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The Tory pitch on the NHS is based on two innocent misrepresentations. They’re huge – like the debt.
A perfect way to annoy nurses is to promise a tax cut for people with the highest incomes ahead of a release from the pay freeze most nurses have endured for the last few years.
I’ve noticed a curious phenomenon when I retweet articles on Twitter. It is not a secret that I am ‘left wing’, whatever that means to the intelligentsia of North London. If I retweet an article from the perspective of how awful this Government, by a left wing ‘seleb’, it won’t be uncommon for people to think ‘nothing to see here, please move on’ . But, if I share something by Fraser Nelson or Isabel Hardman, all hell breaks lose.
Take, for example, the article by Nelson criticising the burgeoning debt burden, published in that well known leftie rag, “The Spectator”. It’s a refreshing honest piece of journalism entitled, “Osborne increases debt more than Labour did over 13 years“. I suspect both Ed Miliband and David Cameron were more prepared for the scenario if Scotland had voted ‘yes’ to independence. Most people I know felt that the story of Ed Miliband’s walk in the park was totally underwhelming. David Cameron, in an outbreak of honesty, meanwhile, let slip that he “resented” the poor. This, for me, represents a clear example the “don’t think of elephants” phenomenon. The harder you try not to think of something, you think of it.
Once, at the Labour Conference held in Liverpool (2011), I asked Jim Naughtie about this famous episode.
Both Naughtie and I burst out laughing. Jim Naughtie is of course not the first person to have dropped a massive clanger. Everyone, including Andrew Neil and Nick Robinson, knows that the pitch by the Tories on tax cuts, when the deficit is being given a second chance to resolve itself, this time by 2018, is a total farce.
I had barely got over the admission that Cameron resented the poor when this suddenly happened.
This is a colossal lie, as Sir Andrew Dilnot CBE, Chair of the UK Statistics Authority, has explained to Chris Leslie MP, the Shadow Chief Secretary to the Treasury, in his letter. The critical paragraph of that letter is this.
Even a PPE graduate from Oxford can begin to get the gist from this graph helpfully provided by Dilnot.
Similarly, because of inflationary pressures – including increasing service demands – on the NHS budget, it is difficult to argue that in real terms there has been an increase in funding of the NHS. That one is also colossal lie, as Sir Andrew Dilnot CBE, Chair of the UK Statistics Authority, has explained to Jeremy Hunt MP, Secretary of State for Health, in his letter here. The critical paragraph of that letter is this.
The Conservative pitch logic is as follows: (1) the Tories are trusted on the economy, (2) Labour is trusted on the NHS, (3) Discredit Labour by repeatedly talking about Mid Staffs despite clearly enduring problems in the lifetime of this period of office, (4) Promise tax cuts in 2018 and ‘more for less’ (by citing examples such as falling crime despite budget cuts). But this logic is based on a surfeit of lies and half truths.
It is a curious phenomenon that crime statistics keep on falling across a number of jurisdictions, fitting very nicely with the argument by libertarians for a smaller state. Furthermore, NHS England has reported on poor recent performance, following the time of the Mid Staffs disaster, in the “Keogh Trusts” during the lifetime of this period of a Conservative-led government. Andy Burnham MP does not repeatedly bring up the example of Harold Shipman, a colossal failure of regulation of general practice which happened instead under the lifetime of a previous Conservative government. It’s been repeatedly reported that Labour ‘do not appear to want to be in power despite being on the brink of power’. But, by that token, the Conservatives are behaving as if they realistically do not expect to be the largest party next May, either. The Conservatives-led Government decided not to take up a golden opportunity of regulating clinical professions, handed on a plate by the English Law Commission, in the last Queen’s Speech of this term. The General Medical Council even signalled their disapproval of this. And, as alluded to above, the debt is exploding while NHS demand continues to increase, leaving a ‘funding gap’ which has been brilliantly discussed by ‘The Health Foundation’. Once again, the patriotic Conservative Party have stuck two fingers up at the best interests of the country by currying favour with their high income (and wealthy) backers, instead. The “jam tomorrow” argument from the Conservatives could be fatal to a frank discussion of the need to integrate health and care from the next Government, whoever it is. But, as my late father often used to remind me, “one lie leads to another”.
Time to turn to the “Black Eyed Peas” for inspiration perhaps.
