I have never been a great fan of the Lib Dem Spring conference - it is always a long journey and by the time you have got into the swing of things it's time to go home again. So I am down here in Watford not up in Gateshead. This spares me the dilemma of how to vote in any debate on the health bill.
Although I should perhaps be reassured by the recent articles by Shirley Williams and David Boyle, for me their arguments for the bill highlight a problem. This is that the points made by Lib Dems in favour of the bill are couched in negative not positive terms. We are told that it is now much less bad than it was and a vindication of our participation in government - what wouldn't those horrid Tories have done left to their own devices? But given the importance of the NHS, in particular to Lib Dems, this on its own won't do. The bill's supporters need to explain why they think it will lead to a better NHS for patients, one that Liberals can be proud of. Making a bad bill less bad may be commendable of itself but that doesn't make it good. And if it is a good bill we need to hear exactly what is good about it.
Not being an expert on health policy myself I have no obvious way of getting beneath the rhetoric and deciding whether the bill is worthy of support or an outrageous sell out to the private sector. I could have a go at reasoning it out, as follows. In the past 20 years government of all stripes (Yes, Labour too) have introduced reforms that broadly embrace some sort of market principles and private sector involvement in NHS services. There may be many reasons for this, but the most obvious one is that a exclusive reliance on direct in-house service provision will inevitably lead either to high costs/inefficiency or to long waiting lists and poor service, or quite possibly all of these.
This is because the NHS is a huge organisation, providing a wide range of services, the demand for which is unlikely to be steady and predictable, and which is at the same time virtually limitless. If it is maintained as a lean and efficient machine with no slack in the system then it is going to be unable to cope with any sudden increased demands on its services, leading to long waiting lists and times. And if provision is made to cope with all eventualities then there are likely to be long periods when services are not operating at full capacity, thus creating huge financial waste. Given the size of the NHS both things are likely to happen. So private sector provision is a way of adding flexibility and coping with the unexpected - all the more necessary if patients are to be treated as human beings not numbers on a waiting list.
So far so good, but beyond that I'm a bit stumped. I have no real way of calculating the precise level at which private sector involvement and competition among NHS providers ceases to be what is necessary for high quality services to patients and starts to be a surrender to greedy capitalists. Nor can I really say whether this is all best organised by the PCTs (as at present) or GP commissioning (as proposed).
I could simply make my mind up on the basis of who is on which side. If David Boyle and Shirley Williams support the bill then perhaps it is a good thing. I could let myself be swayed in favour of the bill by the obvious humbug of Labour's Andy Burnham, who was health secretary in a government which introduced market-orientated reforms and greater private sector involvement, but who now seems to be a born-again Clause 4 supporter.
The opposition of organisations representing NHS professionals isn't necessarily a reason to oppose the bill - professional bodies usually resist change and we should be guided by what is best for patients. At the same I am willing to believe that the level of ignorance that central government demonstrates about local government when introducing its various exciting reforms might well be replicated in its dealings with the NHS.
So I am relieved to be spared the ordeal of voting on this at conference. Even if Lib Dem delegates do vote against the government's proposals, even as amended, this won't necessarily kill the bill. But if Lib Dem ministers do wish to pass it, and not have every future problem that the NHS faces blamed on it, then they need to do more to explain what they believe are its merits and how it will benefit patients.