Earlier this evening I seconded an amendment to the Health and Social Care Bill which would have placed “a duty of candour” on those providing health services requiring them to disclose “full information to patients, their carers or representative about any incident or omission in or affecting their care which may have caused harm, or may in the future cause harm.”

My speech was as follows:

“Lord Harris of Haringey: My Lords, when I was director of the Association of Community Health Councils, the message from community health councils around the country was that people who complained were seeking not compensation from, or retribution against, those who had perhaps caused the reason for their complaint—for example, the death of a loved one—but information. They wanted to know what had happened, and they wanted some reassurance that what happened to them or their relatives would not happen again.

Always, the most tragic cases were those in which people had not known what had happened and discovered the actual circumstances only much later, perhaps when their relative’s case came to an inquest or, in some cases, even long after that. I would like to hope that, in the 10 years or so since I was director of the Association of Community Health Councils, this problem would have become less, but it remains a serious blemish on the health service that, too often, such mishaps are covered up.

In a case reported only three weeks ago—the most recent case that I have come across, but I am sure there are many others—a mother discovered long afterwards that the death of her seven year-old daughter, which she had blamed on herself for not being able to perform the necessary first aid, was actually the consequence of a failure by a paramedic called to the scene. She discovered that only ages afterwards when she became aware of the transcript of the inquiry which led to the paramedic being dismissed. That case, reported in the Doncaster Free Press only three weeks ago, is an indication of the sorts of incidents that one is talking about.

I met the family of someone who had died while detained in a secure mental health facility. They discovered the circumstances in which their loved one had died only when the matter was reported at an inquest. In such incidents, the health service officials knew what had happened and had conducted their own inquiries but did not think it necessary or appropriate to tell the families concerned. That is why it is so important to have this amendment, which would place a statutory duty of candour on the health service, to make it something that runs right the way through the system.

Of course, accidents can never be eradicated. Healthcare is of its very nature a risky business and health professionals are only human, so these things will happen. However, what is unforgiveable is that the fact that something has gone wrong is not told to those concerned. The noble Baroness, Lady Masham, quoted Sir Liam Donaldson, but I thought that she was also going to quote the maxim that he gave:

“To err is human, to cover up is unforgiveable”.

That is precisely the concern that motivates this amendment.

In the White Paper Equity and excellence: Liberating the NHS, the Government said that they will require hospitals to be “open and honest” when things go wrong. That stems directly, I think, from the Liberal Democrats’ manifesto commitment, but, unfortunately, their manifesto referred only to hospitals rather than to the wider health service. I think that the Liberal Democrats intended that such a duty should be statutory, but my understanding is that the Department of Health is looking at this as something that could be written into contracts. As the noble Baroness, Lady Masham, has pointed out, having a lesser status than a requirement to inform a central agency that something has gone wrong would mean a lesser status in terms of informing the family. It is really important that we look at this issue and take it seriously, so I hope that the noble Earl will accept the amendment.

In 2005, a National Audit Office report revealed that only 24 per cent of NHS trusts routinely informed patients of a patient safety incident—that implies that more than three-quarters of NHS trusts do not do so routinely—and 6 per cent admitted that they never informed patients of a patient safety incident. Quite clearly, there is a “culture of denial”. Noble Lords may think that that is rather an alarmist statement, but I am simply quoting from a Department of Health document from 2006.

Lord Mawhinney: My Lords, I am extremely grateful to the noble Lord for giving way. I do not want him to interpret my question as opposition to the general point that he is making, but before he finishes will he say a word about the role of lawyers of health service bodies in these circumstances? I am not a lawyer, as I have told the House before, but in both cases that he has cited I could see legal advisers saying, “Say nothing”. If we are to take this amendment seriously, we need to have some idea of what part the law might play if the Bill were to be so amended. As the noble Lord has experience, I would be grateful if he would reflect on that.

