The vote to pass the S75 Regulations was very similar to the many previous votes. Warm words from the Minister taken to be more important than the words in the actual legislation; bogus and distracting arguments missing the key point; passion from those that defend the NHS; confusion from some; vested interests protected shamelessly – then the LibDems trooping through to support the government. The wider public struggle to understand the real issue, and the media gives it little or no coverage.
The Regulations just fill out what was already in the Act – a one way journey to a very different NHS – starting through the mechanism of using market competition to allow greater entry of private providers, ending with a full economic market for our healthcare and a two tier service with top ups, charges and insurance; division and fragmentation. Along the way the NHS, as a public service based on the founding principles we all support, is destroyed.
Now is not the time to stop our opposition. The intention is clear to all but the Act is complex and even with a positive environment for change it would take many years to have any major impact. But the background is very unfriendly to implementation and we can and should challenge every step along the way. The Act opens up many opportunities for us to become active within the system. We should take them. We should do this alongside the local campaigns that we know will spring up to fight cuts, closures, restrictions and steps towards privatisation.
Our strategy within the SHA should remain the same. We develop and argue for an alternative policy, which we persuade the Labour Party to adopt then implement. We do all we can to slow down implementation of the Act – and the Regulations debate gave us more ammunition to challenge any commissioner who starts to examine putting services out to tender.
We can work with the natural resistance of the NHS to change and the undoubted hostility to the changes from many within the system to ensure that over the next two years as few services as possible are subject to Any Qualified Provider regimes or put out to tender. And we hold the Labour Party to its commitment to repeal the Act.
There are opportunities for public involvement all over the NHS. They may be tokenistic, but they present opportunities to gather information, to agitate, and to question what is going on.
Individual GP surgeries often have some sort of patient participation group. Though GPs are very wary of them, they are paid extra to set them up. GPs are sensitive to what their patients think about them. The National Association for Patient Participation promotes and supports patient participation in primary care. They can help.
Each of the 211 Clinical Commissioning Groups has to have some sort of public and patient involvement mechanism, and they have to hold board meetings in public. The detailed arrangements are down to local decision.
Every local authority has to set up a local Healthwatch – though some are a bit slow to get going. The local Healthwatch has a seat on the council’s Health and Well-being Board. For the first time since 1974 elected local councillors have a direct voice in the NHS, and are responsible for the health of their population.
The 145 Foundation Trusts each have a membership scheme. Some only have local members, but many offer specialised services to a wide area and have a category of members for the “Rest of England and Wales”. The members elect the majority of the Governing Body. The Governing Body appoint, and can dismiss, the Chair and the Non-Executives.