Major surgery or cosmetic changes? The fight for the NHS

Lib Dems turning up pressure on Health Secretary's plans

The Liberal Democrats will demand five major changes to the Government's flagship health reforms as the price of securing their passage through Parliament.

Nick Clegg's party is threatening to join forces with Labour to dilute the NHS and Social Care Bill unless Andrew Lansley, the Health Secretary, agrees to make the changes sought by the Liberal Democrats' spring conference last month.

David Cameron and Mr Clegg will press Mr Lansley to implement at least some of the Liberal Democrat ideas. But the Health Secretary is digging in against major surgery. "He sees is it as a problem of communication," one Cabinet source said yesterday. "That is not how others see it."

At a joint event today, Mr Cameron, Mr Clegg and Mr Lansley will begin their campaign to reassure the public and health professionals over the plan to hand 60 per cent of the NHS budget to GPs, who will commission services themselves, instead of primary care trusts (PCTs). Behind the scenes, the three men face a tense debate on how far to water down the reforms, after Mr Lansley had to promise on Monday to "pause, listen and engage".

Liberal Democrat MPs and peers have agreed to press for changes which would have to ensure that:

* Private health companies do not exploit new rules on competition to "cherry-pick" profitable NHS services;

* Monitor, the new regulator which will set prices and boost competition, also promotes "equity and fairness" in access to health services;

* GP-led consortia meet in public, include other NHS professionals and have tougher rules to prevent conflicts of interests;

* Local councillors get a bigger role, possibly by sitting on expanded consortia boards;

* The pace of change is slowed, possibly by allowing flexibility over the April 2013 date for GPs to take on commissioning.

Yesterday Mr Clegg raised the stakes by going much further than Mr Lansley did on Monday. He told the Commons there would be "substantive changes" to the Bill and said there was nothing "doctrinaire" about the 2013 deadline. In a round of media interviews, Mr Clegg said it would have been "reckless" to press ahead with the reforms regardless of people's concerns. "I would never accept any scheme which could lead to privatisation of the NHS," he said.

Lib Dem MPs say they should not be whipped into supporting the Bill when it returns to the Commons in June as it was not included in the Coalition Agreement last May. They hope Mr Cameron will make enough concessions for them to support the measure. And Tory whips have warned the Prime Minister he will have to give ground to ensure approval by the Lords.

The Health Secretary may have other ideas. He has spent seven-and-a-half years in opposition and in government working up his proposals and is reluctant to tear them up.

How did they get so far without running into the trouble they are now in? Mainly because Mr Cameron trusted Mr Lansley, who became his boss as director of the Conservative Research Department when a fresh-faced Mr Cameron was in his first job.

There have been wobbles since Mr Lansley produced a a White Paper in July, seen by the Liberal Democrats as the biggest breach of the "no nasty surprises" rule they agreed when the Coalition was formed. The Coalition Agreement promised: "We will stop the top-down reorganisations of the NHS that have got in the way of patient care." Mr Lansley is now trying to implement what many experts regard as the biggest top-down reorganisation of the NHS since it was born in 1948.

Last autumn, Mr Cameron asked Oliver Letwin, whose title of Cabinet Office Minister vastly understates the crucial importance of his role as the Prime Minister's policy guru, to road-test the Lansley blueprint. It passed Mr Letwin's test. "Lansley can argue it through with anyone in the Cabinet room but he can't explain it to the public," complained one Downing Street insider. There was another wobble in the new year as more groups representing health professionals lined up against the reforms.

Mr Cameron, believing the problem was poor communication rather than a poor policy, resolved to join the mission to explain it. But his initiative fizzled out, partly because he was swamped by other pressures. "With hindsight, he should have kept that going for more than two weeks," an aide admits. Mr Cameron's dilemma now is how far to push Mr Lansley on concessions. It is too late to pull the plug on the reforms, as the Prime Minister did when he forced the Environment Secretary Caroline Spelman to drop plans to sell off England's public forests. Mr Lansley is warning there will be extra costs if the switch to GP-led commissioning is delayed.

But Mr Cameron knows his tireless work in defusing health as a negative issue – a key plank of his "detoxification" of the Tories – could be undone unless he allays fears over "back door privatisation". As Evan Harris, a former Lib Dem MP and GP who is advising the party in its negotiations, puts it: "The changes we want would be good for the NHS, good for the Lib Dems and good for the Conservatives. We are saving the Conservatives from retoxifying their brand."

PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
News
Bryan Cranston as Walter White, in the acclaimed series 'Breaking Bad'
news
News
Those who were encouraged to walk in a happy manner remembered less negative words
science
Sport
footballChelsea 6 Maribor 0: Blues warm up for Premier League showdown with stroll in Champions League
Arts and Entertainment
Princess Olga in 'You Can't Get the Staff'
tvReview: The anachronistic aristocrats, it seemed, were just happy to have some attention
Life and Style
tech

Board creates magnetic field to achieve lift

News
Renee Zellweger as Bridget Jones
i100
News
There have been various incidents of social media users inadvertently flouting the law
news

Life and Style
Stack ‘em high?: quantity doesn’t always trump quality, as Friends of the Earth can testify
techThe proliferation of online petitions allows us to register our protests at the touch of a button. But do they change anything?
News
Bourgogne wine maker Laboure-Roi vice president Thibault Garin (L) offers the company's 2013 Beaujolais Nouveau wine to the guest in the wine spa at the Hakone Yunessun spa resort facilities in Hakone town, Kanagawa prefecture, some 100-kilometre west of Tokyo
i100
Sport
CSKA Moscow celebrate after equalising with a late penalty
footballCSKA Moscow 2 Manchester City 2: Premier League champions let two goal lead slip in Russia
Environment
Sudan, the last male northern white rhino
environmentThe death of a white northern rhino in Kenya has left the species with a single male. These are the other species on the brink
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    IT Project Manager

    Competitive: Clearwater People Solutions Ltd: Our client based in Chelmsford a...

    Business Intelligence Specialist - work from home

    £40000 per annum: Ashdown Group: An established and growing IT Consultancy fir...

    Business Intelligence Specialist - work from home

    £40000 per annum: Ashdown Group: An established and growing IT Consultancy fir...

    IT Manager

    £40000 - £45000 per annum + pension, healthcare,25 days: Ashdown Group: An est...

    Day In a Page

    Indiana serial killer? Man arrested for murdering teenage prostitute confesses to six other murders - and police fear there could be many more

    A new American serial killer?

    Police fear man arrested for murder of teen prostitute could be responsible for killing spree dating back 20 years
    Sweetie, the fake 10-year-old girl designed to catch online predators, claims her first scalp

    Sting to trap paedophiles may not carry weight in UK courts

    Computer image of ‘Sweetie’ represented entrapment, experts say
    Fukushima nuclear crisis: Evacuees still stuck in cramped emergency housing three years on - and may never return home

    Return to Fukushima – a land they will never call home again

    Evacuees still stuck in cramped emergency housing three years on from nuclear disaster
    Online petitions: Sign here to change the world

    Want to change the world? Just sign here

    The proliferation of online petitions allows us to register our protests at the touch of a button. But do they change anything?
    Ed Sheeran hits back after being labelled too boring to headline festivals

    'You need me, I don’t need you'

    Ed Sheeran hits back after being labelled too boring to headline festivals
    How to Get Away with Murder: Shonda Rhimes reinvents the legal drama

    How to Get Away with Murder

    Shonda Rhimes reinvents the legal drama
    A cup of tea is every worker's right

    Hard to swallow

    Three hospitals in Leicester have banned their staff from drinking tea and coffee in public areas. Christopher Hirst explains why he thinks that a cuppa is every worker's right
    Which animals are nearly extinct?

    Which animals are nearly extinct?

    Conservationists in Kenya are in mourning after the death of a white northern rhino, which has left the species with a single male. These are the other species on the brink
    12 best children's shoes

    Perfect for leaf-kicking: 12 best children's shoes

    Find footwear perfect to keep kids' feet protected this autumn
    Anderlecht vs Arsenal: Gunners' ray of light Aaron Ramsey shines again

    Arsenal’s ray of light ready to shine again

    Aaron Ramsey’s injury record has prompted a club investigation. For now, the midfielder is just happy to be fit to face Anderlecht in the Champions League
    Comment: David Moyes' show of sensitivity thrown back in his face by former Manchester United manager Sir Alex Ferguson

    Moyes’ show of sensitivity thrown back in his face... by Ferguson

    Manchester United legend tramples on successor who resisted criticising his inheritance
    Two super-sized ships have cruised into British waters, but how big can these behemoths get?

    Super-sized ships: How big can they get?

    Two of the largest vessels in the world cruised into UK waters last week
    British doctors on brink of 'cure' for paralysis with spinal cord treatment

    British doctors on brink of cure for paralysis

    Sufferers can now be offered the possibility of cure thanks to a revolutionary implant of regenerative cells
    Let's talk about loss

    We need to talk about loss

    Secrecy and silence surround stillbirth