Lord Harris of Haringey: My Lords, the noble Lord, with all his experience—albeit, like me, as a non-lawyer—is speaking exactly the truth. In many of those cases, the legal advice would be, “Say nothing”. There therefore needs to be a statutory duty, because then the responsibility of the lawyers concerned would be to advise, “There is no option but to tell the patients or their families”.

An interesting point is that insurers in the United States often require open disclosure policies and practice by health providers to qualify for insurance. The international evidence is that, as well as being the right thing to do morally and ethically, being open and honest when things go wrong can actually reduce litigation and complaints.

My concern is that the Government will say that they are doing enough by saying that the duty of candour can be achieved through a contractual process. However, as the noble Baroness, Lady Masham, has pointed out, this would apply only to hospitals with an NHS contract; it would not apply to GPs, dentists, pharmacists or private healthcare providers. I do not see why the duty of candour to patients and their families should be regarded as of lesser importance and impact than those things where there is direct regulation. I hope that the Minister will say that the Department of Health will take this away and that he will come back to the House with proposals to give a statutory duty of candour to protect the interests of patients.”

After a debate of over 90 minutes, the Minister was not prepared to concede a statutory duty of candour although the Government is consulting on how they might make a “contractual” duty of candour work.

I am sure there will be more debate on this at the Report Stage of the Bill.

Eight days ago, the House of Lords adjourned in mid-debate on an amendment to the Health and Social Care Bill which would have restored the role of the Secretary of State for Health to “provide or secure the provision” of health services (which the Government’s Bill would have taken away).

Adjourning in mid-debate is a pretty rare (if not unique) procedure, but it has allowed for all sorts of last minute discussions to take place behind the scenes before the debate resumed this afternoon.

The original amendment was moved by Baroness Williams of Crosby (Shirley Williams as was) and was signed by Lord Patel (former President of the Royal College of Obstetricians), Baroness Glenys Thornton (Labour spokesperson on health in the Lords) and Baroness Margaret Jay (former Leader of the House).  Also debated at the same time was an amendment from Lord Mackay of Clashfern which talked more vaguely about the Secretary of State having “ultimate responsibility to Parliament for the provision of the health service”. 

In last week’s debate, I commented:

“I rise to speak to the amendment in the name of the noble Baroness, Lady Williams of Crosby, because this is an issue that requires greater clarity, and the debate and discussion that has already taken place in Committee this evening demonstrates why that is so. As my noble friend Lord Warner has reminded us, Professor Malcolm Grant, the newly appointed chair of the national NHS Commissioning Board, has made clear what appears to be the Government’s intention with regard to the role of the Secretary of State. I assume that he did so under advice, because you do not take on a role like the chair of the NHS Commissioning Board without extensive discussions with Ministers and civil servants. He must have been briefed on the matter and quite clearly the intention is to separate out the day-to-day responsibility and answerability of the Secretary of State. There has to be some clarity on this point. …

 I have some reservations about the wording used by the noble and learned Lord, Lord Mackay, in that he talks about ultimate responsibility. We may have an inkling about what ultimate responsibility means, but I wonder where else in legislation a phrase such as this is used. I defer of course to the noble and learned Lord’s far superior knowledge of the law. However, in my limited experience in this House, I have never before come across the words “holds ultimate responsibility to Parliament”. It seems a very strange usage and I think that there needs to be greater clarity and understanding about what it means. That is why it might be better to revert to the wording chosen by the noble Baroness, Lady Williams. It is tried and tested and at least we understand it.  …

The final test that your Lordships need to consider is: what do the public expect? The public’s expectation is that government is responsible for what happens in our health service; and unless there are locally elected officials who are responsible for what happens at a local level, they will expect their elected Government to be responsible, and that means the Secretary of State.”

The Government had indicated that they were prepared to accept the Mackay amendment – indeed eight days ago they announced that the amendment had been agreed, even though the debate had not been finished.  And Baroness Williams had also hinted in her speech that she might accept the “compromise” offered by Lord Mackay.

