How might Labour ruin their superior political position on the NHS?
Filed Under (Health and Social Care Bill, Health Policy, Labour Party, Reform of the NHS) by Paul on 22-03-2012
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.
So you can almost feel a journalist’s relief when you say that this Bill is structurally incoherent and it’s not their professional fault that they can’t find the words to give it coherence.
My interview went round that block a few times – but it ended with a direct question about whether Andy Burnham had been right, as Shadow Secretary of State for Health, to say that he would repeal this Bill at the first opportunity.
It’s understandable that in the heat of the recent ‘Kill the Bill’ campaign, when asked what he would do when he comes to power by people who don’t want the thing passed in the first place, he would say he would repeal it.
Killing the Bill in a few years’ time seems like the next best thing to killing it now.
But the politics of the next general election in 2015 are very different from the politics of a campaign against the Bill now.
On Tuesday night I gave the answer to a different and slightly better question. I said that that I am absolutely sure that the Labour Party will not go into the next general election on a platform of ‘let’s have another NHS reorganisation’.
Just imagine what a political disaster that would be.
The NHS specifically and the public in general would run a mile from any political party that promised another NHS upheaval in 2015/16.
Given that this Government promised that there would be no top down reorganisation the electorate will be looking very closely at how all political parties will be talking about improving the NHS. If anyone looks as if they are promising another reorganisation voters will run away from them very quickly.
This would be the single change that could lose the Labour Party its lead on the NHS.
If the Bill were to be repealed there would need to be some form of alternative Bill and alternative structure to replace it. By April 2016 PCTs will have been absent from the NHS for between 4 and 5 years. It would take a further 2 year upheaval to bring about any significant structural changes.
This is not what anyone wants. We do not need another Bill.
The next General Election will be about which Party voters will trust to improve the NHS without structural change and without new money.
The risk of this bill is that the combination of reorganisation costs, more central administration and deep cuts will simply not work. The consequence, with GPs holding the funds, can only be more hospitals going broke, and being taken over by the private sector.
The government now can achieve the privatisation of NHS treatment services by starving it of funds.
They will start to do so AFTER the next election.
The public-private debate will cloud the fact that this is a more expensive way of delivering the service. The extra cost will go to private enterprise.
If the economy does not pick up and health care is unaffordable, there will be less of it whichever regime (public or private) we live under. There will be even less under a private regime than there would under an equally well managed public regime, the difference being dividends, bonuses and lobbying costs.
The shortage of health care will also be quite differently distributed. Under a public regime, those with non life-threatening, non debilitating needs will be disadvantaged. Under a private regime the poor, generally the working classes, will suffer.
That is why, rather than repealing the act, it is important to put the private sector on notice that Health Service assets will be renationalised at the first opportunity.
The opposition from the profession and much of the public is about the direction for the NHS from this Act. In other words, the impact of full-throttle provider competition, the risk of cherry-picking, a disregard for clinical service planning and giving a significant commissioning budget to inexperienced and often unwilling GPs.
If, as most informed commentators predict, this package turns out to weaken standards and service coherence across the English NHS, against the backdrop of a sustained financial squeeze on health and social care, a new government will most certainly want to intervene.
In particular, the spectre of conflict of interest for GPs between their commission and provider/service innovator roles threatens their very core as independent patient advocate. Hence the RCGP’s reluctant acknowledgement they have to get their hands dirty to try and mitigate the challenging practical problems the Act throws up. Will this be sufficient?
The issue for a new administration is not therefore one about public attitude to reorganisation, but rather the extent to which these fundamental flaws can (or cannot) be rectified without legislation the other side of an election. Securing change in the way both Monitor and the NHSCB operate would be an obvious place to start for a new SoS.