After a political fix with Nick Clegg, Cameron is denying MPs their constitutional role to scrutinise this waste-ridden legislation.
David Cameron and Nick Clegg meet nurses and doctors at Guys Hospital in London.
After a politically turbulent summer, coalition MPs might have been hoping for a quiet first week back in Westminster. But as Save the NHS protests and vigils are held across the country, the House of Commons begins two days of crucial debates on the hugely unpopular health and social care bill.
Despite the unprecedented pause and the NHS Future Forum's demolition job of the bill, the chorus of criticism has grown again as doctors, nurses, patient groups and health experts have digested the detail of the reorganised reorganisation and concluded that the government is failing to properly safeguard the NHS.
During and after the so-called listening exercise, David Cameron made much of his willingness to pause, listen and reflect. Nick Clegg, meanwhile, boasted of major concessions to the original plans – plans he himself had signed off last year. In reality, what happened in June was a political fix, more concerned with the future health of the coalition than the future of the NHS, and a fix that has acted as a smokescreen around the detail of the repackaged bill.
The changes to the bill have left it more complex, more costly and less likely to help the NHS change to meet the financial and service challenges it faces. Meanwhile, many essential elements of the long-term Tory agenda – to break up the NHS and set it up as full-scale market – remain in place and need further challenge.
The revised bill will mean more bureaucracy, more complexity, more cost and more waste. It creates at least five new national bodies to manage the NHS, centralising power into unelected bodies. Having promised to "abolish the bureaucracy", the government is trebling the number of statutory commissioning bodies from 163 to over 500.
The scale of change reflects the Tories' long-term plan to set up the NHS as a full-scale market and break up the NHS as a national public service, with patients seeing the services on which they depend subject to the lottery of where they live.
The government's response to the NHS Future Forum promised that the role of the secretary of state in providing the health service, established since 1946, would be restored. However the key wording of the founding act is still changed. Legal analysis commissioned by 38 Degrees confirms what Labour has argued: that the national duties of provision will be weakened and broken up.
Monitor, meanwhile, remains an economic regulator with the power to enforce competition law, fine hospitals 10% of their turnover, or direct commissioners to open up all services to competitive tender.
Far from getting on with real reform in the NHS, we have had a wasted year of chaos and confusion, which is set to drag on as the government forces through the biggest reorganisation in NHS history. £850m will be spent on redundancies, while 2% of PCTs' budgets, almost £2bn, is being held back from patient care to cover the costs and risks of the reorganisation.
All of this is taking place at a time when NHS finances are being squeezed and when all efforts should be dedicated to making sound efficiencies and improving services. It is high cost and high risk, and Labour continues to believe that many of the changes the NHS must make could largely be achieved without legislation and huge internal reorganisation.
Having done his political fix with Clegg, Cameron is now railroading his bill through parliament with a procedural fix. Limited time for debate and the lack of a new impact assessment means that MPs are being denied their constitutional role to properly scrutinise his plans for the NHS. They are being asked to judge the recommitted bill and over 1,100 amendments in rapid time and without the full facts at their disposal. By rushing the parliamentary process, David Cameron is forcing through bad legislation that will lead to more waste, cost and confusion in the NHS.