Live coverage as the health and social care bill returns to the Lords
A round up of today's events:
The government suffered its first defeat on highly controversial plans to reform the health service just hours after the Prime Minister mounted a passionate defence of the shake-up.
David Cameron, whose disabled son Ivan died in 2009, told the Commons the overhaul was essential to ensure that everyone received the "amazing" care his family had.
But peers backed an amendment, by a majority of four, to the Health and Social Care Bill that called for greater emphasis on mental health when it returned to the Lords. There were three Liberal Democrat rebels - Lord Alliance, Lord Carlile of Berriew and Baroness Tonge.
Earlier, the reforms - which puts GPs in charge of budgets - were branded a "disaster" by Labour and respected medical organisations have lined up to criticise it.
During Prime Minister's Questions in the Commons, Labour leader Ed Miliband urged Cameron to "give up" on the bill.
"This is a matter of trust in the Prime Minister," he told MPs. "Can he honestly look people in the health service in the eye and say he's kept his promise of no more top-down reorganisation?"
But Cameron insisted GPs were not just "supporting our reforms, they are implementing our reforms".
"I care passionately about the NHS, not least because of what it has done for my family and because of the amazing service that I have received," he said.
"I want to see that excellent service implemented for everyone and that means two things: it means we have got to put more money into the NHS, and we are putting the money in, but it also means we have got to reform the NHS."
Health Secretary Andrew Lansley has been widely criticised for his handling of the flagship bill, which Mr Cameron was forced to "pause" last year after the fierce backlash.
But the Prime Minister dismissed suggestions Mr Lansley's job could be on the line over the issue.
Paul Jenkins, chief executive of charity Rethink Mental Illness, said the government has a duty to put mental and physical illness on an equal footing.
Historically, mental health services have always been the poor relation within the NHS. The stand the Lords have taken today is an extremely encouraging sign that things are heading in the right direction. We urge the Government to accept this amendment and take this opportunity to help ensure the new NHS finally offers a fair deal for everyone regardless of whether they have a physical or mental illness.
Department of Health said it is committed to balancing both mental and physical health needs equally.
The government is already ensuring this becomes reality, such as through the cross government mental health strategy. We don't think this amendment is the best way to achieve this aim, so we are disappointed that the House has voted this way. We will look at the best way to take this forward.
Ok, I've got to finish now. A colleague of mine from the news desk will be taking over the blog and keeping an eye on this evening's business.
More reaction on that defeat for the government.
Here's Rethink, the mental health charity, which tweets:
Who would have thought that the first successful amendment on #NHSreform would be to put physical and mental health on an equal footing?
Baroness Thornton, the Labour peer, is setting out Labour's position on the bill.
She asks the minister whether the government will use financial privelidge to steamroller the bill through, as they did with the welfare reform bill.
She says she has rarely seen a bill which is:
A piece of legislation that is so unwelcomed by those that have to deliver it
The Lords agree not to go to a vote on the amendments around medical training.
Here's the breakdown of that vote on amendment one.
For the amendment
Crossbench 65
Labour 167
Liberal Democrat 3
Other 9
Against
Bishops 1
Conservative 153
Crossbench 18
Liberal Democrat 65
Other 3
Three Lib Dem rebels - including the serial rebel Baroness Tongue. It looks like Baroness Shirley Williams, who has led much of the Lib Dem attempts to amend the bill, abstained.
You can see the full breakdown here
Peers are now discussing a series of amendments relating to the education and training of health workers in the NHS.
There are concerns that the bill's proposed arrangements could disrupt the plaiing, provision and quality of nurses, doctors and other health workers.
Lord Howe says the government is committed to the training of the healthcare workforce. The secretary of state for health will still have a duty to guarantee effective health workforce education, he says.
Everyone seems a bit surprised by the government's defeat on that vote, which called for the secretary of state to give mental health equal parity with physical health on the face of the bill.
Here's Lord Hunt, Labour's deputy leader in the Lords, on twitter (@LordPhilofBrum):
Vote on mental health #healthbill #stopthebill we win by 2 votes Wow and well done
I think it was by 4 votes, by the way. But, wow, indeed.
