There is plenty for Liberal Democrats to ponder as they head to their Spring Conference this weekend in Sheffield.


They will be asked to consider an amendment supported by Lady Shirley Williams and other senior Liberal Democrats to a motion supporting the Government’s Health and Social Care Bill which is currently going through its Parliamentary Committee stage.

At the last meeting of the committee I raised important questions about the democratic deficit in the bill which should be of real concern to Liberal Democrats who have been told that the Bill will increase local accountability and local decision making about health and social care.

Not only do the new bodies created by the Bill not give communities and patients the powers promised by the government but they actually take power from Health Overview & Scrutiny Committees.

At the moment Overview & Scrutiny Committees can decide themselves which changes they think are significant enough to look at and they can choose to refer a change or closure to the Secretary of State who can overrule a previous decision.

Local Government Group and the Centre for Public Scrutiny agreed that Overview & Scrutiny Committees are:

“possibly the strongest expression of democratic accountability in public services. They allow for robust, independent scrutiny of health care and health issues by elected councillors. Councillors on health overview and scrutiny committees can make independent reports and recommendations. They are a strong model for democratic accountability in public services-they should be retained and not diluted.”

If it ain’t broke, why is the Government meddling here?

There are further concerns that only services which have been ‘designated’, to use the language of the Bill, will be able to be referred to the Secretary of State by the Overview and Scrutiny Committee. 

Some services will be deemed so essential to our healthcare system that they will be placed in a special ‘designated’ category which protects them even if the provider of this service withdraws or fails to provide it.  A new organisation, Monitor, will be responsible for promoting competition in the health service and it will decide what these essential services will be.  Simon Burns, the Minister for Health services has already indicated that London Accident & Emergencies would probably not be protected in this way.

The Government’s response to the white paper suggests that the ‘right to refer’ will be limited to designated services and, despite close questioning in committee, the Minister did not deny this will be the case.  

Health and Wellbeing boards will bring together elected representatives and key health and social care representatives to ensure money is being spent in the best way to improve local services.  However it seems that these boards will not have powers to sign off the plans of GP Commissioning consortia – those who hold the purse strings.

Nor will these non accountable GP consortia even be required to meet in public when they make decisions about how to spend tax payer’s money. The Government have made it clear that GP consortia are accountable to the National NHS Commissioning Board and not to their local area.

I was very interested to learn from Paul Burstow’s interview in the Guardian that he is “open to the possibility of seeing as many as half of GP commissioning boards made up of elected Councillors”.

Much as he may think that he can buy off Lib-Dems with promises such as this, he is going to have a real problem delivering it. Having elected Councillors exercising real power over commissioning, directly contradicts what his own Government’s Impact Assessment has had to say on the matter, which guarantees doctors that they will be free of “interference”

       Impact Assessment C76:

Local health professionals and representatives of HealthWatch sitting on the boards could find themselves mired in national-local disputes if the political complexion of central and local authorities differed. They could also suffer from discontinuities of political leadership due to political turbulence, or a clear lack of leadership if councils were hung.

One of the main aims of the White Paper was to reduce the day-to-day political interference in commissioning decisions by creating a statutory basis for the NHS Commissioning Board and consortia, to protect them from interference in commissioning decisions at both a local and national level. To ensure their autonomy, both board and consortia remain solely responsible for their commissioning decisions, and neither are obligated to gain approval from local councils or health and wellbeing boards for their commissioning decisions. 

Burstow may accuse me of attacking “a phantom bill, a caricature… a hall of mirrors with all kinds of distortions.”  But the kindest interpretation that one can give to his contradictory position is that he doesn’t understand the meaning and impact of his own legislation.



You can read the full discussion in committee here:

The White Paper Response, including the “right to refer” in Section 5.41 and Sections 5.25 -27 which states that GP consortia will be answerable to National Board and not to their local area, can be found at:

The Impact Assessment can be found at:

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