Alex Hern presents the five worst things still in the coalition government’s anti-NHS health and social care bill.
One year on from the introduction of the health and social care bill into the house of commons, and the day that the Royal College of Midwives and the Royal College of Nursing have declared their “outright opposition” to the bill, it is worth looking back at why it is that the bill still incites such opposition.
1. Breaking the link of legal and parliamentary responsibility of the secretary of state for health for the delivery of a comprehensive health service.
As Jos Bell wrote in her parliamentary sketch:
Secretary of state Lansley has done all he can to abdicate ‘the duty of the secretary of state for health to secure the provision of services under Section 1 of the NHS Act’, placing instead those duties on clinical commissioning groups and Monitor…
So where exactly – as Lord McKay later said – does the buck stop? If not the SoS then who will ultimately bear responsibility for maintaining a health service free at the point of need for all?
To ignore this, would, as Baroness Williams said ‘leave us in a world of deep twilight uncertainty’ for Lansley has serially failed to acknowledge that this will also result in a danger to provision in areas where the infrastructure fails – or indeed in the management of national emergencies.
2. Creating an economic regulator similar to Offgem and Offwat to ensure health services are bought and sold through a competitive market.
The bill requires Monitor to ‘prevent anti-competitive practice’.
As Tim Holmes wrote on the eve of UK Uncut’s protest over the bill:
With sharp constraints on the NHS budget in place, this can only force incumbents into atrophy or collapse. Profit-motivated companies are likely to cherry-pick the operations they provide, offering cheap, easy treatments, and leaving the public to pick up the tab for the rest. By competing toundercut each other, they could drive down standards across the board.
3. The lifting of the private patient cap, or setting of a limit of 49%, which sends a damaging message of the place of private income generation within NHS, at the expense of patient care.
Removing the barriers will mean that waiting lists will target patients with higher resources than the NHS tariff, private patients will be prioritised over NHS patients, and the real threat is that the elderly and the vulnerable, those with chronic mental health problems, those with chronic medical problems such as diabetics, renal patients, etc will be a low priority.
There is every possibility that the reformed NHS under these proposals will become exclusive rather than inclusive. Removal of a cap over private income will see Foundation Trusts competing over costs rather than quality, so that those that are run by poor management will risk the stability of the hospital to a much greater extent than prevails now.
4. Creation of a legalistic and complex bureaucracy which will lead our NHS to insurance base and huge costs not spent on patient care, through the use of EU procurement legislation, competition act and Office of Fair Trade
Dominic Browne detailed the changes in June:
In its response to the NHS Future Forum listening exercise (pdf) the government aims to create clinical senates, commissioning consortiums, health and wellbeing boards, a national commissioning board.That’s four types of bureaucracies for the price of the current two: Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs).
How much extra bureaucracy will this mean on the ground? See if you can untangle it for yourself:The clinical commissioning groups will need “authorisation” from the national commissioning board with “input from health and wellbeing boards and local clinicians”. If they don’t get authorisation they might exist in “shadow form”.
5. The risks and cost for patients, staff and managers in the NHS – at least three years potential progress lost in fragmentation of decision making, increased waiting lists, lack of collaboration and loss of expertise.
As we revealed exclusively on Left Foot Forward, the NHS risk register for London details concerns over the negative impact of the reforms:
The consequence of this risk could be that the transformational changes in health services envisaged in London’s QIPP plans in response to the clear clinical case for change, may not be realised in full or are delayed, thereby undermining significant improvements in the health of Londoners.
While all the focus is on the government’s top-down re-organisation of the NHS, the negative aspects of their minor health policies have gone by largely unnoticed, including it, seems, by the department itself. It took them eighteen months to reverse their damaging no-targets policy, which has now led to 43 per cent of patients waiting too long for treatment.
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• NHS assessment of Lansley’s plan’s risk makes for sober reading – Alex Hern, November 24th 2011
• How Tories wrecked the NHS (but learnt to love targets (too late)) – Alex Hern, November 17th 2011
• The House of Lords ties itself in noble knots over the NHS bill – Jos Bell, November 12th 2011
• UK Uncut: Stop the traffic to stop the NHS being run over – Tim Holmes, October 7th 2011
• Tories: The party of NHS bureaucracy – Dominic Browne, June 15th 2011