There are many Lib Dem concerns with the Coalition Government’s NHS white paper (cached – note, crown copyright.) Some of them were documented in the motion we passed at spring conference last weekend (cached.)

To summarise, the white paper provides some evidence as to why the NHS is “failing” and needs to be “fixed”, and then lays out a radical reorganisation (most famously including replacing the quasi-local civil service bodies called Primary Care Trusts, of which there are about 150, with consortia of local GPs set up as private companies.)

Firstly, the “failing”.

The coalition criticises medical outcomes and some of their criticism, for example on cancer survival rates, is statistically valid. However they have made (and continue to make) big bones about heart failure deaths, in comparison to France, and this is lies, damn lies and statistics of the worst kind.

I will give an executive summary of a British Medical Journal rebuttal to Lansley’s nonsense, although I encourage you to read the paper. Firstly, we should point out the rates of improvement on this measure. While the 2005 headline figure is that the UK has double the death rate than France, this fails to see that rates are dropping more than twice as fast here, and are set to overtake France (and thus become the best in Europe) by 2012. We were then in the middle of the European OECD field on this measure, and improving among the fastest. Finally, a fact not in the source, it also neglects that we count sudden unexplained deaths as heart attacks, which the French don’t.

In addition, Lansley frequently says we need to improve efficiency by cutting bureaucracy in the NHS, but again, looking at the numbers, this doesn’t stand up to scrutiny. The NHS is actually one of the most efficient health providers in the OECD – we spend less on bureaucracy – at 3.3 % – than Australia (at 4.2%,) Germany (5.6%,) or the USA (7.3%;) all more marketised health systems. This is mainly because it’s more efficient to just deliver services than to spend all your cash calculating how to exclude the expensive patients, as happens in the USA, and as would have happened here if the coalition hadn’t rolled back on price competition.

Secondly, the “fixing”

Even a spoonful of sugar won’t help this medicine go down. The government’s plans, not in the coalition agreement nor any party’s manifesto in 2010, go far beyond anything required to open up the NHS to local democracy (as the Lib Dems have always argued is required) and constitutes a full reorganisation of commissioning, and the transfer of many (admittedly woefully unaccountable) public bodies’ powers to closed, private GP consortia.

Not only will this reorganisation cost £2Bn, it will also create massive inefficiencies while the system compensates for “learning” the new structures; it breaks a manifesto pledge from both governing parties not to apply a top-down reorganisation, and won’t open the new structures up to adequate scrutiny. In short, it does the opposite of what it says on the tin.

Finally, what we can do about it

The Lib Dem position on this is clear from the motion; the bill needs to be amended to remove the marketisation and to include much more local accountability on commissioning and other decisions. Preferably the amended plans will not contain any reorganisation, except perhaps adding an elected head of the PCTs. If these conditions aren’t met, Lib Dem MPs are under obligation from their conference (see the motion above) to vote down the bill, since it was not in the coalition agreement and it is against Lib Dem policy.

The Labour position is less clear. The last government should have been happy with some parts of the bill (the bits the Lib Dems would leave in,) like making all hospitals “Foundation Trusts” (bodies that have marginally more freedom in commissioning,) although who knows what they think of local variation in services (they, and their supporters, seem to oppose local innovation in all forms labelling it a “postcode lottery”.)

From a game-plan point of view, assuming the government applies some fig-leaf changes in response to Lib Dem concerns and ploughs on, a rejection of the bill at final stage isn’t that bad an outcome. Yes, the system will need to be revisited almost straight away, but it will mean the resignation of the already widely discredited Lansley, the dreadful Ms Milton, and (assuming he didn’t resign at the final vote) the Lib Dems’ Paul Burstow. This will allow new ministers to come in and negotiate a proper set of policies which achieve more reasonable aims and deliver the accountability and flexibility our Health Service needs, our patients deserve, and that this government should have proposed in the first place.

NHS Conkers

At the moment Labour are seeking to derail the whole bill, although oddly the opposition day debate yesterday ran a motion applauding the aims of the legislation (while rightly slating the implementation,) and only requiring it be paused. Labour MPs then proceeded to play NHS Conkers with the Torys, to much jeering and general nonsense, ranting against many things which the bill does not do (or rather, shouldn’t if the government gets the wording right according to its own objectives,) like threaten the obligation of universal coverage or allow private companies to make huge profits out of the new commissioning arrangements, leaving the NHS to pick up the more expensive cases. The only speeches I found remotely listenable to were those made by the two Lib Dems who spoke (other than Simon Hughes early interventions;) John Pugh from Southport, who shut the house up with his appeal for help from the Labour benches to apply effective and targeted pressure to the government, and another whose name I can’t find (please comment if you know who it was.)

If Labour are serious about attempting to improve this bill, and rejecting it if the government resists, they need to up their game. Let’s see some hard work in committee, in the Lords, and finally in the last few Commons debates in 3rd reading, to either get the amendments all reasonable people in the house want to see applied, or to ultimately defeat it and oust the useless team who foisted it on us.

It will take the Labour health front benchers quite a lot of nerve and effort, and they’ll have to drop this pointlessly obstinate stance, if this is going to work. Stop playing conkers with people’s most treasured national asset, come in from the playground and let’s solve this problem like grown-ups please; calmly and effectively.