The arguments over the health bill continue to rumble on and the consequence of the debate is that any light shed on the substance of the proposals has been lost in the heat of political discord. I am but a humble pundit and my conclusions can be oversimplified thus:
1. Labour is being about as dishonest about this Bill as it is possible to be. There is not one single, solitary measure in the proposals which was not being introduced during the last Labour government. Any Labour politicians who says otherwise is lying. Bare-faced, Pinocchio-nosed lying. Competition, GP commissioning, private companies providing care - with huge government subsidies and few targets, fragmentation of the service - all were introduced, or extended, under Labour. The difference with the current proposals is that they offer a coherent approach to the piecemeal New Labour 'let's try this and see what the focus groups say' approach. It may not be everyone's cup of tea but it has the aim of improving the service for the long-term. Labour tinkered and threw money at the NHS, keeping it chugging along while the costs rose and rose; the coalition government is trying to redesign it to work for another 60 years as we all get older and need more and more interventions to keep us chugging along. You can't blame Labour for trying to derail the proposals but their dishonesty is breathtaking.
2. The Lib Dems support the spirit of these changes and we should have the courage to support the letter of them as well. Our Peers are acting on solid principles but if they continue to insist on major changes the Bill will be blunted beyond any practical use and we will look like we twist with the wind on health. That is Labour's role. I don't suppose anyone loves the proposals unreservedly but they are coherent and they are government policy. We should support them - not without reservation but without the impression of panic every time another Royal College (who knew there were so many?!) comes out against the changes.
3. No one likes change. If someone came along to your company and told you that a shadow office would be set up to compete with you for work, you'd probably be fed up as well but that's the modern world of public sector service provision. I experienced it in the 1990s in the local authority I worked for and it stank and completely demoralised the staff. It happened twice, which did nothing to the general mood. However, by the time I left the organisation was incalculably leaner and fitter, proving that the nasty medicine worked there - not without tears but it did work. Because of my personal experience of this process I am not completely for the proposals and I sympathise with the poor people who will have to introduce them. However, I recognise that something has to change in the NHS.
4. The Tories did promise no major changes to the NHS and they broke that promise. We didn't. Let them fight that battle, not us.
The analogy that comes to my mind is an old VW camper van. Everyone loves them and there are lots of old ones on the road which have been patched up and repaired to within an inch of their rivets but there will come a time when the trusty old wagon will not be economically repairable any more. The choice then becomes to pay over the odds or to try something new.
I have always used the NHS and I always will. I believe completely in public sector provision and I am 100% convinced that the NHS will remain free at the point of use and that the service I receive will be just as good, if not better, once the proposed changes are introduced. I wish Lib Dem peers with the power to ruin us at Westminster would recognise this.
If the proposals fail, the government fails and the Lib Dems are done for. So here's a mad idea for the day. Why not suggest that a Lib Dem minister takes over from Lansley in delivering this policy. The poor 'volunteer' would have to be dragged to the Department of Health by several teams of wild horses but they could then set about explaining the changes, which Andrew Lansley has not done. I don't think he has done anything wrong: his only crime has been to stick to his principles, which any sensible politician knows never works. A Lib Dem Secretary of State for Health would be able to present a fresh approach and demonstrate that the Lib Dems can deliver tough changes. They wouldn't become wildly popular but the legacy for our party could be immense. I wouldn't dream of suggesting who that lucky volunteer might be but we have the people to do this and do it well.
The Tories would be delighted because they would perceive the pressure moving away from them but a good Lib Dem Secretary of State could damn them robustly for the manner in which the proposals were introduced, while still playing with a straight bat on getting the sensible changes implemented.