Labour Peers, however, were standing firm and had indicated that they would divide the House on the Williams amendment even if she tried to withdraw it in favour of the Mackay version.

The Government was clearly running scared and at the last minute – just as the debate resumed this afternoon – indicated that if both amendments were withdrawn they would consult all sections of the House to try and find a form of words that would be acceptable to everybody.

There followed forty-five minutes of debate when all sides of the House indulged in an orgy of mutual admiration on reaching a sensible way forward.

This orgy, however, began to go rather flat (if that is not an inappropriate metaphor) when the Minister, Earl Howe,  having promised further discussions then began to explain in some detail why the Government disapproved of the Williams amendment, saying:

“In future, all NHS services will be provided by NHS trusts or foundation trusts, both of which have their own self-standing powers to provide services and do not rely on the Secretary of State’s duty to provide under Section 1(2), or by independent providers. The Secretary of State will have no powers to provide NHS services. That is the reality.  …

There is another reason why it would be wrong to reinstate the duty on the Secretary of State to provide. Under the legal framework of the Bill, the Secretary of State no longer possesses powers to direct others to provide services. Therefore, unless we were to re-impose a system of regulations or directions by which the Secretary of State could delegate his duty to provide and control its exercise, which would risk replicating the micromanagement of the status quo, it is hard to see how this legal obligation to provide services could be fulfilled. For obvious reasons, it would be undesirable to create a situation in which the Secretary of State provided services himself. Also, in practice he would lack the capacity to do so, for example in terms of staff and facilities.”

At which point, the House began to become rather restive – the Minister seemed to be saying that there could only be more discussions provided the eventual wording still restricted the role of the Secretary fo State and the right of Parliament to scrutinise what was happening in the NHS.

So, Baroness Patricia Scotland interrupted:

“My Lords, I hesitate to intervene on the noble Earl, who knows I hold him in the highest possible esteem, but I think he is now treading on some contentious legal issues. Bearing in mind the wonderful consensus that we have now reached, I would just ask him to consider whether, at this stage, some of those issues are really helpful because the noble Earl will know that the Secretary of State does, by his servants, agents or otherwise, provide services and, indeed, there have been times when there has been a pandemic when the Secretary of State has had to make such provision. These are contentious issues which I am sure could intrigue us for many hours, but since we have happily come to the conclusion that we have had a surfeit of such happiness and wish to go forward, I gently say to the noble Earl that this might be a moment when we could swiftly do that.”

Then Baroness Glenys Thornton had a go:

“I respectfully say to the Minister that we could start the whole debate all over again if he continues telling us what the Government do or do not believe on this because that is presupposing, and possibly pre-empting, the discussions that we are about to have. The noble Lord may find it useful, but we have had a lot of this discussion. We have now, I thought, agreed to move into discussions outside the Chamber.”

The Minister kept reiterating that he thought it would be helpful to put on the record the Government’s position.

As he seemed to be preempting future discussions, I tried to get some clarity which elicited the following exchange:

“Lord Harris of Haringey: I appreciate that the noble Earl is moving to a position of not addressing those questions, but it is important that he tells the Committee whether the Government have a fixed mind on these matters or whether they are going to approach with an open mind the discussions that we, in an outbreak of consensus, have agreed should happen and try to build on that consensus. If the views are closed, it raises some very difficult issues for the Committee.

Earl Howe: No, my Lords, there are no closed views. That is the reason why I suggested earlier that it was time to reflect and engage in discussions in the spirit of co-operation. I would not have said that if I had had a closed mind to them. There would not have been any point in the discussions. I simply wished to do noble Lords the courtesy of answering their questions and addressing the points that they had made. If noble Lords would rather that I did not do that, then we can make life easier for ourselves. I will certainly write to noble Lords if they would like to inform me afterwards that they wish to receive a letter. If they do not, I will not write. It is entirely up to them. I do not wish to make work for myself unnecessarily.

