Live blog: Lib Dem Health Minister Paul Burstow at SC Region Conference

With amendments to the Health & Social Care Bill being tabled and ongoing debate whether the Bill should be abandoned altogether, Paul Burstow is addressing South Central Lib Dem Conference, followed by a fringe debate on the Bill. This is some of what he has to say:-

The principles of the NHS, unchanged since the 1940s, are as relevant today. Lib Dems are making a difference to the Bill, and as the minister for integration, talk about the work ongoing to integrate health and social care.

On carers, our manifesto promised more respite care so carers can have a break, not a breakdown. From this April, the NHS will have a duty to work with councils to have a plan to support carers, and £400 million extra will go to support carers. Civil servants are well aware of my desire that they look at things from a carer’s perspective.

We committed to making dementia research a priority for this Government, spending a record amount on research as ‘we are still in the foothills’ of discovery on dementia. There is also a major awareness campaign.

(Apologies for any typos in this)

We are working with the professionals to raise awareness of dementia, and improve the quality of training.

On mental health, we all know someone suffering a problem. Nick Clegg and I launched a new mental health strategy with additional funding for access to talking therapies. This even led to Alistair Campbell Twittering positively about Nick Clegg. There needs to be parity of esteem between physical and mental health.

Now the NHS Bill. The mission must be to preserve the best of the NHS while facing up to future challenges such as an ageing population. I know there are many concerns: we have acted on them. The pause led to significant changes. We are putting competition back in it’s box. No sweetheart deals for the private sector. No race to the bottom based on price. Competition was introduced by Labour in 2006, not by us: without safeguards and with competition law able to be used against the interests of patients in the NHS. Private income in foundation trusts that doesn’t need to be reinvested in NHS services. Cherrypicking took place. £250m on operations that never took place.

Quality not prices. Outlawing any policy of increasing the private sector Market share. This week our peers will go further. Competition, as the Conservatives wanted it to be, is no longer at the heart of reform.

The case for integration has been won and is at the heart of this Bill. Lib Dems have pressed for that to be strengthened.

On dementia, integrated care is absolutely critical. Together, I hope, we shall keep pointing out Labour’s forgetfulness and record. The Bill delivers much that we as a party should be proud of.

That’s the end of Paul’s speech: now to questions.
First. A health worker – why are the majority of health workers so against this Bill? Secondly, why should there be more private beds in NHS hospitals? David Rendel: as people have got to know more about what’s in the Bill; if we are the party that kills this Bill, we will gain respect from the voters. (Applause)

PB: in terms of the concerns of health workers, I and others have spent lots of time to understand their anxieties. Lib Dems in the Lords asked about engagement said there was none with the Royal Colleges etc and the Parliamentary process, even though at Sheffield we said we would use that to change the Bill. On their concerns about fragmentation, we can see the postcode lottery laid bare. I welcome the colleges’ welcoming teh need for integration. On health inequalities, there will be a clear legal duty on everyone not just to seek to tackle them but to account for what they’ve done. Inequalities widened under 13 years of Labour. On patients and private income, currently there is no limit. 32% of the Royal Marsden’s income is private. Increasingly under this Bill they will have to demonstrate how they use it to benefit NHS patients. lib Dems in the Lords pressed for greTer clarity on this, hence the amendment to clarify audit trails and return the focus on NHS patients.

Killing the Bill leaves the NHS wide open to Labour marketisation. What Shirley and others are doing is shielding the NHS from the vagaries of EU competition law. (Some applause)

Second round of questions. Julian Cooper from Witney: what are the defence lines against the attacks on the Bill? Another person: How does a commissioning authority works; is it not just a replacement piece of bureaucracy? evan: On competition, Andrew George at Commons Report stage, the duty to promote choice/competition was raised above the duty to tackle inequalities, which makes the pre-Sheffield position better. The Bill in this respect is no better.

PB: It’s hard to respond while the debate is ongoing, but we do need to communicate: there is a session with ALDC at Gateshead. On the process question: this needed to be grappled with anyway. Huge increase in management overheads in recent years. By bringing in clinicians, you have commissioning that better reflects clinical priorities. Safeguards have been built in. Evan: the Parliamentary process is rushed, but the scrutiny in the Lords has been magnificent and when you see the amendments in the Lords you will see reasons for your concerns to go away.