The bill was backed by Lord Mackay of Clashfern, the former chancellor under Mrs Thatcher, who also rebelled on the welfare bill over Child Support Agency charges, and Lord Alderdyce, a Lib Dem
It was a close vote, but it feels a highly symbolic moment. Health minister Lord Howe's offer to peers to open up discussions with ministers over the issue might have been expected to succeed. But Lord Patel was having none of it.
Why? I'm speculating, but peers are feeling bruised by the government's implacable resistance to second chamber concerns over the Welfare reform bill.
There seems to be a trust issue here.
The amendment passed! Content 244 Not content 240
This was meant to be a "symbolic" amendment, but Lord Patel - who made some powerful interventions in the Welfare Reform bill - has won the backing of his peers. Could this be a sign of things to come?
Earl Howe asks the House not to pursue a vote on Amendment One. He says he is aware of the issues but would much rather "promote parity of esteem between physical and mental health" through ministerial discussions.
Lord Patel is unconvinced however. He's called for a vote, and peers are voting now.
Hi, it's Patrick Butler, here and I'm taking over the blog from Randeep Ramesh until close of play today. You can tweet me at @patrickjbutler
Lib Dem councillor and HuffPo blogger Matthew Hulbert says that the health bill has to be dropped because it's
a Tory Bill, one cooked up by Lansley and his colleagues.
Despite valiant attempts to shave off the rough edges by the Lib Dems, says Hulbert, there's nothing else to do but "Cameron needs to swallow his pride, sack his Health Secretary, and bin this bad Bill".
Meanwhile over at the blueliberalism blog - "ramblings of a right-wing liberal", the cross-dressing politics of blogger Liam Quinn asks is it not time for David Laws to replace Andrew Lansley. After all, Quinn argues, wasn't Laws idea of compulsory health insurance payments into competing funds a really good idea. Seriously.
Sounds like the Lib Dem grassroots are worried about how the NHS reforms - and Andrew Lansley - are playing on the doorstep. After all the local elections are just round the corner.
Over in the upper house Lord Naren Patel, former head of the National Patient Safety Agency, is putting forward an amendment backed by Thatcher's former Lord Chancellor Lord Mackay. It is about getting the Secretary of State to put mental health on an equal footing with physical ailments. It's a largely symbolic amendment to emphasise that ministers have a duty as to the prevention, diagnosis and treatment of "physical and mental" illness.
Earl Howe, the government's man in the Lords, tells peers there's no plan B and the no chance of the bill being dropped. The department of health says that by changing the NHS now - in the form of collapsing primary care trusts and setting up GP commissioners - the taxpayer will save £3.2bn by the end of this parliament.
Andrew Lansley's plans to overhaul #NHS in England have just begun being debated in Lords. To watch live point your browser here. The blog will be following the debate...
Another couple of hours, another voice of dissent over Andrew Lansley's bill. The Faculty of Public Health (FPH), has today joined the growing number of medical organisations which want the Health and Social Care Bill dropped. The faculty, which represents 3,300 public health specialists working in the NHS, local government and academia, announced its decision after finding in a survey of its members that 93% of them believed the Bill would damage both the NHS and the health of people in England.
Responsibility for public health is due to transfer from the NHS to
local councils in England from April 2013 as part of Lansley's plans. My colleague Denis Campbell has been talking to FPH president Dr Lindsey Davies, who was a senior civil servant at the Department of Health before taking up her current role in July 2010. Here's the highlights:
Based on our members' expert views it has become increasingly clear that the Bill will lead to a disorganised NHS with increased health inequalities, more bureaucracy and wasted public funds. The Bill will increase health inequalities because there is rthe real danger that vulnerable groups like homeless people will not be included when health services are being planned.Clinical commissioning groups and service providers will be able to pick and choose what procedures they perform and which services they put in place. Like our members we make decisions based on the best available evidence, and we have a clear mandate from them to take this position. We do not do this lightly. We will continue to do all we can to make sure this Bill is fit for purpose.
Denis points out that the "faculty's U-turn follows its emergency general meeting two weeks ago when members disgruntled that it was not more strident in its opposition to the Bill passed motions calling for it to harden its stance. That led the faculty to consult its entire membership, who appear to agree with the 200 members who attended the EGM".
The Welsh government are taking issue with the PM over his comments about the health service in Wales. In the past Mr Lansley accused the NHS in Wales, run by a Labour administration, of denying patients cancer drugs, failing to control killer infections and cutting the health budget.
