BMA - It's time to toughen up!

"World-class health care for all, publicly funded, free, centred on patients, not profit. So yes to health reforms. But no – always no – to the privatisation of health." Following Clegg's declaration at the Liberal Democrat conference - it sounds like the battle to 'save the NHS' is over. He promised not to let the "profit motive drive a coach and horses through the NHS."

Despite holding the conference in Clegg's constituency hometown of Sheffield, a £2 million police operation was required to keep 5000 protesters at bay, so the Deputy Prime Minister may have considered that such statements were conducive to self-preservation. However, rather than concerns for personal safety, his assertion came as a result of opposition to the reforms from the conference floor. This action might offer a faint glimmer of hope for the NHS and the future health of the Liberal Democrat party.

Congratulations must go to Lib Dem membership for, in effect, throwing out a motion supporting the NHS reforms and voting instead for amendments that were very critical of the Tory proposals. The amendments stated that the Lib Dems did not support the 'damaging and unjustified market-based approach that is proposed.' It also noted, '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'.

Although the amendments were supported by Baroness Shirley Williams and ex MP Evan Harris, this was a grass roots rebellion and received almost unanimous support from the floor. However, faced with certain defeat, Clegg had already agreed to 'accept' the amendments at a breakfast meeting with Williams. The reversal exposes a growing divide between local activists and senior parliamentary members. Despite the possible repercussions for Tory health reforms I think it was interesting to see how gleefully the Daily Mail reported the 'bloody nose' for Clegg. As the newspaper of the Conservative Party foot soldiers it sounds like Lib Dem activists are not the only ones uncomfortable with the coalition arrangement. 

So is it all falling apart? Can we stop panicking and call off the marches? The Guardian reported that Clegg promised Baroness Williams to take 'critical messages' back to the PM. Clegg will hold talks Cameron this week. One Lib Dem cabinet member, refusing to be named, told the Guardian: "I thought we had committed ourselves to give the NHS more money and to leave it alone. I like Lansley, but I do not know why we are doing this." Even Cameron has admitted that the Tories are not getting their message across. 

Clegg told his party "All of us in government are listening and we take these concerns seriously" but it must be difficult to hear anything for all the noise. On Friday the Daily Mail argued, 'what worries this paper is that his revolutionary reforms, barely mentioned during the election, are being rammed through Parliament with only minimal consultation' while even the Telegraph has expressed concern that the reforms risk lowering standards of patient care. The general view of the Tory press seems to be reform rather than transform.

With criticism coming from all sides and commentators beginning to suggest that NHS reform might be Cameron's 'Poll Tax', it might be time for some rethinking. One Tory minister told the Daily Mail: 'We are digging a man trap for ourselves for no good reason. Some of us can see it and are determined to avoid it at all costs.'  

Lansley opens first GP off-licence

Speaking on BBC1's Politics Show yesterday, Health Secretary Andrew Lansley, suggested that the Tories might be ready for a tactical retreat." As you put a Bill through Parliament you look carefully at how the legislation delivers in the context of the reforms that we have set out. We have already made changes, we are not sitting there going: 'Oh, we know the answers and nothing must change'." Lansley said that if the Government could "clarify and amend in order to reassure people" then it would do so.

"Amend to reassure" doesn't sound like much of retreat. Although Lansley, himself, must be under a lot of pressure. Cameron is already complaining that the arguments for reform are not being made effectively and Lansley is now under even more pressure with the BMA's call for him to withdraw the Health Bill. However, the vote may be embarrassing to Lansley but what pressure are the BMA willing to exert upon the Government?

Strike action would inevitably affect patient care and lead to a loss of public support. A refusal to comply with the reforms? As we have seen, the GP consortia are being formed despite their opposition because there really isn't any choice. It would be utterly irresponsible for the structures not to be put in place. Finally, and probably most importantly, the respect that people have for doctors is also the reason for their political weakness. These are professionals committed to their work, thus, essentially conservative. It is a sign of how much the profession has been provoked that they have taken this public action but a frontal assault on the Government is highly unlikely. Unfortunately strong words will not be enough.

So what is the chance of a retreat? For all the efforts of the Lib Dem activists, the power still lies in the hands of the parliamentary party. The grassroots clearly hope to see their MPs vote against the NHS reforms unless their are some radical changes to the proposals but how likely is that? Clegg vowed to look at the amendments "in detail" and told the party that he was "Yes to reform of the NHS - but no to the privatisation of the NHS."

What does that mean? I suspect not much, perhaps a few cosmetic changes. Despite unease amongst the Tories, Clegg still holds the key. During the recent meeting I attended with Clegg, there were a couple of occasions where the veneer of charm slipped and what was revealed was a pretty uncompromising man and rather a bully. For all his pleas of "I'm a human being too", here was someone quite happy to play dirty and that was in a Q&A. Clegg said nothing to suggest he has any doubts about the NHS reforms. Unlike student fees - NHS reform was not a price of the Coalition.

Clegg wants these reforms and has the will to see them through. Without a Lib Dem rebellion the reforms will be passed and, despite the wishes of the party, Clegg seems, at the moment, to have the majority of his MPs under control. Who will rock the boat before the referendum? Anybody wishing to challenge Clegg's authority would be best served by the NHS reforms becoming law and losing the referendum. That would leave the path clear for a leadership challenge.

Perhaps the best insight into his plans came during the speech to conference. He argued that the Lib Dems had to forget the idea of winning over disenchanted Labour voters, a traditionally fertile ground, and focus instead on attracting votes from Middle England. The message was pretty stark. The ship is changing course. Like a drill sergeant, he also warned the party activists to "toughen up". 'Or ship out' may have been left unsaid, but for many in the hall, I think that was the message.


So what is the most likely outcome? Unless the BMA heed Clegg's advice and "toughen up" it looks like the mostly likely outcome will be a challenge to Clegg's leadership. Unfortunately, the privatisation of the NHS and losing the voting reform referendum will be a very high price to pay.



 Thank goodness that's done, time for a 'responsible' pint of wine.