I have said that I believe the balance of advantage for this Committee lies in our agreeing collectively not to amend the Bill at this stage and I am pleased that there seems to be consensus around that view. I believe instead that it would be profitable for me to engage with noble Lords in all parts of the House, both personally and with the help of my officials, between now and Report to try to reach consensus on these important matters. I would just say to my noble friend Lord Marks that that includes the issues that he has helpfully raised this afternoon. I believe that he is right to associate Clause 4 in particular with the matters that we have been considering. Those discussions can be carried out in an informal way with interested Peers or in individual meetings in the House or my department. There is a place for either type of discussion. My concern is only that it is an inclusive process involving Peers from all sides of the House, and that will include listening to the views of the Constitution Committee should it choose to continue its valuable role.

With that, I hope that no noble Lord will feel cheated by the brevity of my contribution and I shall sit down.”

So we’ve been promised discussions and a Government with an open mind.

We’ll just have to wait and see what transpires.

 

 

The first day of Committee stage consideration of the Government’s Health and Social Care Bill is taking place in the House of Lords today. 

To no-one’s surprise the LibDems again demonstrated that they are happy to place their loyalty to the Coalition with the Tories above the future of the National Health Service. 

They voted en masse to reject a Labour amendment which would have reaffirmed the basic principles of the NHS as the first clause of the Bill.

The amendment was to begin the Bill by stating:

“Principles of the Health Service in England

(1) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England must have regard to the principles and values outlined in the NHS Constitution.

(2) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England, or providing services as part of the Health Service in England, must provide quality, equity, integration and accountability, not the market.

(3) The primacy of patient care shall not be compromised by any structural or financial re-organisation of the Health Service in England.

(4) There must be transparency and openness wherever taxpayers’ money is being spent, and all accountable individuals and bodies should abide by the Nolan principles.

(5) “The Nolan principles” means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850).

(6) Schedule (Principles of the Health Service in England) has effect.”

The amendment was rejected by 212 votes to 244.

59 Liberal Democrats voted against the amendment with only one (Baroness Tonge) in favour.*

So can someone just remind me – after all the fuss about how the LibDems were going to fight for the NHS – when did they decide that it wasn’t necessary to require providers of health and social care to provide ”quality, equity,  integration and accountability”, when did they decide that it doesn’t matter if the primacy of patient care is compromised by structural or financial re-organisation, and when did they decide that the Nolan principles of public life weren’t necessary for those responsible for the provision of the NHS?

 

*  The full figures were as follows: in favour of the amendment - 172 Labour Peers, 37 Crossbenchers and others, two Bishops and one LibDem; against the amendment – 147 Tory Peers, 38 Crossbenchers and others, and 59 LibDems.

Earlier today I chaired a fascinating seminar for patient groups and professional organisations which discussed healthcare acquired infections (HCAIs) and, in particular, what needs to be done to better prevent such infections in community (rather than hospital) settings.

As the meeting continued, I was struck by the surprising number of parallels that exist between what needs to be done to cut the risk of such infections and what needs to be done to improve information security.

For example, there were those a few years ago who thought the situation with HCAIs in hospital was so bad that nothing effective could be done.  They have been proved wrong by the success of the initiatives taken over the last five or six years to reduce dramatically the incidence of MRSA and C Difficile in hospitals (80% and 60% reductions respectively). Likewise there are those who throw up their hands in horror about the current tide of cyber security problems and seem to believe that our systems will always be irredeemably compromised.  Hopefully, they will also be proved wrong in a few years time.

The response to HCAIs was in the past seen as better and stronger technical solutions (i.e. ever more powerful antibiotics) and, whilst such solutions remain necessary for those who are infected, the sharp reductions have been achieved by other means – largely through achieving major changes in behaviour amongst staff and patients (i.e. better and more effective hand-washing, greater emphasis on cleanliness etc).  This is mirrored by the increasing recognition that social engineering and behavioural change is an enormously important component of better cyber security and information assurance.

