So few of them have chosen even to abstain which is stated in the agreement.

Why after living under 4 Lib Dem councils did I think they would be any better nationally I'm not sure. I do have a lot of time for the Lib Dem in St Ives in Andrew George but sadly I could never vote for anyone with a yellow rossette again and that includes my boss.

Hello Facebook. On Wednesday 12 October the Health and Social Care Bill received its second reading in the House of Lords and passed to the committee stage without any amendments. If you’re a normal person and not some kind of politics nerd you’re probably asking “Why is this a big deal?” In my opinion it’s a huge deal because in its current form the Health and Social Care Bill will fundamentally alter how the NHS works, largely by stripping away the “National” part of it.

The full text of the bill is here: http://www.publications.parliament.uk/p ... 2_en_1.htm Like all bills it’s incredibly lengthy and wordy, so I’m going to try and summarise the main thrust of it because there seems to be very little understanding about what this bill means and what the potential outcomes of it are.

The central change in the bill is that spending will be put in the hands of local health authorities instead of a national body. On paper this is in the name of choice - each LHA will have the autonomy to decide what its budget will be spent on. However this will inevitably lead to inequality between LHAs - remember how the NHS used to be criticised for being a “postcode lottery”? This bill will pass the postcode lottery into law, and the Royal College of Surgeons have already warned that LHAs keen to cut costs may stop offering expensive operations such as hip replacements and hernia surgery on the NHS.

So who decides how your LHA spends its budget? Unless they’re willing to set up from scratch all the admin required to coordinate NHS treatments and private payments, this work will be farmed out to a group set up by an existing health insurance company - most likely from the US as they have the most experience in this area. Do you really want an American health insurance company deciding whether your gran has to pay for her hip replacement?

LHAs will also be competing with one another, under the assumption that competition will lead to better services. What we’re more likely to see is hospitals prioritising private patients requiring simple operations over those with difficult-to-treat conditions - and in extreme cases, trying to pass unprofitable patients off to another LHA.

Last year a separate piece of legislation saw the relaxing of the monitoring of the 18-week rule, the maximum time that you should wait between referral and treatment (recent figures have shown a 48% rise in those waiting more than 18 weeks since this change). Combine this with your LHA’s new requirement to stay profitable and you’re far less likely to receive treatment within 18 weeks if you’re receiving it on the NHS.

In essence, the Health and Social Care Bill paves the way for a two-tier health system, where to receive treatment quickly (or at all) you’ll need to pay. If you can’t afford private health insurance or to travel to a competing LHA, you might be stuck waiting a long time before treatment.

This bill isn’t yet law - it has to go through the committee stage in the House of Lords followed by a final reading, after which the Lords and Commons will pass the bill back and forth as they settle on the final wording. But so far opposition to it has been limited and barring a massive change of heart from one of the parties it’s likely we’ll see the bill become law sometime in 2012.

If you want to change that, make yourself heard - http://www.theyworkforyou.com has details for your local MP, and http://www.writetothem.com lets you email MPs and Lords for free. Remember that in the general election no-one campaigned saying that they’d neuter the NHS and let health insurance companies dictate how we receive treatment - remind them of that.

The NHS is not a perfect system and I’m not ideologically opposed to changes. But this bill weakens it and is the first step towards a fully private system like the US, where car crash victims refuse to go to hospital because they can’t afford the medical bills. I don’t want that in my country, and I’m sure most of you don’t either. Thanks for reading and feel free to share this.

Andrew Lansley has defended a welcome message played on a continuous loop in English hospitals in which he tells patients their care "really matters to me".