That’s the end of the formal Paul Burstow session, but there will be a Social Liberal Forum fringe shortly.

The fringe speakers are Graham Winyard, former Deputy Chief Medical Officer, Lib Dem Health Committee member and Winchester activist, and Sandra Gidley, former MP and a pharmacist by profession.

Graham thinks the Party should withdraw its support for the Bill. There are three sets of problems with it: what was in it; the ineffectiveness of the structures to tackle the challenges ahead; and the timing of the Bill to coincide with austerity-driven savings. To this has been added a complete failure to win over public or professional opinion. The Health Select Committee has highlighted a number of the likely changes, particularly short-termism. The Ministers say that this is about giving power to clinicians; but that doesn’t need 400 pages of legislation which was a blueprint for marketisation. Our peers have made the Bill much better, but it’s still bad. Ministers’ frustration is understandable, but it took time for professional bodies to understand the essential effect of the Bill. To impose on such a reluctant NHS is dangerous and politically especially so. The ‘de-fanging’ of the Bill in the Lords has been great. But to rally around that work and back the Bill has two problems: credibility (the myth that if only the electorate understood, all would be well) and certainty of the outcome: nobody can be sure, when Parliament is amending amendments already be made. This will not leave the NHS merciless to post-2006 marketisation (stabilising measures would still be needed) and ‘we can’t stop now’ is also a false argument. The quotes from Tim Farron now are instructive.

Sandra agrees, pretty much, with Graham. Is the Bill good enough? Paul Burstow spoke with genuine passion and believes the competition section is better. It’s particularly hard to see the wood for the trees after so many amendments in the Lords, and peers have worked their socks off to make the best of a bad job. Engagement (with the royal colleges) is a two-way process and Parliamentarians must bear some blame for this. The cuts will be noticed by the public in some areas (not all); the risk is that the Bill will be blamed. The Bill should have been scrapped at the time of the ‘pause’; it was not needed to address the change needed. It may be too late too kill it now. The best PCTs were starting to integrate primary and secondary care, and management stability would be a virtue and prevent frontline medical staff from doing more paperwork. Politicians are proud people and don’t like to admit they are wrong: but we should have had a Health Competition Bill to detoxify Labour’s legacy instead.

Paul Burstow is at another fringe on mental health but has promised to visit.

Questions: the first from Uda Chalk of Reading, concerned about the shift at commissioning to GPs. Sandra is concerned at the potential for a developing tension between patients and GPs.

The next questioner represents the Stoke Mandeville Hospital area. It should not have been left to our unelected Lords to amend. The hospital is struggling to cope with financial pressures as it is, and the uncertainty caused by the Bill and the way it has come about is considerable.

Now Evan Harris again: who has looked at the coming tranche of Lords amendments. In the area to be debated on Monday, Lib Dem concerns about outsourcing are not addressed. Had Andrew George’s amendments been taken forward instead, these issues would have been addressed. Essentially, that is the only way the Bill could be saved. No Bill is better than a bad Bill. (there seems to be considerable support for Evan’s view)

Now someone who doesn’t think the Bill should be killed: a councillor from Buckinghamshire. Our vision for change is not being changed; so we are losing the argument. We are not honest about the difference between patient choice, professional judgment and effective management. The Tory view is markets and privatisation: ours is not, but we must engage in the debate in order to change the argument. (He also gets some applause)

Question: what would be the political fall-out if we killed the Bill? Sandra says that as many of the changes are already under way, they may be generally fewer than might be anticipated. The practical problem would be further uncertainty in the professions. Graham thinks there will be an element of chaos whatever happens.

More questions. The 49% limit may be seen as a target. The major concern is that the Bill will be seen as all things to all people. Prue Bray from Wokingham is frustrated about the absence of political strategy, and is adamant that an emergency motion at Gateshead must be debated. (Applause). Another person stresses the importance of doing the right thing even when it means a U-turn.

Sandra responds that on the cap, there was already a problem, so in some ways this might be a good thing in some sectors. She agrees with the need to tackle the political dangers. And the institutions do need to be brought back on board.

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