Shirley Williams Plunges NHS Reforms Into Fresh Turmoil

Liberal Democrat peer in new battle over health and social care bill, while secret emails fuel privatisation fears for hospitals.












Baroness Williams has raised fresh doubts over the health and social care bill following the publication of secret emails.

The future of the government's health reforms has been plunged into fresh doubt as the Liberal Democrat peer Shirley Williams raises new concerns, and secret emails reveal plans to hand over the running of up to 20 hospitals to overseas companies. The revelations come as MPs prepare to return to Westminster on Tuesday for what promises to be a crucial stage of the flagship health and social care bill.

Baroness Williams, one of the original leaders of a Lib Dem rebellion against health secretary Andrew Lansley's plans – who appeared to have been pacified after changes were made over the summer – said she had new doubts, having re-examined the proposals. "Despite the great efforts made by Nick Clegg and Paul Burstow [the Lib Dem health minister], I still have huge concerns about the bill. The battle is far from over," she said.

Writing in Sunday's Observer, Williams raises a series of issues that she says must be addressed. Chief among them is a legal doubt as to whether the secretary of state will any longer be bound to deliver "a comprehensive health service for the people of England, free at the point of need".

Some critics of Lansley believe the Tories are bent on a mission to privatise the NHS, gradually handing it to the private sector. They fear that moves to end the legal obligation on the secretary of state to deliver comprehensive services may be a deliberate part of the process.

Concerns that ministers want more private involvement will be strengthened by details of email exchanges involving senior health officials about handing the management of 10 to 20 NHS hospitals to international private companies. The emails, which were made public following a freedom of information request and were obtained by non-profit-making investigations company Spinwatch, show that officials have been planning since late last year to bring in international companies. This is despite repeated insistences by both David Cameron and Nick Clegg that there will be no privatisation of the NHS. On 16 May, Cameron said: "Let me make clear: there will be no privatisation." Clegg said: "Yes to reform of the NHS, but no to the privatisation of the NHS."

One of the emails released by the department shows that officials at the private sector firm McKinsey, which advises ministers, were in active discussion about bringing in overseas firms to take over up to 20 hospitals in return for contracts running into hundreds of millions of pounds. An email to Ian Dalton, head of provider development at the Department of Health, who is heavily involved in the reform programme, in November last year talks about "interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints".

The emails show that McKinsey is acting as a broker between the department and "international players" that are bidding to run the NHS. The documents even lay out some of the conditions required by "international hospital provider groups" for running NHS hospitals. "International players can do an initiative if 500 million revenue [is] on the table." They also need to have "a free hand on staff management". The NHS would be allowed to "keep real estate and pensions".

The Department of Health attempted to play down the significance of the emails, saying they were referring to what might be done if any one hospital trust asked for the private sector to become involved in running a failing hospital. A spokesman said: "It is not unusual for the Department of Health to hold meetings with external organisations. Any decisions to involve organisations, such as the independent sector or foundation trusts, in running the management of NHS hospitals would be led by the NHS locally and in all cases NHS staff and assets would remain wholly owned by the NHS."

But a spokesman for the public service union Unison said: "Regardless of what Cameron and Clegg say in public, it is clear that behind the scenes the government is planning to privatise the NHS. Private companies will only run hospitals if they see a profit in it. This, together with lifting the cap off the number of private patients NHS hospitals can treat, will completely change the culture of the NHS. It will be profits before patients.

"We demand that the government come clean on their plans. If this is true, patient choice is a complete sham. The move to any qualified provider is clearly about creating a market for private companies. Any MP who votes for the health and social care bill is voting for the end of the NHS."

Williams also raises worries about the extent to which the role of the private sector is being expanded. "I am not against a private element in the NHS, which may bring innovatory ideas and good practice, provided it is within the framework of a public service …" she writes. "But why have they tried to get away from the NHS as a public service, among the most efficient, least expensive and fairest anywhere in the world? Why have they been bewitched by a flawed US system that is unable to provide a universal service and is very expensive indeed?"

She adds: "The remarkable vision of the 1945 Attlee government, of a public service free at the point of need for all the people of England, should not be allowed to die."

John Healey, Labour's shadow health secretary, said: "As David Cameron's government railroads the health bill through parliament, MPs are being denied their constitutional role to properly scrutinise his plans for the NHS. The prime minister has already done a political fix with Nick Clegg on the health bill, and now he's trying to force it through with a procedural fix."

Clegg Calls For 'Probing Questions' On NHS Bill

Clegg's demands over NHS may spark Lords amendments – as Lib Dem grassroots say bill will hurt patients and party.












