“David Cameron's rose garden pact with Nick Clegg has changed the maths. With 170 Tory and 88 Lib Dem peers (the 153 crossbenchers often split 50/50) the coalition partners usually have a de facto majority over Labour's 238. No one party was supposed to have one in the half-reformed system bequeathed by Tony Blair, but no one planned for coalition. Government defeats are down to around 15%.”
Whether it was intentional or not, the Tories also played a political ace card by putting through the legislation on student fees right at the beginning of the coalition. This was a fatal blow to the Liberal Democrats, because they lost public support and credibility from the off, as well as losing grassroots members. The Liberal Democrats are now utterly dependent on remaining in coalition to keep their political power and influence alive, because they will be wiped out if the coalition splits and a general election is called. This means playing second fiddle to their Tory masters, who are showing increasing confidence to push forward their own agenda without fear of reprisal. David Cameron’s recent EU veto is the latest example of the Conservative party increasingly exerting its power in the coalition. In fact, the longer it goes on, the weaker the Liberal Democrats become and the less able they are to break free. The Liberal Democrats are like a patient on intensive care being kept alive by a Conservative party ventilator.
Thus, a coalition Consevative-LibDem Government couldn’t have been a worse outcome for supporters of the NHS. We have already seen how, firstly, Liberal Democrat MPs and then LibDem Peers have towed the party line in the Commons and the Lords to support the coalition Government. Even Baroness Williams, a supposed defender of the NHS, has voted for the Government, abstained, or gone “AWOL” from the House of Lords on important Health bill debates and votes.
As for Labour party opposition, they lack the numbers and they lack credibility on the NHS. Many of Lansley’s polices are simply an extension of Blairite New Labour pro-market, pro-privatisation policies. Make no mistake, though, Lansley wants to go much further and much faster than New Labour intended. Unfortunately, Labour’s credibility gap has not helped in the Parliamentary debating.
For those that oppose the bill and stand for a NHS that is publicly funded, publicly provided, and publicly accountable, this is all very worrying and depressing as there doesn’t seem to be a way to defeat the bill through the traditional political processes. However, there is still a possibility that the bill can be defeated and the key to achieving this is through a united front of opposition from the key medical professional representative organisations. This is because one of the three key stated principles of Lansley’s reforms is “empowering frontline health professionals”. Thus, if the medical profession rejects the bill, it would send a clear public message that Lansley’s key principles are not credible, effectively signalling a vote of no confidence in the bill and the Government’s handling of the NHS. Public confidence in this Government on the NHS, which is already at a low ebb, would collapse. The NHS is already running in to huge problems because of the current financial situation and the £20 billion QIPP efficiency saving programme.
The key alliance that could scupper the bill is the BMA and the Royal College of General Practitioners (RCGP). The BMA already has a policy position of calling for the bill to be withdrawn and opposing the bill in its entirety. The RCGP holds a very critical position of the bill, but has stopped short of officially calling for the bill to be withdrawn. This may be surprising considering the fact that the RCGP survey showed that 75% of RCGP members supported the BMA position for the bill to be withdrawn. It is interesting to note that a motion to call for the bill to be withdrawn was actually put to RCGP Council recently, but the motion was blocked from being voted on because of a technicality (which a prominent GP member of the Future Forum was responsible for pointing out). However, despite this setback, I believe the RCGP has still got a clear mandate from its members to call for the bill to be withdrawn based on its own surveys, and also the fact that the majority of RCGP members are also BMA members.
Although the majority of GPs are BMA members, opposition from the BMA alone is not enough. Whenever the BMA disagrees with the Government, it is labelled as a self interested Trades Union organisation, which supports the vested interests of its members rather the interests of patients and patient care. However, if the RCGP with its 40,000 GP members, came out shoulder to shoulder with the BMA to call for the bill to be withdrawn, this would be the killer blow. Royal Colleges usually try and stay out of politics and the RCGP couldn’t be accused of having vested interests in the same way as the BMA. Such united professional opposition from such key organisations would raise alarm bells in the public perception of the bill and the criticisms of the bill being flawed, chaotic, ideological and driving NHS privatisation, would start to hit home.
Unlike the 2010 election, the NHS will be a key battleground in the 2015 election and being seen to be “toxic” on the NHS by the public is precisely what the coalition will fear most. They will need to back down or face the consequences. It is quite conceivable that the bill could be held up in the Lords and effectively stopped from going through. This would provide the coalition with a “respectable” way out from this mess. It is therefore vital for opponents of the bill to call for united professional opposition to the bill. The more healthcare professional organisations that join in the better, but in reality the RCGP and the BMA would be enough, simply because of the pivotal role of GPs.
United opposition will result in the “retoxification” of the Tory brand on the NHS. The LibDems, who are equally guilty, will be equally “toxified”.