But the PM seems to have been caught out by the Welsh administration's rapid response unit:
Claim: The Prime Minister claimed a third of Welsh patients were waiting over 18 weeks for treatment.
Fact: The Prime Minister is wrong. At the end of November 2011, 22 per cent (1/5) of Welsh patients waiting over 18 weeks and over from referral to treatment. Our target is that 95 per cent of patients should be waiting less than 26 weeks from referral to treatment.
Claim: The Prime Minister claimed 27 per cent of patients treated in Wales are waiting over six weeks for direct access to diagnostics at end November 2011.
Fact: The Prime Minister is wrong. 18 per cent of Welsh patients are waiting over six weeks for direct access to diagnostics. Our target for direct access to diagnostics is eight weeks
Éoin Clarke who blogs over at the Green Benches has (another) exclusive. He's got hold of an October version of the risk register for the NHS in London. And it does not make pretty reading: rising costs, big hospital deficits and services wilting.
London NHS risk report categorically states that Commissioning groups (GPs) may 'not be able to secure [services] [...] within the running cost range'. The potential consequences raised by the London report are that 'quality' of health care may be 'poor'. The London report also says that there may be a 'skills deficit' among commissioners (GPs).
Is there anybody who is actively supporting Andrew Lansley's bill. The Institute of Healthcare Management (IHM), the professional organisation representing the rank and file NHS managers, has publicly opposed the Health and Social Care Bill, claiming its advice has been disregarded.
An IHM member opinion poll found managers had experienced "worsening conditions" for both patients and NHS staff thanks to the reforms. The results were so powerful that within minutes of the request being posted online, the IHM was able to "confidently" say Health and Social Care managers do not support the Health Bill and the "inevitable consequences" of it.
Read more here
Dr Kevin O'Kane, head of the London region of the BMA, has been a loud critic of the reforms proposed by the coalition. He writes:
Last night, around 200 doctors & medical students from BMA London met to discuss the disastrous Health and Social Care (HSC) Bill, or as it is sometimes known, "The Abolition of the NHS Bill". In spite of the Prime Minister's much vaunted "pause for reflection" earlier this year, and a slew of meatless amendments, the damaging essential elements remain intact. If it becomes law, this legislation will result in the break-up of our comprehensive, publicly funded publicly provided health service. In its place will be a post code lottery patchwork provision from private providers, voluntary groups and the remaining rump of our public hospitals. Funding will depend on top-ups from patient charges and private insurance. Crucially, the Secretary of State for Health will no longer be responsible for health care provision such that patients - voters - can no longer hold the government of the day to account for health care. It may sound apocalyptic, but this really is the end of
the NHS.In spite of pre-election promises of no more "top down NHS Re-organisations" the Prime Minister has brought upon us the biggest and most expensive management reconfiguration ever to visit the Health Service. The transition costs to the next system have been estimated as the equivalent of 6,000 nurses' salaries in the first year alone. This exercise is totally unnecessary. If the real aim is to involve clinicians more in the design of health care systems, doctors are up for it - and we can do it without expensive damaging legislation.
The message from London's doctors is that it is not too late to save the Health Service. It is not enough for the Prime Minister to make his Secretary of State a sacrificial lamb: if Lansley goes he needs to take the Bill with him. If this Bill goes through, the winners will be the management consultants, the private health care providers and the insurance industry. Patients - and tax-payers - will be the ultimate losers.
Ed Miliband's reprising of an attack on the Tory Reform Group blog on the health bill is worth a second look. Craig Barrett, a TRG columnist, wrote yesterday that the health secretary is not the man to run the NHS!
The Government was wrong to push these changes as a flagship bill. The fact that many of the reforms do not even require primary legislation makes the resulting headache look embarrassingly self-inflicted. Without a proper mandate, it looks undemocratic.
Mr Lansley seems like a man clinging to a time-bomb that only he cannot hear ticking. The Government urgently needs to look at what he is trying to do and accept that it needs drastic, perhaps total, reconsideration.
Is politics truly the art of the possible? What is certainly impossible is ploughing on without confidence. This is the situation in which Andrew Lansley now finds himself, where self-confidence is no match for the lack of confidence held other people.
