A month ago, ministers gathered round the cabinet table to be told by Andrew Lansley that the health bill was about to finally pass through parliament and become an act. Those attending banged their desks – partly in celebration, partly with pure relief. After 14 months of delays, negotiations and public rows, one of the most unpopular pieces of legislation from this session was finally about to be left behind.
Except it wasn’t. From next month MPs will start voting all over again on Lansley’s plans. What many in the coalition didn’t realise was that the act (as it now is) made so many changes to the infrastructure of the NHS that parliament will face a series of votes simply to create the bodies necessary to make them work. Clinical commissioning groups, Health Watch, Health Education England, Public Health England: the plethora of new quangos at the heart of the act all need to be legislated for.
Normally this kind of secondary legislation would be waved through without debate or a vote. But as with everything else about this act, it won’t be so easy this time. Labour is itching to make an issue out of the NHS again, not least because the reforms have killed the Tories’ reputation for protecting the health service.
Andy Burnham, Labour’s shadow health secretary, told me:
Round one may be over, but… we will continue to challenge this flawed reorganisation every step of the way.
Labour will challenge these documents line by line and seek to close the act’s major loopholes such as the potential for conflicts of interest in the awarding of contracts and the lack of public accountability in commissioning groups.
It is unlikely that Labour will be able to stop them going through, and it wouldn’t achieve much even if they did: the act has already been passed after all.
But it does mean that weary coalition whips have to persuade reluctant MPs to back the legislation all over again. The Lib Dems in particular are furious. They say they managed to get their MPs and peers to back the reforms last time, only to see them undermined by attacks by other Tories.
One coalition adviser told me:
This comes about because of the Department of Health’s obsession for passing all this through parliament. I was astonished when I found out our MPs are going to have to vote this through all over again.