Similarly, without being too Cameron-esque about it, we all have to be in this together. Everyone has to play their part.  Thus, patients and their visitors need to understand the importance of washing their hands with alcohol gel and remembering to do it.  In the same way, individual computer users need to adopt precautions to prevent their systems being compromised.  At the same time, product manufacturers must play their part in making their products less vulnerable to infection (e.g. catheter or commode design can be used to make HCAIs less likely, just as computer software and hardware can have security built in).

Likewise, you cannot help but notice that meetings, whether about HCAIs or addressing cyber security, always conclude that more public education is needed and that the message needs to start at primary school ….

Well, I thought they were interesting parallels ….

After sixteen hours of debate on the Second Reading of the Government’s Health and Social Care Bill, the House of Lords voted on two motions.  The Government won both divisions. 

 The first would have killed the Bill outright by declining to give it a Second Reading – a very rare procedural vote in the House of Lords.  The Government won by 354 to 220.

The second vote was on a motion to refer three parts of the Bill to detailed scrutiny by a Special Select Committee of the House was defeated by 330 to 262.  The total vote reflected the largest turnout of Peers since 1993 (on the Maastricht Treaty - itself the largest vote recorded in the House of Lords since 1831) and it exceeded some of the big votes on Parliamentary Voting and Constituencies Bill. 

The vote also saw 198 Labour Peers voting for the Select Committee referral.  This is the largest vote by Labour Peers ever in the history of the House of Lords.

So where were the LibDems in all of this?

By and large they were with the Tories in pushing the Bill through.  Just two of them (Baronesses Nicholson of Winterbourne and Tonge) rebelled, while 80 (yes, eighty) LibDem Peers trooped through the lobby with 193 Conservatives.  The cross-benchers and others split 56 for the referral motion to 57 against.  The Archbishop of York and five other Bishops also voted for the referral motion.

So the lesson?  You cannot trust the LibDems with the NHS>

The Second Reading debate on the Government’s Health and Social Care Bill has been going on for about thirteen hours with more to come tomorrow.  This was my contribution earlier tonight:

“9.26 pm

Lord Harris of Haringey: My Lords, at this two-thirds point in this debate, I make no apology for focusing my remarks on Part 5 of the Bill, and the quality of the voice for patients that it offers. This Bill is likely to damage irreparably the National Health Service, creating a service that is less accountable and more fragmented; that is increasingly provided by for-profit organisations; and where the relationship of trust between doctors and their patients is undermined. Under such circumstances, an effective structure is essential to support patients in navigating their way through the new arrangements, to ensure that their needs and concerns—both individually and collectively—are not neglected in the brave new world of private suppliers feeding on the remnants of public provision. It is essential to guarantee that, with the democratic deficit that will now open up in health provision in this country, the impact of the changes is catalogued and drawn to the attention of those charged with regulating the new system, of Parliament and ultimately of the public who are paying for it.

I declare a former interest as someone who—for 12 years—was director of the Association of Community Health Councils, then the statutory body representing the interests of the public and the users of the NHS. The Government are now bringing forward another round of proposals to fill the void left by Community Health Councils when they were abolished in 2003. They were succeeded by patient and public involvement forums, which lasted four years before they were replaced by local involvement networks. Again, with a life of four years, LINks are to go, to be replaced by HealthWatch. The sequence of change in consumer organisations is a poor recommendation of the previous Government. I am shocked to see that the current Government are moving forward in a similar vein.

