The NHS Reinstatement Bill

NHS reorganisation

The NHS Bill is expected to have its second reading in March 2016.  It would replace the current NHS architecture with a return to Regional and District Health Authorities.  It may seek to address some genuine problems but it is the wrong solution.

Its supporters say the Bill would prevent privatisation and save the NHS.  Passing legislation cannot do that.  Any determined administration would just pass its own legislation.  The only way to prevent privatisation is to elect a government that is against it.

The NHS does not need another redisorganisation.  To implement the Bill would require the biggest ever top down reorganisation, far bigger than anything we have ever seen before.  Every part of the system would be affected.  Over 500 organisations would have to be wound up and the assets (and liabilities) transferred to the new Authorities – that alone would cause enough arguments to remove any focus on delivering care.  Then over 1 million staff would have to be transferred into new organisations; tens of thousands of senior staff would have to compete for new jobs in new organisations; tens of thousands of contracts would have to be re-negotiated.  Other organisations such as the 150 local authorities would also be caught up in the exercise and an unknown number of private or semi-private providers.  Doing this in stages would just make things worse.

Once things settled there could be some reductions in management and administration running cost but the claim that removing the market would reduce NHS expenditure by £10bn pa is not supported by any evidence or by any rational analysis.

There is often a reference to the experience of Wales which removed the market from its NHS.  Their experience was that the first attempt actually caused much upheaval and increased costs – a second attempt was far more successful.  The aim was achieved although so far there is no evidence of major management and administrative cost reductions.  But the Welsh system was much smaller and simpler than the fragmented monstrosity that we now have in England.  Scotland never had an internal market, but it’s not noticeably cheaper to run than the NHS in England.

Labour is committed to a policy to stop the privatisation of care services and where possible to reverse it.  That policy was constructed in a way which ensured that decisions about how services were provided could be made without any external interference by procurement or competition law; domestic or EU or beyond.  This was set out in the last parliament by Clive Efford’s Bill which gave a solution which cost virtually nothing to implement and required little in terms of any reorganisation.

The Efford Bill did not remove the commissioner/provider split, but then it was never intended to do that.  It would have changed the nature of commissioning to one that was not driven by competition between providers and by market behaviour, so commissioning becomes more like planning and the internal market is removed.

So the NHS Reinstatement Bill will not achieve what is claimed, would be very hard (impossible?) to implement and is not really necessary.

A change in Government is what is actually required.