Thinking about what is going on behind closed doors in Westminster, I decided to take a look at how amendments are passed to the bill and the process that this involves. The transcripts are freely available on the parliamentary website for reading if you happen to find a spare couple of days. As I do not have a spare couple of days, as do very few people, what follows are some points, and examples of amendments, from the debates between 8th and 11th February, with more to follow in due course.
The first 4 sittings were to hear evidence from parties such as The King’s Fund, Royal College of General Practitioners, NICE, Department of Health, the Chief Executive of the NHS itself, chairman of the BMA, directors from areas of the NHS framework including Monitor and Primary Care Trusts. This was an opportunity to discuss the bill as it was published on 19th January, and hear the pros and cons of the propositions as interpreted by “experts” in the field.
However, this is not the area on which I shall dwell, for I feel it is far more important to look at how democratic the process of passing amendments to bills is, and just how the potentially crucial debates are occurring within these meetings. What I saw caused me equal grief, humour and amazement.
For those of you who are unaware of the processes that are entailed in passing an amendment, here is a brief summary:
- Committee is made up of 25 MPs (variable between 16 and 50)
- Governing party always has majority representation
- Amendments can be made by both government and opposition
- Amendments and their reasoning are then debated amongst the committee with it either being withdrawn of voted on where it can either be rejected or accepted.
Proposed by Derek Twigg (Halton – Labour):
clause 1, page 1, line 9, after ‘has’, insert
‘and is accountable to Parliament for’.
This amendment was regarding the Secretary of State’s accountability for the NHS. There is no-where in the Bill that implicitly states that he will be accountable for provision, maintenance and improvement within the NHS. The Conservative counter-argument included quotes such as:
“It will not make any difference” Mr Simon Burns
“Amendment implies that the Secretary of State is not accountable for every other thing in the Bill unless we use those very words” Jeremy Lefroy (Stafford – Con) “Resulting in diminishment of accountability”.
As with all parliamentary debates there is a lot of arguing and nit picking, as anyone who has watched Prime Minister’s Questions will know. However, within this enclosed and more private arena, the maliciousness can unfold:
“Grahame M. Morris (Easington – Labour): Will the Minister explain for Labour Members and for Government Members—a number of them have raised the issue—about unit reconfigurations and hospital closures? If, as the Minister indicates, in relation to a fundamental principle of the Bill—
The Chair: Order. Do not be tempted to reply to that, Mr Burns.
Mr Burns: Mr Hancock, you are as always absolutely right. I am afraid that the hon. Member for Easington is trying to tempt me down a path where I would be slapped down, no doubt in the nicest way possible, by the Chair.”
Inevitably, the amendment was refused with a majority of 13:10.
Proposed by Derek Twigg:
“clause 1, page 2, leave out lines 1 to 4 and insert—
‘(b) must for the purposes of section 1 provide or secure the provision of services in accordance with this Act and the NHS Constitution, through exercising functions in relation to a body mentioned in subsection (2A).’.
It is an important amendment that will explore some of the Government’s thinking on the Bill. The basic aim is to ensure that legislation reflects the rights and duties of the health service to patients in guaranteeing excellence in care under the NHS constitution.”
It was during the debate on this particular amendment that Simon Burns came under particular attack from both the opposition and the chair on a comment he made regarding Nye Bevan;
“it was the boast of Nye Bevan—I apologise for having to mention him in front of Labour Members—in 1946 or 1948 that he wanted to hear the clanging of a bedpan on the floor of Tredegar hospital, which is the ultimate in political control and micro-management. Fortunately life moved on from there.”
The Chair of the committee asked Simon Burns to stop being provocative, to which he replied;
“I thought they would be flattered”
If the implications of this bill were truly to be considered by not just the labour party but realistically viewed, in an unbiased manner, as lay-people with no party line in which to draw, then a proper debate could occur. Naïve as though it may seem for this to be true, it would surely demonstrate a much more democratic process and would certainly reduce the barrage of insults that members from both parties receive.
Refused with a majority of 13:10.
Proposed by Derek Twigg:
“clause 1, page 2, line 6, leave out ‘Commissioning’.
The Chair: With this it will be convenient to discuss the following: amendment 41, in clause 5, page 3, line 22, leave out ‘Commissioning’.
Amendment 42, in clause 5, page 3, line 25, leave out ‘Commissioning’.
Amendment 30, page 221, line 5 [Schedule 1], leave out ‘Commissioning’”
Was quickly debated with only a small number of insults around how Kevin Barron (Rother Valley – Labour) was scowling at The Chair; and was opposed at 13:11.
Proposed by Derek Twigg:
“Clause 1, page 2, line 7, leave out ‘commissioning consortia’ and insert ‘primary care trusts’.
The Chair: With this it will be convenient to discuss the following: amendment 62, in clause 6, page 4, line 3, leave out ‘commissioning consortia’ and insert ‘primary care trusts’.
Amendment 63, in clause 6, page 4, line 4, leave out ‘commissioning consortia’ and insert ‘primary care trusts’.
Amendment 64, in clause 6, page 4, line 5, leave out ‘commissioning consortia’ and insert ‘primary care trusts’.
Amendment 65, in clause 6, page 4, line 7, leave out ‘commissioning consortium’ and insert ‘primary care trust’.”
An interesting suggestion came during the debate from Grahame M. Morris regarding a suggestion that John Pugh (Southport – Libdem), interestingly the only Libdem on the committee, made during the evidence debates:
“take the existing PCT structures; slim down their management costs by 30%, bring in clinicians, and perhaps not just from primary care, to take note of the evidence that we have received as a Committee; and bring in more clinical expertise, including from the secondary sector, and clinicians from other areas, such as nursing in particular, and let those people dominate the board.
We might also want to bolt on additional democratic accountability and some outcome measures, keep the institutional memory of the PCTs, the acquired skills that they have been built up, and their coterminosity with their local authority boundaries. Producing less upheaval and risk, and saving money while creating very few new organisations.”
John Pugh replied in gratitude but also stated that the amendment,
“would provide for only a change of wording”.
With much deliberation over the role and reputation of the PCTs, the amendment was refused at 11:13.
The first of the amendments to be proposed by the government rather than the opposition.
Proposed by Mr Burns:
“Clause 1, page 2, line 13, after second ‘and’, insert ‘paragraphs 7C, 8 and 12 of’.
The Chair: With this it will be convenient to discuss Government amendments 2 and 3.
Mr Burns: I hope that we can deal with the amendments fairly swiftly because they are minor and technical. They clarify two things. The first is that research is not solely a public health function, but spans both public health and the NHS; secondly, they deal with the definition in clause 1 of local authorities’ public health functions.”
My favourite political quote of all time followed from Grahame M Morris:
“Only eight months ago, the coalition agreement stated that there would be no
“top-down reorganisations of the NHS” to get “in the way of patient care.”
If something walks, talks and quacks like a duck, it probably is a duck. To me, this looks like a top-down reorganisation.”
Unsurprisingly, this amendment was accepted by the committee at 13:11.
Perhaps unfairly to the Committee I did perhaps assume that there would be less political line towing, and more common sense employed in their deliberations. But as of yet very little seems to be changing within those four walls, and it may possible be reliant on the parliamentary vote, or that of the Lords to prevent a disruption of the NHS by the Tories.