by Liz Kendall
This week, some parts of the government’s health and social care bill will go back through the committee stage of scrutiny by MPs.
David Cameron and Nick Clegg say they have listened and acted on people’s concerns. Now we’ve seen the government’s actual amendments to the bill, how does their claim match the reality?
The first problem with the government’s new NHS plans is that they are an even bigger mess than they were before.
Initially, the government wanted to scrap primary care trusts and strategic health authorities, set up the NHS commissioning board, public health England and the new monitor at the national level, and GP commissioning consortia and health and wellbeing boards at the local level.
Since then, new clusters of PCTs have been formed to “manage the transition” and David Nicholson, the chief executive of the NHS, has made it clear that he wants to have regional outposts of the NHS board (SHAs anyone?). Following its listening exercise, the government says that GP consortia will become clinical commissioning groups. It also wants to establish new clinical senates and have a bigger role for clinical networks.
These organisations come on top of the bodies that already exist, including the national quality board, the national institute for health and clinical excellence and the care quality commission.
Confused? You should be. It is now completely unclear who is responsible for taking decisions and leading changes in the NHS.
Improving the health of our ageing population, and making £20 billion of efficiency savings over the next 4 years, means the NHS must centralise some services in specialist centres and shift many others out of hospital, into the community and more towards prevention, ensuring they are far more joined-up with social care.
This will require difficult decisions about the future of local hospital services, but the plethora of new organisations being created by the government will make these decisions even harder to make in future. Changes that are urgently required have already slowed to a snail’s pace. The government’s new blizzard of bureaucracy will ensure they grind to a halt.
The original NHS reorganisation was set to cost at least £2 billion; the new reorganisation is likely to cost even more. One of the new amendments to the health bill actually removes the secretary of state’s ability to specify how much money the NHS board and commissioning consortia can spend on administration costs.
The government’s new changes will also lead to a huge centralisation of power in the hands of the NHS commissioning board. The board will “host” (for which read run) the new clinical senates and clinical networks and determine how commissioning groups get other clinical advice.
While it is good news that commissioning groups will now be required to have governing bodies – a quite astonishing omission from the government’s original plans – the NHS board is being given sweeping powers of micro-management, covering everything from the frequency of meetings, to which committees and sub-committees are set up, and even what commissioning groups are called.
Many GPs who were enthusiastic about commissioning will despair at this new top-down control. Just when the NHS needs clinical leadership to drive changes to services, many doctors will instead feel frustrated and simply walk away.
Members of the “future forum” are also likely to be disappointed that the government has failed to act on many of its key recommendations.
For example, the forum was clear that setting up public health England within the department of health would be a mistake, that directors of public health should maintain their ability to provide independent advice, that all non-medically qualified public health staff should be registered by an appropriate national body. But the government has failed to propose any changes to the health bill that would achieve these goals.
The forum’s recommendation that “all significant providers of NHS funded services should be required as an absolute minimum to publish board papers and minutes and hold their board meetings in public” has been completely ignored so far as private providers are concerned.
And healthwatch – which is supposed to be the national voice for patients – remains far too weak. The health minister, Simon Burns, has denied that healthwatch will be a “subcommittee” of the care quality commission, but the government’s own response to the future forum confirms that this is precisely the case.
Most importantly of all, monitor and competition remain at the heart of the bill. None of the government’s amendments will change monitor’s role as an economic regulator, modelled along the same lines as regulators in the utilities, railway and communication industries.
So far, there are no amendments to the clauses that explicitly enshrine UK and EU competition law into primary legislation on the NHS for first time. Monitor will still have the same functions as the office of fair trading and the competition commission will still regularly review the development of competition in the NHS.
There are no strong requirements on monitor to promote integration, just a few weasel words about “having regard to the desirability of persons who provide healthcare… co-operating with one another” and acting “with a view to enabling services to be provided in an integrated way”.
And while the government has promised to change its proposals for dealing with “failing” services, not a single amendment to the clauses which give monitor powers over “designating’”which NHS services can and cannot fail has so far been proposed.
The health bill adds more confusion and red tape to the NHS, when clear leadership, responsibility and accountability for change is urgently required. It proposes a huge centralisation of power, instead of putting local clinicians and patients in control. And the flawed heart of the bill remains the same as it was before.
David Cameron’s new NHS reorganisation is a political fix aimed at saving his reputation and that of his deputy, Nick Clegg. NHS staff, patients and the public won’t be fooled by the PM’s PR spin. The government should scrap its failed NHS bill and start again.
Liz Kendall is Labour MP for Leicester West and a shadow health minister.