The Health and Social Care Bill will be a case study for decades to come in how not to reform public services and how not to legislate. Students of modern government will start with the textbook Failure in British Government: Politics of the Poll Tax, before moving on to the design of railway privatisation and then to the coalition Government's attempt to reform the National Health Service.
The faults of the reform are well known. David Cameron promised before the election that "there will be no more of the tiresome, meddlesome, top-down restructures that have dominated the last decade of the NHS". This pledge was repeated in the coalition agreement with the Liberal Democrats after the election: "We will stop the top-down reorganisations of the NHS."
Andrew Lansley, the Secretary of State for Health, then suddenly announced that he would abolish primary care trusts and give the power to spend £60bn a year of the NHS budget to family doctors.
Mr Lansley said that he had been explaining the rationale for the plan for six years as opposition health spokesman, and that it was our fault that we had not noticed. But now that we had noticed, we still could not understand his explanation. Not least because it contradicted itself. The localism was to be imposed by central diktat. The bureaucracy – it became clear – was to be replaced by a new bureaucracy. Targets were to be replaced by benchmarks.
Mr Cameron realised a year ago that he had a problem. He had been paying attention when Mr Lansley explained it all to him, which was quite often. But it was like asking someone who works in the City what a hedge fund is. They explain; you nod; you think you understand; but five minutes later you realise that you have no idea. So Mr Cameron got George Osborne, his chief political adviser, to look at it for him. In February last year, the Chancellor leaned back in his chair and asked: "Does anybody else think this is a bad idea?"
They should have dropped the Bill then. But, instead, they decided to save it. Mr Cameron ordered a "pause", so that Mr Lansley could have another go at explaining it, and so that his Liberal Democrat coalition partners could devise some cosmetic amendments, which would make it look as if the Government had listened. The pause had the remarkable effect of making the doctors even more opposed to the Bill. The Liberal Democrat amendments made the Bill even more confused and contradictory. And the chief apologist for the whole sorry mess at the Liberal Democrat spring conference in Gateshead last weekend was Baroness Williams, whose status as guardian of her party's principles has now been Clare Shorted.
The Bill is now in injury time in the House of Lords. Tomorrow, peers have their last chance to stop it when they vote on a delaying amendment tabled by Lord Owen, Lady Williams's co-founder of the Social Democrats.
As we report today, a group of hundreds of doctors, representing thousands more, is launching a last attempt to persuade peers to drop the Bill. They intend to stand as candidates at the next election against Liberal Democrat and Conservative MPs on a Save the NHS platform. This is no mere revenge against the Liberal Democrats for betraying another policy for which the party purported to stand, but a serious attempt to persuade the party's peers to do the right thing tomorrow.
It is nearly too late for Nick Clegg to try to save some of his party's reputation. As John Rentoul writes, Clegg has led his party into a coalition government that has gone against fundamental Liberal Democrat principles on student finance and Europe in return for very little: a referendum on a change to the voting system that the party did not really want and the right to claim credit for raising the income tax threshold. This week's Budget will no doubt raise the threshold further, but that is a tax cut the Conservatives want too, and it would be no compensation for setting back much-needed reform of the health service.
We suspect that tomorrow's vote in the House of Lords has already been decided, but The Independent on Sunday wishes the campaign well. If the Bill passes, we hope that the doctors can, by targeting Liberal Democrats – and Conservatives too – in marginal seats, hold the NHS reforms to democratic account over the next three years. If the Government's botched changes damage the NHS, the MPs who supported it must pay the price.
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