Nick Clegg issued a stark warning yesterday that the Liberal Democrats will not back Andrew Lansley's controversial health shake-up without "substantial changes" to stamp out the threat of NHS privatisation.
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In the clearest sign yet of a major coalition schism over the reforms, Mr Clegg set out five key demands which he insists are "non-negotiable". They include blocking attempts by big business to "cherry-pick" services, giving doctors and nurses a greater say in contracting care, and delaying the handover of £60bn of health spending to groups of GPs beyond the planned 2013 deadline.
With the Lib Dems' poll ratings dropping three points to 10 per cent in the latest Independent on Sunday/ComRes survey, Mr Clegg needs to prove his party is able to influence coalition policy ahead of elections on 5 May. The poll also reveals 41 per cent of people believe the Lib Dems should leave the coalition if they fail to secure changes on the health reforms.
The Deputy Prime Minister wrote to all 56 Lib Dem MPs in an attempt to counter claims that the Government's decision to "pause" the progress of the Health and Social Care Bill was simply a PR stunt.
In the letter, Mr Clegg stresses: "There will never be privatisation of the health service on our watch." He said the Lib Dems "must remain supporters of the need for reform of the NHS", including more involvement of local people in how services are run. "We are seeking evolution not revolution... but I also... should be clear about some of the areas that I think are non-negotiable during the Government's listening exercise."
Mr Clegg's letter sets out five red lines: competition should be driven by quality, not price; family doctors should not commission services alone; GP consortia must not go ahead in 2013 if they are not ready; the principles of the NHS constitution must be protected; and GPs must work "hand in glove" with councils. At the Lib Dem conference last month, delegates demanded 23 changes.
Mr Lansley apologised last week for failing to communicate his radical overhaul of the way care is provided after the Royal College of Nurses passed a vote of no confidence in him. Alan Johnson, Labour's former health secretary, uses an article in the IoS today to launch an attack on Mr Lansley, claiming the Health Secretary is "a technocrat... smug in his self-belief, hawking a half-baked blueprint".
The 141 Primary Care Trusts in England are to be abolished, with the role of contracting health services handed to GP consortia. But concerns have been raised by health professionals and patient groups, as well as the Lib Dems who fear decisions will be taken behind closed doors. Lib Dem MP Andrew George, a member of the Health Select Committee, demanded Mr Lansley "bin his reforms".
Tension is also mounting about who is in charge of rescuing the policy. In particular, there is unease among Tory MPs about the efforts of Craig Oliver and Andrew Cooper, who arrived in No 10 last month to head communications and strategy. "This was supposed to be the big fightback test for the whizz kids, but so far they seem to have made things worse," said one senior backbencher.
On Tuesday, Mr Lansley will be joined by David Cameron at the latest listening exercise in Downing Street. Hospital chiefs are expected to raise concerns that as many as 22 trusts are crippled by multimillion-pound private finance deals which could prevent them becoming foundation trusts as planned by 2014. On Wednesday, the NHS Future Forum is due to begin drawing up a report proposing substantial changes to the Health and Social Care Bill. However, there have been complaints that no public health expert is included on the panel.
Meanwhile, Labour claimed the "pause" ordered on the progress of the Bill was a "complete sham" after leaked emails revealed long-planned public events were being "rebadged as listening exercises". John Healey, Labour's health spokesman, said: "David Cameron hasn't been straight on the NHS from the start. He didn't tell people his plans before the election, and won't talk now about the far-reaching changes that will turn the health service into a free market."