Of course, the Government’s objectives are laudable: “No decision about me without me” is as resonant as previous rhetoric about putting the patient at the heart of the NHS or the mantras about patient empowerment 10 to 15 years ago. Some of your Lordships will even remember John Major’s Patient’s Charter—that daughter of the Citizen’s Charter and that cousin of the Cones Hotline. How does the high-sounding rhetoric match up to the reality of this Bill? How far are patients going to be involved in decisions about managing their own care and treatment? It is simply not clear whether these are adequately safeguarded in the Bill. A duty to promote involvement or a duty to promote choice is not a sufficient guarantee. Who will hold clinical commissioning groups or the NHS Commissioning Board to account for the extent to which they have promoted that involvement or choice? Where will patients go for redress if they find that their family doctor will not refer them for treatment or investigation but insists on managing that treatment or conducting that investigation within the practice, thereby keeping the resource that would otherwise go with that patient? What will be the process for ensuring that key commissioning decisions are in line with the preferences of those affected by them and that those decisions reflect the expertise that patients have in their own conditions and the experience that patients collectively have of their local services?

Presumably we will be told that this is where HealthWatch will come in, but what will HealthWatch mean in practice? The first problem is that it is unclear how local healthwatch groups will be constituted. If individuals are simply going to be self-selected, their views, though valuable, will not necessarily be representative of all service users, and there is a risk that because of that they will not be treated by commissioning groups as having legitimacy. Members of local healthwatch groups need to have their own local accountability and must have the resources to engage with the wider community to be able to assess and represent their views.

Resources will also be necessary to enable local healthwatch groups to provide advice, support and advocacy. This will be an important and potentially substantial role in the brave new world of the NHS that this Bill creates: a world where patients will no longer be clear whether their GPs are acting in their interests or to bolster their practice’s coffers; a world where decisions about what is to be commissioned will be taken with no clear system of public accountability; and a world where for-profit providers will increasingly squeeze out those that are not-for-profit and where profitable treatments will be cherry-picked.

A strong system of patient advocacy and support will be needed, but will it be provided? This will depend on the decisions of hundreds of local councils. The money provided by the Department of Health will not be ring-fenced, and there will be no mandating of local authorities about the nature and quality of HealthWatch services that should be supported. All this is in the name of localism, that same localism that has seen the budgets of LINks drop dramatically this year, in some instances by more than 50 per cent, despite, as the Minister told a number of us last night, the Department of Health saying that it has increased the resources available. The resources went up, but the resources available for local healthwatch went down. It is a localism that means that the Minister can offer us no assurances that those advocacy services that he promises us will be adequate. In future spending rounds who will argue with the Treasury for the moneys for HealthWatch? Will it be the Department of Health, which will have no say in whether the services expected are being delivered, or DCLG, which will have no interest in those services, or will the current commitment be allowed to wither on the vine as no department fights its corner?

Is it even appropriate that local healthwatch groups should be resourced via local authorities which themselves will have responsibilities for social care provision? Is there not a potential or perceived conflict of interest here? How comfortable will a local healthwatch group be in criticising its paymasters about the quality of that provision?

Finally, there is the relationship with national HealthWatch. A national structure is essential for the views and concerns of local healthwatch groups to be captured and articulated at national level, but that national structure must grow from and be a creature of the local groups, not sit above them as a mere sub-committee of a regulator, moreover a regulator to which requests for action and even criticism may need to be directed by that structure.

The new NHS will need a strong and independent user voice. The Government keep citing the proposals on HealthWatch as evidence not only that such a voice will exist but that the patient will indeed be central to the myriad new structures that they are proposing.

Yet the danger is that what we are being offered is no more than a fig-leaf whose own legitimacy will be flimsy, a fig-leaf whose resources will be plundered as local government itself faces a future with rapidly dwindling money, a fig-leaf whose independence is compromised by its relationship with a paymaster whose provision it is supposed to be monitoring, and, above all, a fig-leaf protecting the nakedness and insufficiency of the protestations that no decisions about the patient will be taken without him or her. My Lords, it is just not good enough.”

