This week the Government will publish its Health Bill to reform the NHS. It will be the biggest health bill ever and will take up both a lot of Parliamentary time and, over the year, most of the discussion about health care politics will centre on it. Of course that is at it should be. They are the Government and they are bringing in the changes that the current Secretary of State has referred to as ‘revolutionary’.
The importance of the discussions about the Bill will lead to a lot of very sharp comment about parts of it in both Parliament and the country. The Government will not only say “Are you favour of our Bill or not” but will expand that to “Are you in favour of reform or not”. They will try and characterise all opposition to the Bill as being simply in favour of the status quo – “If you are against this change, you must be against all change.”
If you are against this reform you must inevitably be conservative.
I have been in several discussions over the past few weeks where people have tried to put me into that box. And since it is a box into which I do not want to be put, one of my tasks for the next 6 months will be to be part of a discussion that will clearly delineate a position on reform which is not precisely that of the Government.
There are several reasons for this.
Firstly, it is simply bullying to say that if you are not in favour of the changes put forward then you are in favour of the status quo. And it’s a really good idea never to give into bullies. So clearly developing another position for reform will demonstrate that it is logically untrue that the only alternative to what the Government wants is the status quo.
Secondly, this Bill and these reforms will get into trouble. At various stages the Government will – as it has done already – shift its position from saying “this is revolutionary” to saying “this is simply a continuation of Tony Blair’s reforms.” They will claim therefore that everyone who supported Tony Blair’s reforms must support the Coalition Government reforms. And when Blairites don’t, they are simply being oppositional. Its important therefore to demonstrate the distance there is between what a continuation of reform would have achieved rather than the different approach of this Government.
Thirdly, whilst it appears strong at the moment – with a coalition majority in both houses – this too will pass. Both in health and in other areas the Government will get into trouble and at some stage in 2014/2015 there will be another General Election. At the General Election I expect the politics of the NHS to have a higher salience with the public than in 2010. It would not be politically useful if there were only two possible positions on the politics of the NHS – in favour of the Government reforms- or in favour of the status quo. The public will need there to be a variety of change and improvement approaches put before them. The Labour Party will be a part of that process.
Fourthly, if the NHS is not successfully reformed in the next decade, the rising demand for health care with a limited public resource to meet that demand will lead to a combination of long waiting times, rationing and co-payments. This would signal the end of the NHS. One alternative is that the Governments reforms work. But I don’t think I would want to hang the future of a major part of my society on the chance of the current Secretary of State’s reforms all ‘working’. Therefore if the debate is between these reforms and doing nothing, the country may decide, unless there is another choice, doing nothing is a safer bet.
But if NHS reform is some way stopped, this would place the NHS in great danger.
So over the next 6 months, 3 or 4 times a month, I will write a piece which raises some general questions about how the reform programme needs to develop in the next few years, ending – in the middle of the year – with some different sets of answers to those key questions that the Government have. Some of them will be similar to the Government’s intentions, and some will be different, but as I said above it would be good to be able to demonstrate that there are more ways to reform the NHS.
These will be published as “Developing the case and capability of NHS reform”. Others will be doing this as well.
The rest of the blog will run as normal. Posts pointing out how this bit of what the Government is doing don’t fit in with that bit, and how the actual issues that are being developed in the Bill will cause problems when it becomes an Act. Together with other posts pointing out that what they intend may not work the way in which they intend it.
Whilst I would not go as far as the Today programme in saying NHS reform will be the political issue of 2011. It will certainly be important – and above all interesting.