The Metropolis

Like peasants, we beg the Lords for health care. Like Lords, they said 'bugger off'

Josh Hall | Thursday 13 October, 2011 16:39

Here’s the story so far: unelected government writes Bill intended to dismantle the NHS – a Bill no one wants, and which was not contained in any manifesto. Government pushes Bill through Parliament with relative ease. Bill is then voted on by a group of unelected landowners (or children of previously unelected landowners), religious leaders, and other people similarly poorly qualified to make decisions about the nation’s health.

So what exactly were the Lords voting on yesterday – and what does the Health and Social Care Bill mean?

Within the wide-ranging legislation there are two main themes: marketisation, and disconnection from the state.

The Bill will allow private companies to involve themselves in the commissioning process, meaning that the private sector will not only be able to benefit from the NHS budget – it will also be able to determine how that budget is spent. Competition between providers will increase dramatically, the most significant result of which will be a driving down of quality and safety standards in favour of increased profit margins.

This marketisation will also hit the provision of care. Private companies will, by nature, only be interested in the jobs that can be completed at the highest profit and with the lowest financial risk. This means that complex and costly procedures like cancer care will be pushed to one side.

The second theme is the new fissure between the health service and the government. Despite Tory protestations, the Bill still absolves the Health Secretary of his or her longstanding duty to provide care. There are two main problems with this: primarily, it means that there will be no executive oversight of care. Instead, commissioning bodies will have free reign – commissioning bodies which will be increasingly reliant on private sector care providers who will, as we have seen, only be interested in the most profitable jobs.

Secondly, it removes the all-important democratic governance of the NHS. At every level the health service will be run by unelected individuals. The British public will have no way of influencing decisions about the care it receives.

The National Health Service, one of the very best institutions this country has produced, is being gutted. This is not hyperbole; this is the reality with which we will all have to cope.

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This extraordinary, historic event is not a one-off aberration. It is not some rare blip in which Parliament finds itself out of step with the country. Rather, yesterday’s votes were the reification of the abstract processes by which we are governed in this country; processes which masquerade as democracy, but which bear not even a family resemblance to even the most basic of democratic principles.

Yesterday, the fate of the National Health Service – a service on which all but the very richest depend – was decided by 789 people. Those people are not accountable to you or me. Some are accountable to political parties. None are elected. Not one has a democratic mandate.

The Lords does not make a habit of voting down Commons legislation – and reasonably so. The Commons at least has a semblance of democratic accountability. Unelected Lords stymieing legislation drawn up by an (allegedly) democratically elected government would be little better than the Queen refusing to give her assent.

And yet this is exactly what the Lords should have done yesterday. Indeed, they had a democratic duty to reject this Bill – and they failed in this duty.

A rally on Westminster Bridge achieved nothing. Petitions were ignored. A mass letter writing campaign failed comprehensively. During the debate several Lords mentioned the unprecedented amount of correspondence they had received on the issue, and yet those thousands of protestations (protestations from the people who use and rely on the NHS every day) went unheeded.

What an extraordinary situation we find ourselves in: a situation in which we, citizens in an ostensibly democratic country, must beg Lords for our healthcare, like grubby serfs. Is it not even more extraordinary when the clear will of the public is completely disregarded in favour of a few extra pounds for some American healthcare providers?

There is no support for the changes that this Bill will bring about. The public does not support the legislation. Medical professionals do not support it. The only group that does support it is the government – and, of course, the private health companies.

The social contract, the contract under which we allow ourselves to be governed, is now broken. The government has demonstrated that it has no intention to act within the boundaries of democracy. We are therefore no longer obliged to keep our dissent within the boundaries of the law.

As a demonstrator at this weekend’s Westminster Bridge rally said: if the government won’t work for us, we must stop the government working.

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