Beware of the Reinstatement Bill

Many campaigners expressed concerns during the passage of the Lansley nonsense that the NHS was being packaged up to make privatisation easier and a sell off inevitable.

As has been said many times the only way to prevent privatisation is to elect a government that does not do it. Anyway.

The NHS Reinstatement Bill  suggests that the NHS is reorganised so that (around 40) health authorities would be directly funded to plan, organise and provide the services for the relevant area. The health authorities would be under the direction of the secretary of state and their management would be appointed. Oversight would be through a form of Community Health Councils although they would not have any actual powers or duties and again would be appointed. This structure is, as the advocates of the Bill point out, pretty much the same as in the 1980’s before Trusts were invented.

The rationale for the reorganisation is that it would prevent or deter privatisation. Well it may well do the exact opposite and make privatisation far easier.

If we assume that the reinstatement bill is passed and that it can actually be implemented. What would a Tory secretary of state do with the huge powers the bill provides? One option would be to use the powers of direction simply to instruct the health authorities to put all services out to competitive tender. This is what the Tory government did to local authorities in the 1980’s. To make this easier to implement the secretary of state would use the powers of appointment to put supporters in all the right places.

But it could be even worse. Implementing the Bill would achieve the creation of a small number (around 40) of integrated organisations; all the complicated work of TUPE transfers, assets transfers, contract renegotiation, management appointments would all have been done. Changing how such an organisation is managed would be simple. Each heath authority could be privatised easily. This has also been mentioned as a risk to GP practices – if the form much larger groups with a more rational traditional management set up and proper contracts then they become a far more obvious target for private providers.

Implementing the Bill would already have removed many non-executive directors, thousands of governors and millions of members of foundation trusts as well as removing the oversight powers of local authorities and (presumably) the role of Healthwatch. So all the likely centres of opposition to selling of services would already have been shut down.

One protection from privatisation is the complexity of the NHS. Potential privatisers are put off by the instability of the funding, the sheer complexity of all the organisations involved and the public and patient involvement rules which they at least have to acknowledge. Scrapping all these protections could be a terrible mistake.

Perhaps this is all a clever plot?