Health Matters | Paul Corrigan's blog

A report in the Guardian last week explained how some Labour Party policies that were announced at the Labour Party Conference were developed.

Before the Conference I commented on the difficulties that the Party front bench had got itself into by saying it would repeal the Health and Social Care Act of 2012. On the face of it this looks like good, simple politics. (The Act is unpopular, ergo repealing the Act will be popular).

But the problem for the front bench is that if you repeal the Act you will have to replace a set of organisations that it introduced. Given their number and importance, you would need to create a whole new set of organisations to replace the ones you have abolished.

This looks a lot like reorganisation and since that reorganisation would be being led by Parliament – and comes from the top – that would make it a top down reorganisation.

Given the weariness that the NHS feels about facing another top down reorganisation this will, as the election gets nearer, become a problematic promise.

At Conference fringe meetings the Shadow Health Secretary of State firmly suggested that local government would become the local commissioners of NHS care – and that it was established policy. As we shall see there are some difficulties with this. Apparently Ed Miliband and Ed Balls felt that it was premature to announce this policy since it may have some cost implications which need examination.

As a consequence Andy Burnham’s conference speech proposed clearly that the Act was going to be repealed – but the move to local government was less surely put forward.

At one level – given that there are more than two years to go before the policy needs to be finalised – there is a lot of time to work through the economics of this in detail.

My problem with the policy though is not just the general detail but the direction.

One of the main Labour criticisms of the Health and Social Care Act was the belief that it was fragmenting the NHS. One of the main slogans Labour have been using is that they will put the ‘N’ back into the NHS.

To me it seems that while there may be a lot of arguments to be made for giving local government responsibility for commissioning, making the NHS more ‘National’ cannot be one of them.

Local government has a long and powerful record in this country. There are two main differences between local government and the National Health Service.

First local government – as the adjective suggests – takes pride in its locality. When you talk with local officers in local government they are all proud of the way in which their locality does things differently from their neighbours.  This is not some side issue for local government – it is the core of its being.

Second local government is not just about having a different administration between one area and another but that administration is converted into local government by local elections. In most years there are elections where political parties stand for election in order to obtain power. Candidates stand on platforms which say they will use power differently from the other candidates. When they win they are expected to do those different things.

This is essentially local and not national. And local elections give legitimacy to what local government can do.

Let’s explore a possible scenario which may make the point.

The General Election of May 2015 is won by the Labour Party on a platform which includes repealing the current Health and Social Care Act and giving the current powers of CCGs to local government. The Bill is introduced in 2015 and – given it is repealing the whole of the 2012 Act – it is a big one. It is passed in 2017 – to be implemented in April 2018.

Unless this government is very different from all other ones there will be some electoral midterm problems, and in 2017 a Conservative opposition starts to make considerable gains in local government. The elections in 2018 are likely to provide a landslide for the opposition…

The 2018 local elections loom and will take place 5 weeks after local government takes over nearly all NHS commissioning.

The amount of money that local government spends on the NHS dwarfs all other budgets and local elections really do become all about what the NHS in our locality should do.

In the lead up to the 2018 local elections there will also be a political argument about the extent to which the private sector is involved in providing services to NHS patients.  In many localities it is likely that Labour and Conservative party candidates will disagree about this. The NHS becomes the issue about which local politicians are disagreeing in every locality.

Because of where we are in the electoral cycle 2018 is likely to be a good year for the opposition, and in this scenario the opposition are the Conservatives. They will probably get about 45% of the vote and make sweeping gains of whole councils with local campaigns to offer patients more choice of different providers. They will expect to be able to commission care for NHS patients from different independent and third sector providers. This policy will be very different in other localities where the Labour party may have won on a policy of not commissioning other providers.

The Health and Social Care Act of 2017 had a policy, let’s say, of recommending that the NHS was a preferred provider of services to NHS patients

But in the summer of 2018 more than half of the local authorities in the country are starting to develop policies of choice and of commissioning from the private sector.

Under these (very likely) circumstances what would a Labour Government committed to putting the ‘N’ back in the NHS do when clearly that ‘N’ is becoming more fragmented?

They would resist the outcome of the policy that they have just spent 2 years pushing through the Houses of Parliament. They would threaten local government with a new act that would take these powers away from them.

It’s more than likely that in the first month after a Labour Government had given local government the responsibility for local NHS commissioning, that same Government would have to pass restrictions on the localisation policy it had just passed.

As a way of strengthening the ‘N’ in the NHS this is a very odd policy to which to commit..