I have put my name down to speak on the Second Reading in the House of Lords on the Health and Social Care Bill next week. So have 98 colleagues.  So far.

This must be some sort of record for any Bill (other than those dealing with House of Lords reform).

The level of interest demonstrates that there is widespread concern across the House about what the Government’s Bill will do to the NHS.  Apart from the Government’s apologists on the Tory benches (and those LibDem coalition loyalists), there is a consensus that what is proposed is unnecessary, reckless, wasteful and bureaucratic.

The Government’s proposals were not in the Conservative Party’s election manifesto.  Nor were they in the LibDem manifesto.  They were not even in the Coalition Agreement.

There is absolutely no mandate for the changes proposed and they go against the promises made that there would be “no more top-down reorganisation of the NHS”.

The interest in the Second Reading debate has meant that the session is to start three and a half hours early on Tuesday and there is now going to be an overspill session on Wednesday morning.

There are not normally votes after Second Reading debates in the House of Lords.  However, the Health Bill is so controversial that there could be a vote to kill the Bill at that stage.

Despite speculation, it is unlikely that an outright move to block the Bill will pass: the Conservative peers and most LibDem peers will vote as a block to prevent that happening and cross-bench peers may feel that it would be unconstitutional for the House of Lords to refuse to consider a Bill coming from the elected House.

However, the role of the House of Lords is to scrutinise legislation and there is a proposal from Lord Owen and Lord Hennessy to refer three sections of the Bill for detailed consideration by a Select Committee of the House that could call for evidence and hear witnesses.  The rationale for this is that these are sections of the Bill that were not properly considered and that the sections concerned also raise fundamental constitutional principles in that they could potential weaken Ministerial accountability to Parliament on the NHS and would also make it more difficult for decisions to be challenged in the Courts.  If passed, this might have the side effect of delaying the Bill into the next session of Parliament.

The vote on this proposition is likely to be much closer, but if it is to be passed at least eighty members of the House form the cross-benches (and Government rebels) will have to join Labour peers in supporting it.

There are signs of nervousness in the Department of Health and all peers have been invited to a meeting with Ministers and the Chief Executive of the NHS to “allow Peers to ask any final questions” at 7pm on Monday (such a late start for an all-peers Ministerial briefing is also pretty unprecedented in my opinion).

As Sir Alex Ferguson might say it’s squeaky bum time for Ministers and the coalition.

The first really big applause line in Ed Miliband’s Leader’s Speech this afternoon was his affirmation that he would be true to himself, his own instincts and values.  And the big roar of approval came when he said:

“You know, I’m not Tony Blair.

I’m not Gordon Brown either.

Great men, who in their different ways, achieved great things.

I’m my own man.”

And then later he brought the Conference to its feet with a mid-speech standing ovation following a passage on the NHS:

“There is no greater public interest than our National Health Service.

Cherished by all of us.  Founded by Labour.  Saved by Labour.  Today defended by Labour once again.

Why does Britain care so much for the NHS?  Because, more than any other institution in our country, the values of the NHS are our values.  It doesn’t matter who you are.  Or what you earn.  The NHS offers the highest quality care when we need it.    ….

And when I look at everything this Tory Government is doing, it is the NHS that shocks me most.

Why?  Because David Cameron told us he was different.  You remember.  The posters.  The soundbites.  David Cameron knew the British people did not trust the Tories with our NHS.  So he told us he wasn’t the usual type of Tory.  And he asked for your trust.

And then he got into Downing Street.  And within a year – within a year – he’d gone back on every word he’d said.

No more top-down reorganisations?  He betrayed your trust.

No more hospital closures?  He betrayed your trust.

No more long waits?  He betrayed your trust.

And the biggest betrayal of all?  The values of the NHS.  Britain’s values.  The values he promised to protect.  Betrayed.

Hospitals to be fined millions of pounds if they break the rules of David Cameron’s free-market healthcare system.  The old values that have failed our economy now being imported to our most prized institution: the NHS.

