This weekend’s NHS vote is the Lib Dems’ last chance

10 March 2012: Colin Leys says party members face a choice – is loyalty to their leaders more important than the future of the health service?

Nick Clegg is urging Lib Dem members meeting in Gateshead to ‘move on’ from ‘divisive’ debates about the NHS. But is the party really divided over the NHS? Most Lib Dems I know are for the NHS – not uncritically, but passionately too. What really divides them is whether to let their leaders underwrite its destruction.

A crucial moment was missed in the summer of 2010 when Andrew Lansley published a white paper that proposed to do exactly what the coalition agreement said would not happen (‘We will stop the top-down reorganisations of the NHS that have got in the way of patient care’). The leadership failed to take a stand on principle and refuse to support Lansley’s project. As the Lib Dem peer Lord Greaves pointed out in the Guardian on Friday, they missed a second opportunity at the time of the ‘listening pause’ last year.

Ever since then, Lib Dems have been caught between loyalty to their leaders and loyalty to their principles, with the NHS the focus of both. The final act in this drama is now under way. The last batch of Lib Dem amendments to the bill – which Nick Clegg and Shirley Williams, in a letter to party members, assured them would complete the preservation of the NHS – have since been withdrawn, entrusted to ‘assurances’ given by the Conservative minister of health, Earl Howe. The bill will now reportedly be rushed through the Commons and given royal assent in less than two weeks’ time.

What everyone who has seriously studied the bill knows is that none of the ‘concessions’ secured by the Lib Dems in the Lords, including those that have now been entrusted to the assurances of Lord Howe, seriously affect its real aims. The Lib Dem peers know in their hearts that by ‘winning concessions’ but voting with the Conservatives on all the key elements in the bill they have actually enabled Cameron and Clegg to pass a law which is strongly opposed by most of the public and by virtually the entire NHS workforce.

Even pro-market health policy experts think it will increase costs, reduce the quality of care, increase inequality, increase fraud, and diminish trust in doctors. It involves a reorganisation of the kind the prime minister promised explicitly not to undertake, and it has begun to be implemented in advance of any legislative authority, with already costly and chaotic results. As Lord Owen justly says, it is a constitutional outrage.

For party members who pride themselves on belonging to a party of principle, dedicated to democracy, openness, and all forms of integrity, the dilemma is acute. If they ‘move on’, they will be moving on from being that kind of party. If they decline to move on, and refuse to hand over the NHS to the multinationals, they will create a lot of trouble but will save their reputation for honesty and for being genuinely committed to the NHS and the values it represents.

Colin Leys is an emeritus professor at Queen's University Canada and an honorary professor at Goldsmiths College London. He is the author with Stewart Player of The Plot Against the NHS