A demonstrator protests at Tory-Lib Dem moves to reform the NHS.

The Tories and Liberal Democrats are facing a fresh clash over the government's NHS reforms after Nick Clegg encouraged his MPs to put "probing questions" to ministers when the bill returns to the Commons on Tuesday.

In a two-hour meeting with his parliamentary party on Monday night, the deputy prime minister held out the possibility that he will accept amendments to the heath and social care bill when it moves to the House of Lords later this month.

Clegg's move means that Lady Williams could be backed by Liberal Democrat ministers if she attempts to amend the bill to guarantee that the health secretary has a legal duty to deliver a comprehensive health service free at the point of need.

But a source at the Department of Health indicated last night that Andrew Lansley, the health secretary – who has already amended the bill after the government's "listening exercise" – would not accept fresh amendments on this point.

The source said: "Our view is that the legislation is watertight on the secretary of state's obligation to ensure there is an NHS available to all. That was always our view. But we amended the legislation to reassure those who were not sure."

Clegg said earlier in the day that he accepted the view that there was no need for fresh amendments on this issue.

In a speech on schools in south-west London, he said: "Let me be absolutely clear. There is nothing, nothing, nothing in any of the government's plans which in anyway threaten the basic founding principles of the NHS...There is no question, legally or politically, of the secretary of state under these new arrangements being somehow able to wash his or her hands of the NHS."

But at Monday night's meeting of the Lib Dem parliamentary party, Clegg admitted that ministers still had to work hard to clarify the bill for MPs and peers with concerns.

Paul Burstow, the Lib Dem health minister, is to offer further briefings to MPs and peers who will also be invited to meet officials at the department of health.

All sides accept that it is too late to table further amendments on the NHS reforms when the bill is debated by MPs at report stage on Tuesday and Wednesday and at third reading on Wednesday . But Lib Dem MPs have been encouraged to put "probing questions" to ministers for possible amendments that will be tabled in the House of Lords.

One Lib Dem source said: "We hope that we will not need to amend the bill further. But we may have to." Another Lib Dem source said: "There will be robust interventions in the debate."

Lib Dem whips believe that the overwhelming number of MPs will support the amended bill. But Andrew George, the Lib Dem MP for St Ives, said he would rebel.

The battle within the Lib Dem ranks was exposed last night in leaked emails, in which grassroots members of the party vented their anger at the leadership.

Jeremy Sanders of Huddersfield Liberal Democrats wrote in an email to John Pugh this week, the Lib Dem backbench health committee chairman, that "yes, we can try to get improvements to the details, but none of these changes are going to alter the basic fact that the legislation is based on the assumption that what the NHS needs is a system based on private sector involvement, free market competition and internal markets.

"Quite honestly, if our MPs are willing to go along with this, what exactly won't they be willing to support?"

In the same batch of emails obtained by the Guardian, Robert Hutchison, a Lib Dem councillor in Winchester, tells Pugh that "in my view is that if Lib Dem MPs vote for the bill this week — without further major amendments — it will damage the NHS and damage the party".

Charles West, one of the key party activists on the NHS, has written to party members to back an appeal against the the Lb Dem's conference committee decision not to debate the health bill at the forthcoming party conference. "I have therefore written a letter of appeal to the Federal Conference Committee against their narrow decision not to take the motion that I and over 100 conference reps submitted in June, and in case that appeal fails we are submitting an emergency motion which will achieve the same ends".

Last month Andrew George, the Lib Dem rebel on the health bill, emailed Lib Dem activists with a blunt message: "of course I'll try to influence colleagues but some are still basking in the synthetic afterglow of the post-pause Bill revision, perhaps having duped themselves that it's 'job done'! People need to wake up to the fact that we can say what we like at Conference, but the MPs main chance to influence would already have passed!"

Labour twisted the knife into the Lib Dems with the party's health spokesman John Healey arguing that Nick Clegg's claim that he had met 11 out of the 13 changes demanded by his party's spring conference resolution was "wrojng". "He's failed on seven and sallen short on six". Baroness Thornton, the party's spokesperson in the Lords, warned that the lack of scrutiny in the Commons — where 1,000 amenments mean just 40s of parliamentary to consider each one — could see the bill be put into a specialist committee to examine whether there is enough time to debate the bill.

Writing in the Guardian, Tory MP Sarah Wollaston, a former GP who had criticised the health bill, says now is the time to back the coalition's plans as "the structural changes to the NHS have passed the point of no return".

She argues instead that the bill needs to be amended to ensure that the choice of who is appointed to sit on and run the new NHS National Commissioning Board, a quango with £60bn to spend, is fairly and openly discussed.