Saturday, March 12, 2011

Liberal Democrats stand up and are counted with Shirley Williams and Evan Harris on NHS #ldconf

I've written many times about how Shirley Williams is my political hero. In fact, we probably don't need the political in there. I have so much respect for the contribution she's made not just in this country, but internationally.  

I still have going round in my head a speech she made nearly 30 years ago, where she talked about how, sometimes, in order to advance your beliefs, you have to scale unscaleable heights. That was in the context of putting herself forward as Alliance candidate for the Crosby by-election. It's so true, and although I'm not anywhere near as good a mountaineer as Shirley, that philosophy has never left me.

Over six decades, Shirley has helped shape our nation's future. And she hasn't stopped yet. Today, in the debate on the NHS at Party Conference, she argued passionately against the worst of planned Coalition reforms.

Twitter was full of the persuasiveness and excellence of her speech was was extremely well received in the hall. I'm not at Conference, and I am, frankly, disgusted at the lack of coverage. I asked on Twitter if there were copies of her speech available. Chris Mills was sitting near her, so he went and asked for. Apparently there is no copy, because it was delivered off the cuff, from a few notes. She let him take photos of her notes on the understanding that they would be published and he very kindly sent them to Spidey and I so we could share them too.

He didn't have to do that - he could have just kept them to himself and published them when he got home so I really appreciate that. I'm also very grateful to Shirley for sharing something so personal. They show how clearly her mind works. My notes would have scribblings out everywhere and would be a complete and utter mess, and I would never be able to transform them into a coherent speech.

Here they are:

Her main points were concerns about the lack of accountability of the new GP consortia and the fact that the private sector would cherry pick the most profitable work and would have no interest in treating patients in the most need. Her speech was greeted with rapturous applause. I admire the way she's opposed Coalition policy on this in such a constructive way. She's made it clear that she supports the Coalition and respects the work of our ministers, but that this NHS re-organisation was not mentioned in the Coalition Agreement and our Parliamentarians should not consider themselves bound to support it. Sounds fair enough to me.

The amended motion passed, which I will reproduce below with all the amendments in the right place, unlike the Lib Dem website which has them all published separately, calls on Liberal Democrats in Parliament - Lords and Commons, to make a stack of amendments which would improve the Health Bill and protect patients from the greatest risks of private sector involvement. 

The movers of the motion knew that they had no chance of winning the vote and decided, sensibly, to go for the conciliatory approach and accept both amendments. The proof of the pudding, of course, is yet to come. Conference is in no mood to see this motion quietly filed away and forgotten about and will be expecting our ministers to take clear and measurable action to improve this bill. They will not get away with anything less and we will expect the Federal Executive and Policy Committees to proactively make sure that Conference's wishes are carried out.

Here is the motion in full:

Conference believes that the NHS is an integral part of a liberal society, reflecting the social solidarity of shared access to collective healthcare, and
a shared responsibility to use resources effectively to deliver better health.

Conference welcomes much of our Coalition Government's commitment to the founding principles of the NHS: available to all, free at the point of use, and based on need, not the ability to pay.

Conference welcomes the vision for the NHS set out in the Government's White Paper, Equity and Excellence: Liberating the NHS, which commits the Government to an NHS that:

i) Is genuinely centred on patients and carers.

ii) Achieves quality and outcomes that are among the best in the world.

iii) Refuses to tolerate unsafe and substandard care.

iv) Puts clinicians in the driving seat and sets hospitals and providers free to innovate, with stronger incentives to adopt best practice.

v) Is more transparent, with clearer accountabilities for quality and results.

vi) Is more efficient and dynamic, with a radically smaller national, regional and local bureaucracy.

vii) Gives citizens a greater say in how the NHS is run.

Conference particularly welcomes the proposals to introduce real democratic legitimacy and local accountability into the NHS for the first time in almost forty years by:

a) Extending the powers of local authorities to enable effective scrutiny of any provider of any taxpayer-funded health services.

b) Giving local authorities the role of leading on improving the strategic coordination of commissioning across the NHS, social care, and related childrens' and public health services through councillor-led Health and Wellbeing Boards.

c) Creating Health Watch to act as a local consumer champion for patients and to ensure that local patients are heard on a national level.

d) Returning public health duty to local government by ensuring that the majority of public health services will now be commissioned by local authorities from their ring-fenced public health budget.
Conference recognises however that all of the above policies and aspirations can be achieved
without adopting the damaging and unjustified market-based approach that is proposed.
Conference regrets that some of the proposed reforms have never been Liberal Democrat policy,
did not feature in our manifesto or in the agreed Coalition Programme, which instead called for an
end to large-scale top-down reorganisations.
Conference therefore calls on Liberal Democrats in Parliament to amend the Health Bill to provide
I)              More democratically accountable commissioning.
II) A much greater degree of co-terminosity between local authorities and commissioning areas.
III) No decision about the spending of NHS funds to be made in private and without proper
consultation, as can take place by the proposed GP consortia.
IV) The complete ruling out of any competition based on price to prevent loss-leading corporate
providers under-cutting NHS tariffs, and to ensure that healthcare providers ‘compete’ on
quality of care.
V) New private providers to be allowed only where there is no risk of ‘cherry-picking’ which
would destabilise or undermine the existing NHS service relied upon for emergencies and
complex cases, and where the needs of equity, research and training are met.
VI) NHS commissioning being retained as a public function in full compliance with the Human
Rights Act and Freedom of Information laws, using the skills and experience of existing NHS
staff rather than the sub-contracting of commissioning to private companies.
VII) The continued separation of the commissioning and provision of services to prevent conflicts
of interests.
VIII) An NHS, responsive to patients’ needs, based on co-operation rather than competition, and
which promotes quality and equity not the market.

Conferences calls on:

1. The Government to uphold the NHS Constitution and publish an audit of how well organisations are living by its letter and spirit.

2. Liberal Democrats in local government to establish local Health and Wellbeing Boards and make progress developing the new collaborative ways of working necessary to provide joined-up services that are personalised and local.

3.  The government to seize fully the opportunity to reverse the scandalous lack of accountability
of publicly-funded local health services which has grown up under decades of Conservative
and Labour governments, by:

a)  ensuring full scrutiny, including the power to require attendance, by elected local
authorities of all organisations in the local health economy funded by public money,
including Foundation Trusts and any external support for commissioning consortia;
ensuring that all such organisations are subject to Freedom of Information requirements.
b)  ensuring Health and Wellbeing Boards (HWBs) are a strong voice for accountable local
people in setting the strategic direction for and co-ordinating provision of health and
social care services locally by containing substantial representation from elected local
councillors; and by requiring GP Commissioning Boards to construct their Annual Plans
in conjunction with the HWBs; to monitor their implementation at meetings with the HWBs not less than once each quarter; and to review the implementation of the AnnualvPlan with the HWBs at the end of the year prior to the construction of the Annual Plan forvthe forthcoming year.
c)  Ensuring commissioning of health services has some degree of accountability by
requiring about half of the members of the board of commissioning consortia, alongside GPs, to be local councillors appointed as non-executive directors.
d)  Offering additional freedoms only to Foundation Trusts that successfully engage substantial proportions of their local populations as active members.

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