NHS: how is out-of-control government to be checked?

Lansley’s NHS Bill which returns to the Commons next week still, even after the ‘pause’, raises acute issues of accontability. Whilst some of the more extreme proposals have been slightly modified, the fundamental underlying ideology remains intact. It will still lead to irrevocable break-up of the NHS by opening it up to unlimited privatisation. This is a bill of which there was no mention whatever in either the Tory or LibDem manifestos, but which had clearly been several years secretly in the making, and was then to be hurriedly rammed through Parliament irrespective of argument by the ruthless deployment of the Government majority whip. Everything about this bill stinks – the secrecy, its imperviousness to parliamentary debate, its mindless use of whipping power. So how can such abuse be stopped?

The measures contained in the revised bill still remain extreme. The crux of the bill remains the transfer of commissioning to GP consortia which is likely in most cases to be outsourced in whole or in part to US healthcare providers or big UK PPP operators (Capita, KPMG, BUPA, etc.) which will both accelerate privatisation and create a major conflict of interest between commissioning and provision of services. Competition still predominates over equality of care so that private companies will still retain the right to tender on all contracts under EU law. There will be no accountability at the top: the Secretary of State’s duty to provide a health service for all disappears and the new quango National Commission ing Board is answerable to no-one. Already there is evidence of hospitals giving priority to private patients, whether British rich or foreigners, in order to increase revenues.

This is torpedoeing the NHS without any electoral mandate and with a farcical passage through Parliament, with a thousand new amendments having been tabled but almost none of which will be debated. So what redress to such a blatant affront to parliamentary democracy and to the wishes of a large majority of the electorate and the medical profession? The Lords may still act as a brake on some of the worst excesses of the bill, but is unlikely to stop its main structure being railroaded through Parliament. That raises the fundamental question as to whether any government should be allowed to play fast and loose with all the constitutional conventions of electoral consent and proper and effective parliamentary decision-making. There is a strong case for a President, elected by popular consent, who would be empowered inter alia to disallow legislation until it had met all the necessary constitutional safeguards blocking a slide into unaccountable autocracy. The political functions of such a President would not in any way cut across the social and ceremonial duties of the monarch. It is a case that now needs serious consideration.