So where are we with the Health and Social Care Bill?

Last month Dr Phil Hammond wrote in his Private Eye column:

When MD asked health secretary Andrew Lansley to reduce his unintelligible 358 page health bill to 140 characters or less, he wrote: "Putting patients and their doctors and nurses in charge, accountable for the results they achieve."

Put like that, it sounds rather attractive to a Liberal, so how has the government got itself into such a mess over this bill?

The first reason is that is has stirred up an issue that is inherently difficult for the Tories. Fairly or not, voters tend to see Labour as the party of the NHS, so the conventional wisdom holds that the best the Tories can do with health is to defuse it as an issue. And that David Cameron did very effectively as leader of the opposition. The Tories needed to be very sure of their ground if they were going to stir things up again on health.

The second reason is that, though Lansley has held the health brief for his party for years and has obviously put a lot of thought into his proposals, he has failed to communicate what he hope to achieve through them even to his closest colleagues. The tweet he suggests in the quotation above is a single shining exception.

And the third reason is that the government has tried to bring in these changes all at once. This is the mistake Caroline Spelman made with her plans to sell off or make over state-owned woodland to private sector, community and charitable groups. If she had started with one or two pilot schemes involving respected bodies like the National Trust of local wildlife trusts, these plans might well have proved popular. Certainly, the opposition to Spelman ignored the fact that most woodland has always been privately owned and never showed that this was worse run or less available to the public than that in the public sector. But proposed all at once, these moves provided opposition and pressure groups with too lumbering a target.

This is the point Simon Carr made about Michael Gove and free schools in a rather sugary profile in the Independent:

The introduction of free schools has been properly Burkean. They've started slowly with 30-odd in the first year or so, and seem to be popular enough for another 70 to be up and running by the end of this year. Good or bad, they aren't destroying public education, as their enemies claim – not yet and not unless all schools become free schools.

If you read the whole thing, do bear in mind that Burke was a Whig and not a Tory as Carr imagines.

So where does the bill go from here and what should the Liberal Democrats do about it?

David Cameron has shown himself ruthless in dropping people who threaten him and his touch-feely Conservative brand. It may well be that Lansley is on the way out and his bill with him. If it is not withdrawn then Lib Dems must continue to try to amend it. In particular, the the duty of the Secretary of State for Health to provide services needs to be retained.

But the trouble is that we have spent months campaigning for the status quo when we like to think of ourselves as a radical party. And there has been a great deal of enthusiasm expressed for central planning when in other areas of policy, notably the economy, we have rather weaned ourselves off our faith in it.

We need a policy on health that goes beyond this. One obvious direction to explore is local democracy in the NHS. Experimentation is fine when it allows clinicians to develop new services, but people need to have some means for doing something about it when they see that they are not getting those services in their own area.

As Paul Burstow wrote on Lib Dem Voice last year:

In 2002, conference debated Chris Huhne’s report into Public Services Quality, Innovation, Choice, which amongst other things recommended making the NHS more responsive to patients needs and choice by ensuring that decisions are made locally in response to local needs and preferences.

And, interestingly, he went on to claim:

Largely unnoticed the Health and Social Care Bill delivers on these recommendations by radically altering the relationship between the NHS and local government by ensuring that in the future Councils will be responsible for taking a lead in shaping local health services through Health and Wellbeing Boards.

Lansley and his bill may well fall, but the need for Liberal reform of health services will remain.