Sorry, sorry, sorry, sorry
Hey, baby my nose is getting big
I noticed it be growing when I been telling them fibs
Now you say your trust’s getting weaker
Probably coz my lies just started getting deeper
And the reason for my confession is that I learn my lesson.
Time for a new regeneration. The New Secretary of State for Dementia.
Ed Miliband looks a bit awkward eating a bacon sarnie, or simply looks a bit “weird”. This man doesn’t look like your next Prime Minister?
But switch back into the reality. A cosmetic reshuffle where the present Coalition had to ditch a Secretary of State more toxic than nuclear waste from Sellafield to transport in a catwalk of tokenistic young hopefuls, “governing for a modern Britain”.
And engage a bit with my reality: where English law centres have been decimated, nobody is feeling particularly “better off” due to the cost of living crisis, GPs have been pilloried for being “coasters”, criminal barristers have gone on strike, or you can’t get your passport on time.
Whisper it quietly, and nobody wants to admit it, that despite all the concerns that Labour will front another set of middle-class neoliberal policies, Labour is in fact going to walk it on May 8th 2015 as the new UK government.
This will obviously be quite a shock to the system, and you can already feel the Civil Service behind the scenes mentally preparing themselves for a change in flavour for the dementia policy.
The current dementia policy had “Nudge” fingerprints all over it. “Customer facing” corporates could become dementia friendly so as to allow market forces to gain competitive advantage for being ‘friendly’ to customers living with dementia.
The Alzheimer’s Society got thrust into the limelight with the Prime Minister’s Dementia Challenge, ably supported by Alzheimer Research UK, to offer the perfect package for raising awareness about dementia and offering hope for treatment through basic research. This private-public partnership was set up for optimal rent seeking behaviour, with the pill sugared with the trite and pathetic slogan, “care for today, and cure for tomorrow.”
Except the problem was that they were unable to become critical lobbying organisations against this Government, as social care cuts hit and dementia care went down the pan. Dementia UK hardly got a change to get a look in, and it looked as if a policy of specialist nurses (such as Admiral nurses) would get consigned to history. They are, after all, not mentioned in the most recent All Party Parliamentary Group report on dementia.
It is widely expected that Labour’s NHS policy will be strongly frontloaded with a promise of equality, which the last Labour government only just managed to get to the statute books. Insiders reckon that this policy will be frontloaded with an election pledge with equality as a strong theme.
In the last few years, it has become recognised that caregivers feel totally unsupported, people get taken from pillar to post in a fragmented, disorganised system for dementia with no overall coordinator, and there are vast chasms between the NHS and social care treatment of dementia.
The next Government therefore is well known to be getting ready for ‘whole person care’, and it now seems likely that the new Secretary of State for Health and Care under a new government will have to deliver this under existing structures. This will clearly require local authorities and national organisations to work to nationally acceptable outcomes for health and wellbeing through empowered Health and Wellbeing Boards. This will help to mitigate against the rather piecemeal patchwork for commissioning of dementia where contracts tend to be given out to your friends rather than the quality of work. Health and Wellbeing Boards are best placed to understand wellbeing as an outcome (which can become missed in research strategies of large corporate-like charities which focus on care, cure and prevention).
And the switch in emphasis from aspirational friendly to a legal equality footing is highly significant. The new policy for dementia under the new Secretary of State will be delivering what people living with dementia have long sought: not “extra favours”, but just to be able to given equal chances as others. Environments will have signage as reasonable adjustments for the cognitive disabilities of people living with dementia in the community under the force of law, rather than leaving up to the whim of a corporate to think about with with the guidance of a fundraising-centred charity to implement.
With the end of the Prime Minister’s Dementia Challenge in March 2015, which has been highly successful in places in delivering ‘dementia friendly communities’, a commitment to improved diagnosis rates and improved research, it is hoped that the next government will be able to take the baton without any problems. It will be quite a public ‘regeneration’ from Hunt to Burnham, but one which many people are looking forward to.
How is parliamentary procedure being followed to take the previous statutory instrument on NHS procurement out-of-action?
A Statutory Instrument is used when an Act of Parliament passed after 1947 confers a power to make, confirm or approve delegated legislation on: the Queen and states that it is to be exercisable by Order in Council; or a Minister of the Crown and states that it is to be exercisable by Statutory Instrument. 1.15 pm last Tuesday (5 March 2013) saw Andy Burnham MP, the Shadow Secretary of State for Health, go head-to-head with Norman Lamb (The Minister of State, Department of Health). Lamb was invited to comment on the regulations on procurement, patient choice and competition under section 75 of the Health and Social Care Act 2012.
