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May 18, 2011 6:07 pm
Where will the Liberal Democrats end up on competition in the National Health Service and the role of Monitor, the new economic regulator? Heaven may know. They do not.
On a day when the debate within the coalition teetered close to farce, Andrew Lansley, health secretary, found himself diving for a taxi to avoid questions from reporters over whether remarks by Nick Clegg, the deputy prime minister, marked “the end of the bill”.
The Lib Dem leader has signed a policy document declaring that “the decision to establish Monitor as an ‘economic regulator’ was clearly a misjudgment” and “I have come to the conclusion that we must not make this change”.
He told Lib Dem peers and MPs on Tuesday night: “There must be no change in the way competition law operates in our NHS. No to establishing Monitor as an economic regulator as if healthcare was just like electricity or the telephone, and no to giving anyone in the NHS a duty to promote competition above all else. This is a veto.”
It is also sophistry. The bill does not require Monitor to promote competition “above all else”. It requires it to protect patients’ interests “by promoting competition where appropriate, and through regulation where necessary”.
The intervention has enraged many Tory MPs, who on Wednesday evening pointedly cheered Mr Lansley during the weekly meeting of the backbench 1922 committee.
It also left Mr Lansley fumbling as he spoke at the King’s Fund health think-tank, defending the role of competition and extolling its ability to produce joined-up care, not fragmentation.
Asked if Mr Clegg’s declarations were acceptable, Mr Lansley insisted that the bill “does not change competition law inside the NHS” but that Monitor would be there “to make sure that where there are abuses in terms of competition, it will take steps to prevent that happening”. The creation of Monitor as an economic regulator, he pointed out, was “in the coalition agreement”.
Many lawyers say he is broadly right. Much of competition law already applies and is overseen by an advisory body, the independent NHS Co-operation and Competition Panel. It has sometimes ruled that the NHS is in breach of competition principles and sometimes that mergers of hospitals and community services are in patients’ interests.
The policy document Mr Clegg put his name to says the panel should continue as an advisory body to the revamped Monitor, which itself “should be empowered to ... act against anticompetitive practices”, although “only when this is in the interests of patients” and equality of access.
Evan Harris, the former MP who is vice-chairman of the Lib Dems national policy committee, said its MPs “will not vote for Monitor to be an economic regulator”. Monitor should promote collaboration but also be free to “enable competition where appropriate”, he said.
This sounds like a distinction between promoting and enabling competition. What the party was saying, Dr Harris said, was not “no marketisation” but “no more marketisation – because it is very hard to row back from where we are now” without lawsuits. Crystal clear, that.
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