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."

Barn owls are among species that could be affected
charity appeal
Sarah Silverman (middle) with sister Reform Rabbi Susan Silverman (right) and sister actress Laura Silverman (left) at Jerusalem's Western Wall for feminist Hanuka candle-lighting ceremony
peopleControversial comedian stages pro-equality Hanukkah lighting during a protest at Jerusalem's Wailing Wall
Arts and Entertainment
The Bach Choir has been crowned the inaugural winner of Sky Arts’ show The Great Culture Quiz
arts + ents140-year-old choir declared winner of Sky Arts' 'The Great Culture Quiz'
After another poor series in Sri Lanka, Alastair Cook claimed all players go through a lean period
cricketEoin Morgan reportedly to take over ODI captaincy
Life and Style
ebookNow available in paperback
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

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

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Finance Director

    £65000 - £80000 per annum: Recruitment Genius: Finance Director required to jo...

    Recruitment Genius: Medico-Legal Assistant

    £15000 - £25000 per annum: Recruitment Genius: This is a unique opportunity fo...

    Ashdown Group: (PHP / Python) - Global Media firm

    £50000 per annum + 26 days holiday,pension: Ashdown Group: A highly successful...

    The Jenrick Group: Quality Inspector

    £27000 per annum + pension + holidays: The Jenrick Group: A Quality Technician...

    Day In a Page

    Homeless Veterans appeal: 'You look for someone who's an inspiration and try to be like them'

    Homeless Veterans appeal

    In 2010, Sgt Gary Jamieson stepped on an IED in Afghanistan and lost his legs and an arm. He reveals what, and who, helped him to make a remarkable recovery
    Could cannabis oil reverse the effects of cancer?

    Could cannabis oil reverse effects of cancer?

    As a film following six patients receiving the controversial treatment is released, Kate Hilpern uncovers a very slippery issue
    The Interview movie review: You can't see Seth Rogen and James Franco's Kim Jong Un assassination film, but you can read about it here

    The Interview movie review

    You can't see Seth Rogen and James Franco's Kim Jong Un assassination film, but you can read about it here
    Serial mania has propelled podcasts into the cultural mainstream

    How podcasts became mainstream

    People have consumed gripping armchair investigation Serial with a relish typically reserved for box-set binges
    Jesus Christ has become an unlikely pin-up for hipster marketing companies

    Jesus Christ has become an unlikely pin-up

    Kevin Lee Light, aka "Jesus", is the newest client of creative agency Mother while rival agency Anomaly has launched Sexy Jesus, depicting the Messiah in a series of Athena-style poses
    Rosetta space mission voted most important scientific breakthrough of 2014

    A memorable year for science – if not for mice

    The most important scientific breakthroughs of 2014
    Christmas cocktails to make you merry: From eggnog to Brown Betty and Rum Bumpo

    Christmas cocktails to make you merry

    Mulled wine is an essential seasonal treat. But now drinkers are rediscovering other traditional festive tipples. Angela Clutton raises a glass to Christmas cocktails
    5 best activity trackers

    Fitness technology: 5 best activity trackers

    Up the ante in your regimen and change the habits of a lifetime with this wearable tech
    Paul Scholes column: It's a little-known fact, but I have played one of the seven dwarves

    Paul Scholes column

    It's a little-known fact, but I have played one of the seven dwarves
    Fifa's travelling circus once again steals limelight from real stars

    Fifa's travelling circus once again steals limelight from real stars

    Club World Cup kicked into the long grass by the continued farce surrounding Blatter, Garcia, Russia and Qatar
    Frank Warren column: 2014 – boxing is back and winning new fans

    Frank Warren: Boxing is back and winning new fans

    2014 proves it's now one of sport's biggest hitters again
    Jeb Bush vs Hillary Clinton: The power dynamics of the two first families

    Jeb Bush vs Hillary Clinton

    Karen Tumulty explores the power dynamics of the two first families
    Stockholm is rivalling Silicon Valley with a hotbed of technology start-ups

    Stockholm is rivalling Silicon Valley

    The Swedish capital is home to two of the most popular video games in the world, as well as thousands of technology start-ups worth hundreds of millions of pounds – and it's all happened since 2009
    Did Japanese workers really get their symbols mixed up and display Santa on a crucifix?

    Crucified Santa: Urban myth refuses to die

    The story goes that Japanese store workers created a life-size effigy of a smiling "Father Kurisumasu" attached to a facsimile of Our Lord's final instrument of torture
    Jennifer Saunders and Kate Moss join David Walliams on set for TV adaptation of The Boy in the Dress

    The Boy in the Dress: On set with the stars

    Walliams' story about a boy who goes to school in a dress will be shown this Christmas