Let me tell David Cameron this.  It is the oldest truth in politics.  He knows it and the public knows it.

YOU CAN’T TRUST THE TORIES WITH THE NHS.”

The Conference loved it.  It is the sort of stuff that will reinvigorate the Party and the Party’s base.

And that after all is the first step to winning in 2015.

The Government Chief Whip in the House of Lords is the Baroness Anelay of St Johns and she was wearing her best Steel Magnolia visage this afternoon when she moved that the Welfare Reform Bill should be committed to a Grand Committee. 

I should explain that committal to a Grand Committee means that the Committee Stage of a Bill is not taken in the Chamber on the floor of the House and that the detailed line by line consideration of the Bill takes place in a Lords’ Committee Room (usually the Moses Room – so named after the rather magnificent picture in it of Moses handing down the tablets of the law).  Procedurally, it also means that there can be no votes on amendments during the Committee Stage and the Grand Committee procedure is usually only used for comparatively non-controversial or highly technical Bills.

 

However, the Welfare Reform Bill is hardly uncontroversial.

And Grand Committee proceedings are less high profile than sessions in the Chamber of the Lords.

But there is an equally important access point as Baroness Campbell of Surbiton, herself a wheelchair user, pointed out:

“My Lords, normally I would not come in on the next day after participating in a very lengthy and big debate the night before. I generally need 24 hours at home to recover. However, this morning I was woken by several phone calls from disabled people who told me of this proposal and urged me to come in to speak to you. I feel compelled to be here. I am deeply concerned at the noble Lord’s proposal. I had understood that the technical parts of the Bill would happen outside the Chamber—and we can live with that. However, the new proposal that takes us completely away from the Chamber unfortunately makes it tremendously difficult to have access, not just for disabled Peers to participate effectively—it is much easier in here—but for disabled people who are following this debate online or on the TV and who come here to brief us. It will be almost impossible for them to do this. Yes, a few can come into the room, but it will be more difficult.

Perhaps more importantly, not to be able to test the opinion of the House—I know it is not often done in Committee—on one of the most significant pieces of legislation for disabled people in my adult life is deeply disturbing. I ask the noble Baroness the Chief Whip please to reconsider.”

The problem for the Government is that they have got into a frightful mess with their legislative programme.  Most of their Bills are deeply controversial and, despite having the longest Parliamentary Session since the Great Reform Act of 1832, the Government is running out of legislative days to deal with all of them before the Session ends next Spring and Bills that haven’t been through all their stages fall.

Negotiations through “the usual channels” between the Government and the Opposition on how to manage the Bill had broken down – the first time in at least a decade that it has not been possible to reach an agreement.  As a result, the Chief Whip was bringing a motion to the House to refer the Bill to a Grand Committee that would have to be voted on, whereas normally such procedural questions are approved without dissent because there has been an agreement on the procedure to be followed.

During the course of the debate it transpired that there had been some serious negotiations.  It had been agreed in principle that the Bill could be split into two parts with one part being considered on the floor of the House and the rest being considered in a Grand Committee – this in itself would have been pretty unusual.  However, while the Government was prepared to concede four days of debate on the floor of the House before moving into Grand Committee for perhaps another twelve days of consideration there, the Opposition was seeking eight days on the floor of the House.

Most people would have thought that maybe a compromise might have been possible – like six days on the floor of the House.

However, the Government Chief Whip broke off negotiations, withdrew her offer and ploughed ahead with a proposal for the whole Bill to go into Grand Committee.

Her negotiation style is clearly based on that of a traditional mafiosi school: “If you don’t do as I say, the baby gets it”.

In this case, the baby did get it and the Government won the day with a majority of 52: 263 votes in favour (159 Conservatives, 74 LibDems and 30 Cross-benchers and others) and 211 against (167 Labour, 4 Bishops and 40 Cross-benchers and others).

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