Norfolk MP Norman Lamb’s white-knuckle ride on NHS reforms
When asked to sum up the last few days, it's clear it has been a busy and stressful time for North Norfolk MP Norman Lamb since he appeared on the BBC Politics Show on Sunday morning.
Norfolk MP Norman Lamb has spoken of the 'white-knuckle ride' he has experienced since taking the biggest political risk of his career so far by speaking out about the controversial NHS reforms.
'It's quite a white-knuckle ride whenever you speak out. I realise I'm taking a big political risk and inevitably I'm under a lot of pressure, but I genuinely think it's in this Government's interest to do it.
'If it's difficult for me personally, I have got to handle that, but it's in the Government's interest and, most important of all, in the interests of the NHS and patient care.'
As chief parliamentary and political advisor to the deputy prime minister Nick Clegg, the Liberal Democrat MP became the most high profile member of the current Government to publicly voice his concerns about the Health and Social Care Bill.
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Mr Lamb did tell Mr Clegg what he was going to do, but it remains behind closed doors whether this was with or without his leader's blessing.
Cynics have painted Mr Lamb's public criticism of the health reforms as a planned act aimed at garnering more support for a Liberal Democrat Party that has lost popularity since forming the Coalition with the Tories. They also point to the impending local elections next month.
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This is clearly something that upsets Mr Lamb, and he admits he finds it depressing that there should be so little faith in the motivations of politicians.
The former Lib Dems' health spokesman says: 'I have intervened because I feel strongly about the NHS and the need to protect it. Having done health for three-and-a-half years I know a bit about it and I felt it was right I intervened at this stage, to raise my concerns and my motivation is to get it right for the NHS and for patients.
'That's my sole motivation in this and my hope is that people won't assume every action of a politician is a cynical act driven by party advantage or elections. Politicians can sometimes act because of something they believe in strongly and that's what I am doing.
'I want to use this period constructively, to seek to influence debate so we get it right.'
It was back in 2001 that the fresh-faced new MP secured his first debate - which happened to be on orthopaedic waiting times, and he said that it had been a particular area of interest for him ever since.
'I have always campaigned on health and I can't ever escape from it. I'm actuely interested in how we get the system working efficiently to improve care and do it in a cost effective way.'
So it is no surprise that he says that change is necessary, because health costs are rising in every country across the developed world, but there is no extra money so reforms are vital.
But the plans to hand over the majority of the NHS budget to GPs has caused widespread concern.
At a heated public meeting in Norwich last week, organised by Keep our NHS Public, the reforms were described as an 'ideological attack' on the NHS. But Mr Lamb says he remains comitted to the key principle of the NHS. 'I and the Lib Dems and the Government as a whole have made it very clear there is a complete commitment to the central commitment of the NHS for people to get care free when they need it, irrespective of their means.'
It's no secret that when they were both shadowing the health brief, Mr Lamb and Andrew Lansley had an almighty falling out in the run up to the general election over the financing of long-term care for the elderly.
Now that Mr Lamb has spoken out, some political commentators are describing this as 'a fight to the death' between the him and the health secretary over the NHS.
It's clear that he was pushed on The Politics Show into stating whether this was an issue over which he would resign, and his clarification on this is: 'I would hope that any principled politician would not go along with something they are fundamentally concerned about'.
What is not clear is just how many changes will need to be made for Mr Lamb to feel that he no longer has fundamental concerns about the NHS reforms.
Mr Lamb's wish list of amendments or additions to the reforms:
Top of his list is accountability. 'GPs would be spending a lot of public money and we need them to be accountable for the way in which that money will be spent. Getting that right is critical.'
Exactly how to do that is the hard part, and when asked how this could be achieved, it is clear Mr Lamb is still keen on the model he drew up as the Lib Dems' health spokesman - a sort of slimmed-down version of PCTs called local health boards which are elected, not appointed, which then devolve a substantial amount of power and responsibility to GPs. But within the remit of the current Health and Social Care Bill, he would like to see Health and Wellbeing Boards strengthened. Currently they will be set up by local authorities, like Norfolk County Council, and will have at least one councillor, directors of adult social services, children's services and public health, as well as a healthwatch representative and representatives from relevant commissioning consortiums, but so far it apepars the GP consortia will only have to pay regard to the board's recommendations. Mr Lamb said one change could be that local health plans have to be agreed with these boards. 'That's one option and to a degree I have got an open mind about the precise shape but what I'm saying is it needs to be addressed. It's a weakness of our current system that exsiting PCT boards are appointed and not accountable.'
He says GPs, and other health bodies, should hold their meetings in public and transparency is vital to avoid any conflicts of interest, particularly when GPs have financial interests in private companies.
He's also calling for clarity on strandards of governance and competency which need to be met before GPs can take on responsibility for budgets.
Private providers and competition:
In his own health blueprint for the Lib Dems, Mr Lamb put forward that there should be no state monopoly of provision of healthcare, but he stresses that the key driving force behind private involvement must be the care of the patient.
He believes essential services should be exempt from private providers or competition, and that the question 'is this in the interests of the care of the patient in the NHS?' should be asked before involving private providers. 'You can't have competition on A&E. You have got to have an A&E that serves the community and can't undermine it. But for various elective procedures it might make sense to allow the patient to choose.' He said a good example of private sector success story was Circle Nottingham, which is 50pc employee-owned, and which had reduced costs by 15 to 20pc by redesigning the operating process, while at the same time maintaining high standards.
Rights to treatment within 18 weeks
Mr Lamb points out that the NHS Constitution gives a right to the patient to be treated within 18 weeks. He says: 'If not then they have the right to be treated privately but no one is told about this right. Not many people even know about the NHS constitution - shouldn't we be telling people about that right with a legal duty to inform patients about their right to be treated elsewhere if they are not treated within 18 weeks? That would act as an incentive to the system to ensure they treated people on time.'
Mr Lamb says colleagues across the political spectrum are signed up to empowering GPs, but he adds: 'We don't want to impose a new system on people before they are ready because the consequences of new organisations taking over before they are ready and before we have learned the lessons of how it works could lead to financial failure at a time when the money is so tight.'
There should still be pressure for GPs to take on responsibilities and services and it should be impossible for GPs to opt out of reform, but this needs to be more of a gradual process or it could be 'incredibly dangerous'.
He adds: 'I would like to move away from a big bang transfer - in essence I want a shift from revolution to evolution.'
Roles for other clinicians
While putting other clincians formally on to the commissioning consortia could lead to a conflict of interest (for example a hospital doctor could influence where GPs send patients), Mr Lamb does believe that other clinicians need to have a key role.
He suggests one way of doing this could be to have them represented on the Health and Wellbeing Boards.
One of the criticisms has been that using more private providers will lead to more secrecy over how public money is spent, as 'commercial sensitivity' is cited to protect the value of contracts. 'We need to interpret commercial confidentiality very narrowly. In some circumstance it genuinely has to be kept private, but that ought to be the exception and not the rule. The public has a right to see where the money goes.' He said rules could be changed to make it more diffuclt to justify secrecy.
NHS trusts going bust
'What we have to ensure absolutely is that a hospital that is run for a community's benefit can't simply go bust and disappear. There have to be mechanisms in place to prevent that from happening - to keep it running and maintain essential services.'
NHS Commissioning Board
The idea is to have an NHS Commissioning Board that helps to oversee the GP consortia and which also commissions some of the more specialised health services. Concerns have been raised about the accountability of this body, and Mr Lamb says he wants to see to have the same standards of accountability, governance and transparency that you would expect of other public bodies.