Health Matters | Paul Corrigan's blog

The phrase “developing the NHS during the long age of austerity” was one that I first used in December 2011. It’s one to which I will return frequently over the next few months. Read the rest of this entry »

One of the really interesting tussles taking place over the next few months concerns who is actually implementing the Bill. This may sound like an odd issue to bring up because one might think that the constitutional process is obvious. The Government manages to get a Bill passed by Parliament, the Queen signs it, and the Government implements it.

But as the Bill becomes an Act the people that will carry out its implementation will be very different.

One of the things we learned last week was that both political parties in Government – who have been voting for this Bill at regular intervals for the last 15 months – are simply delighted that it has at last left Parliament. For them, the actors and actresses in the theatre of parliament, the show is over.

The Cabinet banged the table with glee that it had gone (Did they ever do that at your school? – No they never did in mine either.). There is huge relief in Parliament. The Bill has passed and outside the Select Committee no-one will give much thought to what happens next.

It isn’t this part of Government that does the implementing.

Insofar as politicians continue to be involved it is the job of Ministers to oversee implementation.

Now, I am now going to say something that may startle you. I know it may not have looked like it for the last 18 months, but this group of Ministers have had previous experience with Parliamentary legislation. Admittedly it was in opposition, but before this Bill they did know how to argue amendment and move legislation through.

(I know, I know, but I am not saying that this group of Ministers had learnt to do it well - just that they had some experience of doing it).

None of these Ministers have any experience of implementing a Bill in Government.

But the people who run the National Commissioning Board have been implementing legislation since before the Cabinet learnt to bang their desks when given a half day off at school.

So if you had to put money on who will be most effective in implementing this Bill I would not put much on the Ministers.

This partly explains the numbers in yesterday’s post. The accountable officers in 6 out of 10 PCTs are similar to the accountable officers that existed under the PCT system. The old system will reproduce itself in the new where it can. But the old system will where it can use implementation to grab more power than it had before.

So if Ministers are not really capable of implementing the Act and the NCB writes its own rules for implementation, then surely the field is open to just one sort of implementers? The National Commissioning Board.

But on the ground there is in fact another group of implementers – the GPs in Clinical Commissioning Groups. If they don’t implement this Act then not a lot that is new will happen. (If GPs – as accountable officers – decide to walk away, not a lot that is new will be implemented).

And within a few hours of the Bill’s passage the combination of the National Association of Primary Care and the NHS Alliance sent out the following letter to their members who are and will be some of the main implementers of the Act.

“The passage of the Bill has been nothing if not controversial. The NHS Clinical Commissioning Coalition of NAPC and NHS Alliance has been a strong advocate of Clinical Commissioners throughout, while working hard “behind the scenes” to ensure that we are given the necessary powers to match our new responsibilities. As clinicians, we now have a real opportunity to

transform local services and health.

The last few months have seen a sometimes polarised debate of strong political and professional opinions, which have led to passionate and public disagreement. In retrospect, we can all think of ways in which engagement could have been improved. We have also learnt some important lessons

around managing our relationships at a time of significant turmoil.

But now the parliamentary stage is over, it is vital for our patients and our populations that the profession and primary care reunites and finds ways of making the new NHS structures and arrangements work. As the NHS Clinical Commissioning Coalition, both NHS Alliance and NAPC are committed to helping you meet the challenges ahead. We must demonstrate quickly to our

patients, colleagues and the country that these changes have not been just some bureaucratic shift of organisational structure but that they will have a real and meaningful impact on the health and the health care of all NHS patients.

The NHS Clinical Commissioning Coalition is keen to support you in this process. We shall be publishing a monthly newsletter which will update you on everything that is going on and provide examples of the innovations, advances and improvements in patient care that you, as CCGs, are driving. Please let us know of any early wins as well as the challenges you face in your CCG so that

together, we can continue to win the argument for GPs being at the very heart of the reform programme.

Meanwhile, we must ensure nationally and locally that the new arrangements are allowed to work. That is why both of us are meeting regularly with the Secretary of State, ministers, Department of Health, leaders of the National Commissioning Board (NCB), Monitor and many others. We now

have an urgent mission and we are endeavouring our utmost to ensure that CCGs and their leaders are masters of their own destiny.

On April 24th we have organised a first meeting of CCG leaders following the passing of the Health and Social Bill. This represents a unique opportunity for us for us all to determine our own future April 24^th will also be a crucial opportunity for us discuss progress and concerns and to put the results

of those discussions to the Secretary of State, Chairs of National Commissioning Board and Monitor as well as others. . Please also let us know of any way in which we can help you to make clinical commissioning a success in your area.”

It’s important not to underestimate the potential of this letter. These two GPs organisations plan to short-circuit the relationship between what is talked about nationally as policy and what happens to GPs in practice.

They plan to use the April 24 meeting to bring the experience of the actual implementation on the ground to the Secretary of State and present him with different implementation solutions at both a policy and a practice level.

