Right queer goings on at the Lib Dem Spring Conference this weekend, after Shirley Williams started bowling from the pavilion end last week. A procedural vote yesterday to decide which NHS motion should be debated today had the ditch-the-bill motion win on first past the post; and then, by some quirk of bent Lib Dem voting logic, the Williams didn’t-we-do-well motion won. Since the two motions were in some respects mirror images of each other, it did not seem to Dr No that yesterday’s vote was the end of the world: a vote against Squirls’ motion sends much the same message as a vote for the ditch-the-bill motion, the only significant difference being the former lacks the explicit ‘ditch’ directive of the latter.
We have now had the debate and vote. Squirls, inevitably last speaker before the vote, continued to bowl from the pavilion end. Having LBW’d bill opponents, she continued bowling hard, telling delegates Lib Dems had achieved a ‘very great deal’ – an intriguing turn of phrase. She naturally reminded delegates that most people – unlike Lib Dem peers – do not understand the details of the bill, before having another poke at the press – read Polly T – for parroting lies, like the claim that 49 percent of beds will go to private patients; a ‘lie’ that Dr No will return to shortly.
And then came the vote, or rather two, and a right queer result. The first vote, to remove the clause calling on ‘on Liberal Democrat peers to support the third reading of the bill’ from the motion succeeded, by 314 to 270 votes, but then so too did the second vote on the now gutless ‘didn’t-we-do-well’ motion. If Dr No reads this right, it is a hollow victory for bill opponents: party activists have explicitly not backed a mandate for Lib Dem peers to support the third reading. But nor have they achieved a vote calling explcitly for the bill to be dropped. It is a queasy weasely sort of outcome. One fears that when push comes to shove, the Lid Dem peers will indeed achieve a ‘very great deal’ with the Tories, and vote for the third reading; and soon after the NHS (Annihilation) Bill will indeed gain Royal Assent. Pandora’s Box will be officially open.
Now, the 49 percent row is interesting, because it gives us insight into how both sides present their case; it also, in passing, shows how convoluted and difficult to follow this amended bill of amendments has become. The heart of the question is how much private work NHS hospitals can do. Historically, the percentage, with rare exceptions, has been low, in single figures. Given that rather puts the choke on revving up private activity, the Tories intend to lift the cap to just under half, judged by trust income, just under half being chosen for legal reasons, so that the majority, even if only just, of trust activity can be said to be health ie public service activity. The relevant clause doesn’t mention 49 percent, although it is clearly implied. In its roundabout legalistic way, the amended bill defines the primary purpose of an NHS foundation trust to be “the provision of goods and services for the purposes of the health service in England” and then adds:
“The NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.”
Or, in simpler terms, a trust may get up to 49 percent of its income from private activity. At this point, it does look as though Polly is correct: trusts do have, in effect, even if it is not worded that way, a ‘right’ to the 49 percent, giving rise to the opening line of her article that so incensed Squirls: “On Thursday Shirley Williams led her erstwhile rebels into the government lobby to vote for hospitals’ right to use 49% of beds for private patients.”
This is the kind of language up with which the Baroness will not put. For a start, Polly converted 49 percent of income into 49 percent of beds – which may or may not be reasonable. Squirls hit back hard, saying yesterday: “There has never been a right for hospitals to offer 49% of their places for private patients. The so-called 49% is a myth or, to put it in non-parliamentary language, a lie.”
Neither side has told the truth, the whole truth and nothing but the truth. But it does seem, at least to Dr No, the effect of the clause, despite the fact it mentions neither a right nor 49 percent explicitly, and notwithstanding further amendments that require approvals before raising the percentage, is to enshrine in law (and so in effect make it all but a ‘right’) an option, subject to approvals, for trusts to earn all but half their income from private activity.
Squirls may be correct on the strict letter, but Polly is right on the broad effect. The clause does indeed appear to offer a ‘very great deal’ to foundation trusts. Parrot one, Peer nil.