The discussion is reported in Hansard.
Lamb describes an intention to ‘amend’ the legislation
Lamb explains:
“Concerns have been raised that Monitor would use the regulations to force commissioners to tender competitively. However, I recognise that the wording of the regulations has created uncertainty, so we will amend them to put this beyond doubt.”
The problem is that this statutory instrument would have become law automatically on 1 April 2013, and still promises to do so in the absence of anything else happening. The safest way to get this statutory instrument out-of-action is to ‘annul’ the law, rather than having the statutory instrument still in force but awaiting amendment. Experts are uncertain the extent to which statutory instruments can be so easily amended, while in force.
Most Statutory Instruments (SIs) are subject to one of two forms of control by Parliament, depending on what is specified in the parent Act.
Fatal motion
There is a constitutional convention that the House of Lords does not vote against delegated legislation. However, Andy Burnham has said the exceptional nature of the Section 75 regulations, which force all NHS services out to tender, meant he needed to table a ‘fatal’ motion in the second Chamber. Indeed, Lord Hunt later tweeted that this fatal chamber had forced a rethink on the original Regulations:
The main effect of delegated legislation being made by Statutory Instrument is that it is effective as soon as it is made, numbered, catalogued, printed, made available for sale, and published on the internet. This ensures that the public has easy access to the new laws. This statutory instrument (SI 2013/057:The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013) is still available in its original form, with no declaration of its imminent amendment or annulment, on the official legislation website here.
The “Prayer”
The more common form of control is the ‘negative resolution procedure’. This requires that either the Instrument is laid before Parliament in draft, and can be made once 40 days (excluding any time during which Parliament is dissolved or prorogued, or during which both Houses are adjourned for more than four days) have passed unless either House passes a resolution disapproving it, or the Instrument is laid before Parliament after it is made (but before it comes into force), but will be revoked if either House passes a resolution annulling it within 40 days.
A motion to annul a Statutory Instrument is known as a ‘prayer’ and uses the following wording:
- That an humble address be presented to Her Majesty praying that the [name of Statutory Instrument] be annulled.
Any member of either House can put down a motion that an Instrument should be annulled, although in the Commons unless the motion is signed by a large number of Members, or is moved by the official Opposition, it is unlikely to be debated, and in the Lords they are seldom actually voted upon.
Indeed, this is exactly what happened. Ed Miliband submitted EDM 1104 on 26 February 2013, which currently – at the time of writing – has 183 signatures – with the exact wording:
“That an humble Address be presented to Her Majesty, praying that the National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 (S.I., 2013, No. 257), dated 11 February 2013, a copy of which was laid before this House on 13 February, be annulled.”
The purpose of “amending” the legislation
Lamb later provides in his answer:
“Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improve services for patients—not an end in itself. What is important is what is in patients’ best interests. Where there is co-operation and integration, there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make that point absolutely clear.”
How the Government “amends” the legislation is clearly pivotal here. Integration is another “buzzword” in the privatisation ammunition. Colin Leys wrote in 2011:
“In the emerging vision of the Department of Health, however, integrated care has always been associated with the drive to enlarge private sector provision, and the Kaiser [Permanente] connection emphasised this. The competitive culture attached to integrated care in the Kaiser model, coupled with the keen interest of private providers in all integrated care initiatives, were constants, and put their stamp on official thinking about the future NHS market.”
A possible reason for why this emphasis on competition has failed is that in other markets, such as utilities, rail and telecoms, there is a strong case that competition has not driven down cost at all, because of shareholder dividend primacy. Another good reason for people in favour of the private market to discourage competition is that competition might even inhibit a drive to integration, and integration is strongly promoted by private providers (and, incidentally, New Labour).
What does the Act itself say about ‘annulling’ statutory instruments?
According to s. 304(3), “Subject to subsections (4) to (6), a statutory instrument containing regulations under this Act, or an order by the Secretary of State or the Privy Council under this Act, is subject to annulment in pursuance of a resolution of either House of Parliament.” So, at the moment, we are clearly in limbo, with parliament yet to pass a EDM, and new redrafted Regulations yet to appear. However, it is still a very dangerous situation, as the original set of Regulations is still yet to be enacted on 1 April 2013.
