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Three ways out of the NHS bill for the government

How the government can step back.

The Health and Social Care Bill is in disarray.

All of the professional clinical organisations are against it. All of the health service unions are against it. Even the bill's supporters want this problem to go away. One supporter, Nick de Bois MP, called it a "phenomenal political mess". And when (finally) the bill was explained to the Prime Minister, he exclaimed “we’re f**ked”, it showed that even Cameron does not want the bill. So why is it being rammed through Parliament?


The bill has taken up over a year’s worth of parliamentary time. It has had the longest common’s committee stage of any bill for a decade and it was subject to an unprecedented “pause” last summer. It has had an unusually long Lords Report Stage - so long that the final vote will be a few days before the end of the parliamentary session. No one wants this bill, but it will be an immense climbdown for the government to drop the bill now, because all that effort will have been wasted.

To drop the bill, the government needs a face-saving reason. I will give three.

During the opposition day debate on the NHS Risk Register (22 February), Jeremy Lefroy, the Conservative MP for Stafford, said that the Francis Report on the Mid Staffordshire Inquiry will "report soon, indeed, quite possibly while we are still debating [the Health and Social Care Bill]”. Mr Lefroy said that it was vital that the recommendations of the Francis Report are "carried through" and that this would need further legislation.

On the current timetable, it is likely that as soon as the bill is passed it will have to be amended to implement the Francis recommendations.

This is the first face-saving action: the government could say that there is an immediate need to pause the bill so that it can be changed to implement Francis. Pausing the bill so close to this year's Queen's Speech inevitably means that there will not be enough time to pass the bill during this parliamentary session. Parliamentary convention means that such bills have to be re-introduced in the new session, extending the passage still further. However, such "prorogation" of a bill also gives the government an opportunity to drop the Bill without losing face. Cameron can use Francis to drop the Bill, and to introduce another Bill that implements the recommendations.

The Health and Social Care Bill mentions social care on every page: in the title. Elsewhere in the bill, social care is totally ignored, yet it is social care, not healthcare, that presents the big funding challenges in the future. In July last year, the Dilnot Commission reported on proposals for funding social care. The government said that they would publish a white paper on social care "in the spring of 2012". This white paper has not yet been published and now it is reported that Number Ten has taken control of this policy away from Lansley. The government can drop the bill and save face by saying that the bill must be altered to put a greater focus on social care citing the Dilnot recommendations. This is the second face-saving action.

On Friday, the government lost its appeal against the Information Commissioner’s demand that the Department of Health should publish its transitional risk register. This document lists the potential risks of the new policy and the actions being taken to mitigate those risks. Currently MPs and peers are voting blind, not knowing the effects of their votes and when the risk register is published some may change their mind about supporting the bill. This is the third face-saving action: Cameron can say that the Information Commissioner’s decision means that MPs and peers need time to consider the Risk Register and make suitable amendments to the bill.

These are three important reasons the government can use to drop the bill. But even these are not enough for Cameron and Clegg. Their pride iis so vast that they cannot bring themselves to admit that they were wrong to sign the foreword to the original bill and support it for a year.

They are scared of hubris: we bill opponents celebrating its demise and their loss of face.

So here’s an open and generous offer: if the government drops the bill we should all pledge not to gloat and congratulate the government on doing the right thing. Protecting our NHS is worth far more than the short term pleasure from hubris.

Richard Blogger writes about the NHS and social policy at NHS Vault.


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