This chapter examines the rhetoric of government and opposition in the Parliamentary debate over the 2010 NHS White Paper ‘Equity and Excellence’. It treats the debate as a process of deliberative argument in which Secretary of State Andrew Lansley justifies his reorganisation, and explores the extent to which his policy argument was scrutinised by both the opposition and by members of his own coalition government. If representative democracy depends upon significant reorganisations being adequately explained, debated and examined, then it is important to consider the extent to which this happens, even while accepting that limitations in time and expertise in Parliament will always place limitations on this.

The chapter suggests that Lansley offered an unjustified reorganisation based on market-based governance (although presented as ‘social enterprise), and decentralised accountability, which would at the same time generate substantial savings in a time of financial austerity (see Chapter 2). This is contrasted with the often fragmented arguments offered by voices in the opposition. We ask questions about the extent to which Parliamentary debate is able to adequately scrutinise governmental proposals of the complexity of healthcare reorganisation, especially at the beginning of a new term in office.

Introduction

This chapter examines the 2010 Coalition Government's proposals to reorganise the National Health Service. This debate and policy discussion has been chosen because of being so contentious – with the government putting in place an unprecedented ‘pause’ in its passage through the legislature to address concerns from senior Liberal Democrats, medical representative groups and the general public. It is also the case that, despite the government struggling to get their legislation through Parliament, and perhaps losing the argument as to the necessity and form of their reorganisation, the legislation was still implemented in a heavily-modified form which led to significant disruption as Primary Care Trusts were abolished and GPs asked to lead the commissioning process (see Chapter 18).

The chapter examines the Parliamentary debate around the reorganisation's White Paper, examining the extent to which the reorganisation was scrutinised, and suggesting that many of the problems the government experienced in passing the legislation came from the government's inability to present a coherent argument in their favour. It presents an argument-driven, rhetorical analysis of the debate, while accepting that alternative forms of analysis are equally possible.