Archive for October, 2011

The day the NHS felt a bit under the weather

October 12, 2011

There’s been enough hyperbole on Twitter today to to give Health Ministers a run for their money as the House of Lords rejected two amendments designed respectively to slow down the progress of the Health Bill (Lords Owen and Hennessey), or bin it altogether (Labour).

Despite claims littering my feed that the NHS has now been destroyed by those bastard Lords, there are still a few stages that it needs to go through. Yes: by waving the Bill through its second reading, peers have indicated that they’re going to enact it eventually. But to describe this as the death knell for the NHS is a little premature.

There are those who are implacably opposed to the Bill on the reasonable grounds that with £20bn of efficiency savings to make before the next election, forking out £3bn on a top-down reorganisation is an unnecessary expense. The Government’s argument is that the reforms are needed to facilitate these savings, a point accepted to some extent by Shadow Health Secretary Andy Burnham – though he argued at the weekend that legislation is avoidable.

The concessions the Lib Dems managed to force on Andrew Lansley after the “pause” in the legislation in the spring seemed to have bought their votes today. After all that faff it would have been a bit churlish of them to reject the whole thing.

So while we are stuck with this piece of legislation, we know that the thing is malleable. Heck, what might have swung the vote on the Owen-Hennessey amendment today (to refer certain parts of the Bill on accountability to a special committee) was probably the Health Minister’s last-ditch promise to make a necessary amendment to make clear that the Secretary of State will still be accountable, thus negating the need for Owen’s committee. There’s been a lot of uninformed stomping of feet about the behaviour unelected members of the upper house but, to be fair, they have been a lot less partisan and childish in their approach to the legislation than our elected representatives in the Commons.

Contrary to popular opinion the purpose of the Bill is not to privatise or destroy the NHS, but to devolve responsibility for commissioning hospital and other services to GP surgeries. Yes, the new system may lead to more private sector operators providing services, but the NHS will still be free at the point of delivery. And there’s no rule saying that the private sector has to be evil. One problem the NHS faces even now is that services for some conditions are not integrated well enough. Why shouldn’t a private sector company with expertise in logistics and supply chain management be drafted in to help design services?

Of course there are still major concerns with the legislation:

  • The Government have promised “no frontline cuts” but are devolving the responsibility for cuts to local areas. That amendment to maintain the accountability of the Secretary of State will at least make sure he gives a shit.
  • There’s a danger that private sector companies could profiteer from the by creaming off the most lucrative surgeries and leaving trusts with ever-dwindling budgets to carry out costly but essential work.
  • While it’s probably a good thing for hospitals and other providers to be more business-like in order to improve the patient experience and make savings, they can’t be forced by the regulator to fight to the death when people’s lives are at stake and where collaboration may well be the solution in many cases.
  • NHS trusts are to be freed up to perform more private work. It’s difficult to see how this could not lead to longer waiting lists for NHS patients.
  • There are a lot of health conditions, including long-term or rare conditions, that would be ignored by GPs so need to be commissioned on a regional level – patient groups and specialist providers will want assurance that they won’t fall through the gaps.*

I’m pretty confident that none of these will get past the Lords. There are enough of them who are open-minded and wise enough to make sure the dodgiest bits of the Bill get expunged during the Committee and Report stages.

And there will be plenty more opportunities to Save The NHS.

*This post is completely personal opinion, though I should declare an interest that I do work for examples of these in my job.