Nick Clegg comes out fighting on Andrew Marr - but he must not have final say on Health Reform Bill

I am so tired today. I had a rare bout of Insomnia last night. Normally nothing keeps me from my sleep, but for some reason I woke up at half past midnight and didn't get back to sleep till 4. That might have been ok if I hadn't had to get up at 6:30 to see Anna off to her choir concert - of which more later.

At least I was awake to watch Andrew Marr. It was good to see Nick Clegg come out fighting after a pretty miserable weekend. He seems to have got the message that he needs to be more robust about accentuating the differences between us and the Tories. Somebody observed to me over the weekend that actually it might be his experience in Europe which keeps him quiet. Apparently in the EU, negotiations are done behind closed doors and there aren't any public disagreements. This coalition is not the EU, and it's not a negotiation between nations.  It is essential to show the differences between the two very different parties from two very different traditions who make up our current government. It's possible to do that in a civilised way. What's the problem with saying, when Cameron makes deeply offensive comments about people on Incapacity Benefit, that Liberal Democrats don't see it quite that way and give our reasons why in a calm manner?

Nick said that the reasons we went into coalition a year ago with the Tories still stood. There was an economic crisis to deal with and the country needed a Government willing to step up and sort it out. He said that there was nothing progressive about borrowing £400 million a day, putting taxpayers' money into the hands of bond traders when it should be going into public services.

He also emphasised that for every £8 the coalition cuts, Labour would have cut £7.

He talked about what the Government is achieving in terms of becoming the greenest government ever and one of the most child friendly in Europe and at the same time delivering tax cuts for the lowest paid. We need to find many more examples. The difficulty we have is that it's a bit of a hard sell to tell people that they'd be in more pain, paying £200 more in income tax, and 6p more for every litre of petrol, when they are already feeling very tightly squeezed. One major thing Nick didn't mention was that we've kicked the Tories' ridiculous idea of cutting Housing Benefit by 10% for people who have been out of work for a year. That's a major concession for some of the people who really need it most.

The discussion then turned to the Health Bill. This is where Nick and I are going to slightly part company. I'm very happy that there are going to be "substantial, significant changes" to the Health Reform Bill. That no bill was better than a bad bill. He went on to say, and here's the rub, that he would not ask any peer or MP to vote for it if he thought it undermined the NHS. As far as I can see, it's not for Nick to decide alone. We have very clear democratic processes in this party and I would expect that the changes would have to comply with the will of the Conference, which overwhelmingly passed this motion.

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 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 much of 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 for:
I) More democratically accountable commissioning.
II) A much greater degree of co-terminously 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:
1. On the Government to uphold the NHS Constitution and publish an audit of how well organisations are living by its letter and spirit.
2. On 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 Annual Plan with the HWBs at the end of the year prior to the construction of the Annual Plan for the 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.

That, I would suggest, is our litmus test, not just Nick's opinion, and I expect our Parliamentary Parties and Federal Policy Committee to robustly involve themselves in that judgement.

There was some good stuff in there and an indication that Nick gets what needs to be done. Marr asked him if he might accept a Tory peerage or if he'd join the Tories. The look on his face was a picture - I knew he never, ever would because liberalism is a good part of his DNA, but his answer to this very stupid question was direct:

"I am not a Conservative, never have been, never will be, and I will be carried out in my coffin as a card carrying Liberal Democrat."

I never doubted that for a second. Conservatives don't have helping the poorest and most vulnerable people on their radar, yet Nick's very first major speech as leader was about helping people with mental health problems and he made that happen in Government.  He needs to get out of the Westminster Bubble and out on the stump again.