Cameron Is Railroading His NHS Bill Through Parliament

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.

Government To Investigate 'West Lothian Question'

Commission will look into long-running complaints about rights of MPs from parts of UK with their own parliaments or assemblies to vote on legislation affecting only England.












The commission will look into complaints about the rights of MPs from parts of the UK with their own parliaments or assemblies to vote on legislation at Westminster affecting only England.
Ministers are to set up an expert inquiry into limiting the voting rights of Scottish, Welsh and Northern Irish MPs at Westminster, the government has confirmed.

The commission into the so-called West Lothian question will look into long-running complaints about the continuing right of MPs from parts of the UK with their own parliaments or assemblies to vote on legislation affecting only England.

Mark Harper, a junior Cabinet Office minister, said the panel of "non-partisan" academic experts on the constitution, the law and parliament would investigate how England-only laws are handled by both the Commons and the Lords, now that there are devolved legislatures in Cardiff, Edinburgh and Belfast.

Backbench MPs in the main UK parties have stepped up their complaints about the anomaly at Westminster where Scottish, Welsh and Northern Irish MPs can still vote on issues such as health, policing and education issues when they are onlyrelevant to England.

Many non-English backbenchers, particularly nationalist MPs in the Scottish National party and Plaid Cymru, voluntarily often avoid votes on England-only legislation except on controversial measures or on bills which have a significant financial impact on their countries.

Michael Moore, the Scottish secretary, said: "We understand how exercised colleagues in England are but if there was a simple solution to this, it might have been found some years ago but we will endeavour to do this because it has been ignored for a very long time."

The West Lothian question was first posed by Tam Dalyell, then MP for West Lothian during a debate about devolution in 1977.

It is regarded as one of the most serious anomalies of devolution, with control over most major domestic policies in Scotland, Wales and Northern Ireland now solely in the hands of the devolved parliaments and assemblies.

Successive governments have played down its significance because they feared it would play into the hands of nationalist parties by weakening ties to the UK parliament, and diluting the influence of Scotland, Wales and Northern Ireland at Westminster. It could also accelerate pressure for a more federal structure for the UK.

Even so, the UK government promised to set up a commission on the West Lothian question as part of their coalition agreement in May last year, chiefly under pressure from the Tories. The government had been expecting to make a formal announcement on the commission's remit and membership after the October recess. It will publish the final details about its scope later this year.

UK ministers were forced into an early announcement on Thursday to block a private member's bill from the Tory backbencher Harriett Baldwin, the MP for West Worcestershire, which seeks to limit voting rights at Westminster, and has unexpectedly passed a series of hurdles in the Commons.

Baldwin's bill, which is not supported by the UK government, is due to complete its passage of the Commons on Friday and would then go to the Lords. It would require ministers to state on each bill whether it only affected England, to put non-English MPs under pressure not to vote on it.

Baldwin said she wanted to study Harper's statement before deciding whether she would drop the legislation (territorial extent) bill and allow the issue to be studied by the commission instead.

Harper said the commission would not study the financial impact of devolution because of existing work by Treasury ministers, nor would it question the number of MPs sitting in the Commons. This issue was already being addressed by existing proposals to cut the number of MPs.

"The government is clear that the commission's primary task should be to examine how this house and parliament as a whole can deal most effectively with business that affects England wholly or primarily, when at the same time similar matters in some or all of Scotland, Wales and Northern Ireland are lawfully and democratically the responsibility of the separate parliament or assemblies," Harper said.

Many English backbenchers across all the major parties have been critical of and irritated by the issue. As she unveiled her bill in February, Baldwin said the West Lothian question came from the "heart of middle England".

She told the Commons: "How can it be right for it to be possible for potentially decisive pieces of legislation to be voted on in this place by, and carried by a majority of, members of parliament who are not legislating on behalf of their own constituents? That is not a question that we can carry on parking in that car park for ever."

Tom Harris, the Labour MP for Glasgow South, said he disagreed fundamentally with limiting MPs' voting rights. He said the Conservatives had relied heavily on Northern Irish unionist votes at Westminster for 50 years, even while Northern Ireland had its own legislature.

It was right to do so, he said. "We're a UK parliament. MPs always have responsibilities outside their own constituencies and even outside their nations. MPs vote on issues affecting Libya, for example, and I don't have many Libyans in my constituency."

He said the ability of Scottish or Welsh or Northern Irish MPs to control or influence English policy was overstated. There were far more English MPs than those from other nations or areas: there are currently 533 English constituencies against 59 in Scotland, 40 in Wales and 18 in Northern Ireland.

The UK government's legislation to cut the total number of MPs to 600 for the next general election in 2015 will leave England with between 500 and 502 seats, depending on the size of the electorate in 2015, Scotland with 50 to 52, Wales with 30 and Northern Ireland with 16.

"My bottom line is this: Scotland got devolution because it is a small nation, and it's easily possible for every single Scottish MP to vote one way and be out-voted by a small fraction of English MPs, but Scottish MPs don't decide English issues. You would need every single non-English MP to vote in that direction."

Eddie Bone, chairman of the Campaign for an English Parliament, said the issue needed urgently to be addressed as discontent in England about the "imbalance" between Westminster and the devolved areas was increasing rapidly, particularly with the upsurge in support for the Scottish National party.

"If they don't deal with it soon, they will have missed the window of opportunity with the people of England to save the union," Bone said.

Elfyn Llwyd MP, Plaid Cymru's constitution spokesman, said it was time for a federal system: "The problem is that Westminster is trying to do two jobs. It is trying to act as both an England and a UK parliament.

"England deserves to have its own administration to deal with issues which affect England only. This would then ensure that there is a clear distinction between what is a matter for England and what is a matter for other countries too. The lines are too blurred as they are."

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.