This means that one of the answers to the question “who is going to implement the Act?” could be the people who are going to carry it out.

The next few months will show whether GPs will be the implementers of the Act or will have it implemented upon them.

As the Health and Social Care Bill was clearing its final hurdle in the House of Commons – just after 10 o’clock on Tuesday evening – I was on the Radio 4 programme “The World Tonight” talking about the Bill.

I mentioned recently that it’s fun talking to journalists about the Health and Social Care Bill because they, as a matter of professional pride, expect to be able to explain very complex things very simply. Yet they are all to a person defeated by the experience of trying to do that with this Bill. Read the rest of this entry »

Last Tuesday unusually saw a debate on the Health and Social Care Bill in both Houses of Parliament at once. In the Lords the 3rd Reading of the Bill is the last their lordships will see of the Bill. In the Commons there was an opposition day’s debate discussing a motion advising the Government to drop the Bill. This in itself was unusual since next week the Commons will have its own opportunity to vote to drop the Bill when the real thing returns to the Commons for a debate on the changes made in the Lords. Read the rest of this entry »

I try very hard to believe it but I just don’t think that leaving the NHS ‘much the same as it is today’ is really being ‘tough and bold’.

Some readers felt that I was being a bit harsh on the PM on Tuesday when I charted his failure to spot the problem that the health policy was to become on 4 separate occasions between the summers of 2010 and 2011. They felt that my suggestion that he had not really paid sufficient attention to what he was trying to achieve -because he didn’t really do the policy work – was a mite unreasonable. Read the rest of this entry »

The point I have been making over the last week is that whilst the Government may have a reform policy, it has lost control of its implementation. So I am sure if you asked a Government Minister what their policy is on FTs you would find that they still believe that all trusts should become one.

The political parties that form the Coalition Government both have a chequered history when it comes to NHS Foundation Trust policy. In 2002/3 when the Labour Government was developing the legislation that created them, the Conservative and the Liberal Democrat Parties voted against the legislation all the way through to its passage. Read the rest of this entry »

One of the apparent aims of the most recent Liberal Democrat amendments to the Health and Social Care Bill being discussed in the House of Lords is to ‘stop the application of European Competition Law to the NHS’. Read the rest of this entry »

Long term readers will remember that near the beginning of April last year the Chair of the Health Select Committee commented that the Government had ‘lost control of its health policy’

For two months the Government outsourced the formulation of their health policy to the Future Forum and then accepted all of the recommendations from the random group of people that made it up. Read the rest of this entry »

Answer: Because it lost control of NHS reform.

Today – or if they don’t get to it on Wednesday – the House of Lords will stage a further debate about stopping the development of the third sector in the NHS.

Long term blog readers will remember that their Lordships debated this issue in November 2011 and that I commented on the issue at the time. In that post I asked if the Department of Health would become the only Government department forbidden by law to develop the capacity of the third sector.

This part of the mess  that is the Government’s NHS reform policy stems from their ‘U’-turn last June. Then, in order to persuade the BMA that they were not in favour of greater private sector involvement in the NHS; they said that they would pass legislation,

“…to outlaw any policy to increase the market share of any particular sector of provider”

and amended the Bill to that effect.

This does not reflect the policy of any other Department of State. So, for example, the Department for Education or Department of Communities and Local Government can argue that the third sector should be providing more services – for example for young people or environmental services.

But this will be illegal for the National Commissioning Board and the NHS.

And the passing of this law will have an even bigger impact.

We know that NHS bodies are always anxious to avoid breaking the law. This makes it likely that the NHS Commissioning Board – and the NHS in general – will interpret the Health and Social Care Bill as meaning that capacity building – and other policies which support the development of social enterprises and voluntary and community organisations -would become illegal. As a result, it could make it harder for charities and community groups to provide the services and support that many (particularly those who are vulnerable and hard to reach) rely upon.

Which means that the NHS will not only be the only part of Government that cannot have a policy to develop a higher proportion of services through the third sector, but they may also be unable to spend taxpayer’s money on improving the capacity of the third sector to provide health services for NHS patients.

Let’s remember that when this Government published its White Paper in July 2010 it said that it wanted to create in the NHS, “the largest social enterprise sector in the world.”

The gap between their intentions of July 2010 and the practice of February 2012 is now enormous.

They have reached this state of affairs by trying to change the law to appease the BMA’s anxiety about introducing more competition into the NHS.

It didn’t change the mind of the BMA – it just created a mess.

This is what happens when a Government loses control of its policy on NHS reform.

As I mentioned yesterday the Government has been using scatter-gun tactics in its attempt to argue its case for NHS reform. For some time they have been trawling through a wide range of sources to try and find support for the necessity for their reforms.

The trick they are trying to pull off is to claim that by being in favour of reform (as many are) you are in favour of their reforms (which few are). Read the rest of this entry »