Tories Regret NHS Changes!!! Read All About It

Those who read the Times today can see further justification for one of our arguments – that the mainstream press don’t understand the NHS.

Just for clarification then.

The Lansley proposals were perfectly coherent and set out to turn the vague quasi market that was the NHS in 2010 into a regulated market based on the model used for the utilities. We know this as he said so!  This was mainstream Conservative neo-liberalism.  It made (supposedly) business friendly GPs into commissioners, it removed any effective political oversight and planning, and it paved the way for mandatory competition for all services.

The White paper – Liberating the NHS – actually got quite a favourable response – only the usual suspects of the trade unions and Labour Party were resolutely against it.  A brave few, like Irwin, spelt out exactly what the proposals really meant.

Lansley’s model got messed up because of concessions made to the LibDems as part of the Coalition Agreement – LibDems hated Strategic Health Authorities so they had to go – but the LibDems were happy enough with the basic idea of a more real market.

There were months of argument during the passage of the Bill and some telling blows were landed by Labour and a few dissidents from other parties and none.  Outside Groups found their voices. The conspiracy theories claiming the Bill became an Act only because of the active collusion, passive acquiescence or incompetence of everyone including the trade unions hardly fits the facts, or the remorseless logic of parliamentary procedures. Anyway, resistance there was and it led to the “Pause” and the concessions made (although mostly cosmetic in effect) which just made a mess ever messier.

The resistance was eventually quite strong but in the end the three groups that could have saved the NHS all failed.

The GPs could have stated they would not be part of the grand plan.  But too many GPs were in fact leaders in promoting the Lansley vison; they wanted to be the commissioners.

The LibDems could have at least muted the worst of the changes but they were bought off by a lot of guff, mostly from Lord Howe, and by some promise of electoral reform – which they never got.

Finally the conclave of Royal Colleges could have pulled the rug, but (allegedly) arm twisting, blandishments, promises and threats to the leadership of the RCs stopped that happening – although many RCs to their credit did mount continued opposition.

So we got the Act and then we got the Regulations which made clear compulsory competitive tendering was now the norm for the NHS.

The Times, bless it, claims this was not about privatisation.  Well it depends on how you define it.  Maybe the purpose was not to move away from our free at the point of need NHS to a proper market with vouchers, with charges, co-payments and top-ups.  Maybe the aim was not a two tier NHS with a residual emergency service for the poor.  Maybe.

What is so obvious you would expect the Times to see it was that the Act would shift more and more provision onto private organisations – not just for the delivery of services but also around planning, procurement and commissioning of services.  For most of us that is privatisation.  And we have seen this unfolding albeit at a much slower rate than is sometimes claimed.  And you can’t pretend that was not understood; just read what legions of Tories and LibDems said during the passage of the Bill about choice and the advantages of having a plurality of providers not an NHS monopoly.

In the same paper there is an opinion piece by the current NHS Chief (whatever that means now!) Simon Stevens.  His view is that in many respects the NHS as a system is still amongst the best in the world but it faces three major challenges.

First we need joined up care not fragmentation – especially for increasing numbers of older people with multiple conditions.

Second we need more emphasis on prevention and less on treatment.

Third we have to reduce the unnecessary variations and get better at spreading best practice.

And of course dominating everything – how do we pay for it?  The Times offering is yet again about efficiency in buying gloves, not using agency staff, and shutting hospitals – brilliantly original thinking.

Taking the three Stevens challenges – the argument about privatisation fits part of the first challenge as most of the evidence suggests that competition works against the kind of cooperation needed to join up services.  The SHA is clear it supports removal of the market from the NHS.  But there is more to say.  We pretty much support Whole Person Care although much detail needs to be developed.

For the SHA however we need to be as eloquent, radical and consistent in dealing with the much bigger picture.  We have more to contribute in the debate about shifting to a model around shared decision making and community development for example. We have to ask more of Royal Colleges in reducing variations and poor practice.  We have to find how to change views on the role of Public Health and move it from the margins to the centre. We have to think how major changes can be made without reorganisation and disruption.  And we have to say how the money would flow!

Anyway – if the Tories genuinely regret the chaos caused and if the LibDems listen to some of their saner rank and file members then they will all support the Private Members Bill from Clive Efford; which removes the worst stupidities around compulsory competition.  A Bill that requires no reorganisation, few if any redundancies and saves £100ms of further payments to management, consultants, lawyers and procurement experts.

They won’t.