the claim that 98% of the Royal College of GPs want the Bill to be withdrawn, only 7% of its 44000 members responded to their survey and less than 6% called for the withdrawal of the Bill. The same is true of the Royal College of Paediatrics and Child Health – the alleged 79% of their members cannot be calling for withdrawal of the Bill as only 15% responded to the survey and less than 12% call for withdrawal.
Inflexibility?
It was not long ago that the Opposition were castigating the government for an ‘arrogant’ and ‘inflexible’ approach to reform. When the government responds by having an unprecedented level of debate on the content of the bill, and accepted hundreds of amendments, it is complained that the process has been “tortuous” and that the Commons is merely “rubber-stamping” a heavily-amended bill. The contradictions and confusions in Labour’s opposition to the bill hint at politically expedient point-scoring rather than serious and thoughtful opposition.
Look at the underlying facts
The government is not introducing NHS reform out of an ideologically driven aim to introduce competition come what may: the reforms are to give clinicians real responsibility and build on the virtues of competition into the health service without compromising the central principle of healthcare provided according to need and not according to ability to pay.
Private activity is only permitted insofar as it contributes to supporting the treatment of NHS patients; and private providers of services can compete on quality, rather than price, ensuring that the best possible treatment is available to NHS patients. The possibility that this could lead to postcode lotteries is dealt with by a statutory requirement to tackle health inequalities within the NHS.
Insubstantial opposition
The Secretary of State, Andrew Lansley MP, put his finger on it when he observed that the Shadow Secretary of State for Health has been reduced to shouting slogans. The hollow opposition to the Health and Social Care Bill is a mess of contradictions and confusions. This is an obvious example of a trend I observed in the Labour Party back in November – that they are in danger of becoming a “fast food” opposition, serving up the political equivalent of insubstantial “happy meals” that look good but don’t have much substance.
When Labour asked the government to listen, they scheduled hours of debate and accepted hundreds of amendments. The bill addresses the challenges of health inequalities and private provision, and above all brings in structural reform that maintains for the long-term the guiding principles of the NHS – the best possible treatment for patients, according to need and not ability to pay.
What more do they want? I am not sure that even they know!