Last week the BMA wrote to all MPs outlining their continued hostility to the Health and Social Care Bill. Their briefing behind that letter makes really interesting reading. Two main political themes emerge. The second of these I will post about tomorrow.
The first is that despite (but I think really because of) the Government’s June reform of its own reforms, the BMA still thinks the Bill needs to either be withdrawn or substantially amended.
“The BMA acknowledges the efforts of Government to listen to and address some of the concerns that have been expressed about the Bill to date. Despite some improvements to the Bill over the summer and , despite there being some positive aspects to the reforms, such as getting clinicians more involved in planning health care, real problems remain. This BMA still believes that the Government reform plans pose an unacceptably high risk to the NHS in England, threatening its ability to operate effectively and equitably, now and in the future. This is why the BMA continues to call for the Bill to be withdrawn, or at the very least, to be subject to further, significant amendment.”
BMA Briefing on the Bill
The Prime Minister’s belief that following the amendments he forced on the Secretary of State in June, the profession would support the Bill, has not really worked.
This I am afraid comes back to the same problem as of a year ago. Then the Government had no narrative for its reforms. It did not offer an explanation of what the big problem with the NHS was, and could never therefore explain how the detail of their reforms would solve it. What was the question to which GP commissioning was the answer? Not having told us what the problem was they had to be hazy about how their reforms would tackle it.
There was a very big hole where the Government’s narrative should have been and since everyone assumed they must have some sort of reason for doing it people began to find their own explanations for why the biggest health bill ever was being pushed through Parliament.
A range of explanations surfaced, all of which seem to add up to an overarching narrative that the Government had a “”secret plan to privatise the NHS”. Indeed by the time the Government called for a pause in their reform programme in April/May last year nearly 60% of the population believed that the Conservatives had such a plan.
This is a very difficult place for a Government to be. How do you counter the idea of a ‘secret plan’? Every time you deny it the point is reinforced, because you are not going to tell us – because it is ‘secret’.
So anxiety about this public belief led to the sound of the screeching of brakes being applied – and a dramatic U turn. This was the attempt to create the narrative that they had changed their changes, and for a few weeks this was good, if very temporary, politics. Many people recognised that the Government had indeed changed their changes.
But the problem for the reform of the reforms – from June onwards – is that there is still no simple explanation of the problem that this new set of Government reforms is going to solve. If the Government could not explain to us what problem GP led commissioning consortia was going to solve, how would “clinical commissioning groups in close relationship with clinical senates” solve anything? The new explanation of the big picture was even more elusive.
The last three months have been very similar to the previous six. Where was the narrative for which Conservative MPs could argue as they went out into the country? “This is the problem with the NHS and this is how our reforms will solve it.”
At best Tory MPs can say that these new reforms are better than the previous ones. But that’s not a confident narrative that they can take out and argue for.
So over the summer the BMA found itself still in the same position that it had been since December 2010 when the Bill was published. They had no Government narrative to compete with. They have never had to disprove what the Government was saying, they only had to create their own story about what the government were planning to do and people would give it credibility.
On the streets of many towns in England last weekend people were being asked to sign a petition to ‘save the NHS’ (which many people would of course sign). The Government have failed to force those people, and others such as the BMA, to engage in a powerful debate about what they are doing.
The best that any believer in the reforms could do when confronted with the petition is say that “honestly, we don’t want to privatise the NHS”. They could not say “we are doing it for these clear reasons”.
This was clearly demonstrated by the statement from the Secretary of State in the papers earlier this week that said simply that it was ‘scaremongering to say that his plans were aiming to privatise the NHS’.
So at the precise moment when the public is looking for a lead from the Government as to why the Bill as back in the House of Commons what it came up with was still not an explanation of why they are doing it. The best guidance the public have been offered is an argument that says that other people’s explanations are in some way scary.
In terms of the politics of the reform programme September is a lot like March. The Prime Minister successfully got his Secretary of State to change his policy, but the problem had not been with the policy, it had been with the lack of explanation of the policy. So the PM solved the wrong problem. He changed the policy and made it even more difficult to construct an explanation. And he left as his Secretary of State someone who is really very, very interested in the detail of policy.
But given that the Secretary of State couldn’t really explain the big picture of why a reform policy that he had spent 6 years creating mattered, he is not likely to be able to explain the big picture of a policy that has been cobbled together in a few weeks by a range of people he doesn’t know.