That we need urgently to consider what this Health Bill is doing is obvious. In all likelihood that means starting all over again. Moreover, it is clear to me that the current Health Secretary is not the man to preside over this process.
Ouch!
Apologies. A phone call dragged me away from the blog. But things are hotting up. On Comment is Free, Ali Parsa, the founder of Circle Health which became the first company to take over the running of an NHS hospital, takes on his critics
Concerns over independent companies competing with the public sector often centre on accountability and profit. It is true that some lost their way in recent years in the quest for profit. Profit for an enterprise is like oxygen, food and water for the body: necessary to sustain life, but not the point of life. Just as the entire public sector can not be condemned for the failure at Mid Staffordshire hospital, it is wrong to judge every non-state operator according to the actions of a guilty few. The key here is the accountability of all operators to public scrutiny.In fact, the search for new solutions in healthcare gives us a great opportunity to create a fairer society. At the moment, two single square miles – the City and Whitehall – control over 90% of our productive assets. This concentration of ownership is unique among developed countries, and has produced unacceptable consequences. For instance, the richest region in Germany is two times more prosperous than the poorest; in France this ratio is four times; in the United States five times; in Britain it is a shameful 10 times.
Healthcare professionals must be empowered to set up their own alternatives. GPs provide a great example of how healthcare professionals can be freed to own and deliver their own services. They set up and own their practices, and sell their services back to the NHS as single-handed practitioners or small partnerships. This model could be expanded to nurses, midwives, hospital consultants and countless others, so that many more professionals could come up with new solutions that they control for their patients.
However in a sharp riposte Ian Greener, professor of social policy at Durham University, writes "Why Ali Parsa is wrong about healthcare (and the NHS)". He writes, in somewhat more restrained language than some commenters, that:
First, the NHS is facing an efficiency saving, not a deficit, and this is a political decision, not a shortfall in funds. It is a political decision how much money the NHS gets, not a market-based one. It is seeing just as many patients as ever – it is not short of demand.Second, the NHS is better funded than it has ever been. But it started from a low base, and is still one of the worst-funded healthcare systems in the developed world. It has been systematically underfunded for much of its existence. To call it unsustainable is plain wrong – it is arguably, in terms of how much it costs and the services it providers, the most efficient healthcare system in the world.
Third, the reason why so much British manufacturing is overseas-owned is because of the openness of our economy, not because we've been protecting it. Will Hutton has been making this clear since the mid-1990s (and even before that). Germany and France have protected theirs from hostile overseas bids – he is just plain wrong on this point. The City of London he appears to be castigating for concentrating ownership is a significant beneficial of this, while at the same time also being an example of what he regards as offering examples to us of how great Britain is. There is contradiction after contradiction here.
Fourth, the idea that concentration in ownership leads to inequality is a massive confusion. There is the world of difference between the jobs most public sector organisations provide and those provided by the City of London – to conflate the two is ridiculous. Regional differences in income and wealth are important – but to imagine that breaking up the NHS will make things better is bizarre. The problem is the stupid rewards we allow those working in the City of London, not the ownership of the NHS. The problem is inequalities in income and wealth, not public ownership.
Finally, the free-for-all in healthcare that he suggests follows from his argument is completely misplaced. Healthcare is not unsustainable, and the near public monopoly on it has made it fantastically affordable in the UK. As I've said many times in this blog, the entry of providers of others types means we have to keep comprehensive providers open (as Circle have benefited from at Hinchingbrooke), meaning that those providers cannot fail, while at the same time pretending we are introducing competition. There is no real failure if particular providers cannot fail. If there is no competition.
Postscript: The Health Service Journal (paywall) has this rather timely story on Circle
Circle will have to cut costs at Hinchingbrooke Healthcare Trust by 10 per cent if it is to break even next year, it has emerged. The private sector company took over the running of the trust in Cambridgeshire last Wednesday – the first such arrangement in the NHS. A progress report on Circle's business plan for 2012-13, presented to the trust board last week, predicts income could fall to £98.7m next financial year. Meanwhile, costs will increase marginally, leaving the trust with a £10.1m hole. "Based on the most likely scenario, the quantum of savings required is circa £10m in 2012-13. This represents circa 10 per cent of total trust revenues," the report says.
Can the NHS transfer or hive off its services to bodies outside the health service's control? That issue is very topical, given the coalition's drive to get more private and voluntary outfits starting to offer healthcare through the introduction of "any qualified provider". Today sees the start of a test case at the High Court in London which could have a major impact on the NHS's ability to outsource certain services. Denis Campbell reports:
Michael Lloyd, a retired railway worker from Stroud in Gloucestershire, is challenging Gloucestershire Primary Care Trust's decision to transfer some key patient services to a specially created Community Interest Company, called Gloucestershire Care Services CIC. Lloyd will argue at the two-day hearing that, because the CIC is not an NHS body and its staff are not NHS employees, the planned new arrangement is likely to prove contrary to local patients' long-term interests.District nursing, community physiotherapy and out of hours medical and pharmacy services are among those that have been transferred to the CIC, as well as sexual health services, community dental services and the running of community hospitals. The value of these services is thought to be about £80m a year, according to Lloyd's lawyers, Leigh Day & Co.
The case is significant because, as Leigh Day & Co point out, "Government policy seeks to separate NHS commissioners [PCTs] from NHS providers [hospitals] by requesting PCTs to transfer their provider services to other organisations." Campaigners may hope that a victory for Lloyd would help stop what some see as the break-up, or creeping privatisation, of the NHS in England. Members of the Stroud Against The Cuts campaign group gathered at the High Court this morning to show their support for Lloyd at the judicial review hearing.
Leigh Day & Co add: "Lawyers argue that the proposal by NHS Gloucestershire to enter into a contract with a company such as GCS for the provision of their NHS community services, without undergoing a fair and transparent process, is unlawful for domestic public law reasons and for EU public procurement reasons.
"The PCT is legally able to transfer its community services to another NHS body without undergoing a procurement process the Claimant's preferred option. However, if the PCT chooses to offer up the NHS services to non-NHS bodies, it has to undergo a proper and fair procurement process, offering the opportunity to other potential providers, in particular from the Claimant's perspective to other NHS bodies with a proven track record of community service provision."
Rosa Curling, Lloyd's solicitor, added: "It is clear that the PCT's decision-making process has not been open and transparent and they have not properly considered the options available to it, which would allow the services to remain provided by an NHS body. The PCT is under clear legal duties to do so and its failure renders the decision to enter into a contract with GCS unlawful."
Lloyd wants the High Court to declare the PCT's contract with the CIC unlawful and force it to reconsider its decision, thereby prompting a new bidding process.
UPDATE: Dan Gregory, who tweets at @CommonCapital, points out that the question is not whether the NHS can farm out services but whether it's legal "to give work to a social enterprise with no competition". Thanks Dan.
Kailash Chand, the GP who has been a critic of the coalition reforms, has emailed to point out his epetition to "drop the bill" has now got more than 50,000 people signed up.
Dr Chand hopes his petition will get the 100,000 signatures needed to force a debate in the Commons, which could add more delay to the bill's parliamentary progress. So far it's been retweeted by Rio Ferdinand, Jamie Oliver, Stephen Fry and John Prescott.
If you are so inclined sign here.
There's a Twitter storm developing around Clare Gerada, the widely respected doctors' leader who has been a fierce critic of the government's health bill. In today's front page Independent story on the health bill written by health editor Jeremy Laurance and Whitehall reporter Oliver Wright, there are hints that behind the opposition lies financial gain for Dr Gerada. This stuff could be explosive or it could be a smear.
The relevant paragraphs are:
An investigation by The Independent indicates that one of the Bill's most assiduous critics, the chairwoman of the Royal College of GPs Clare Gerada, could gain financially if it were abandoned. Dr Gerada is a partner in one of London's biggest health centres, the Hurley Group, which runs 13 practices across the capital and could suffer from the increased private competition proposed by the Bill. Ms Gerada has condemned the reforms, saying they will result in a "fragmented, expensive and bureaucratic" health service.But some of her colleagues within the Royal College have questioned whether she is "practising what she preaches" against competition. A statement on her behalf by the Hurley Group said competition could improve the NHS "in the appropriate setting" but "forced competition" in all parts of it would not.
The resulting punch up on Twitter is notable for who stepped up to the plate. Richard Horton is editor of the Lancet. David Rose is former health reporter who now works on the Times news desk. John Rentoul is the Independent's chief political commentator. Toby Young... well he needs no introduction.
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