Since the autumn of last year I have blogged several times about the rather odd truth that the Government really doesn’t seem to care much about the detail of their Health and Social Care Bill. Since June last year they have been agreeing amendments to almost every part of the Bill (and then amendments to these amendments) with a reckless disregard for whether the Bill still makes any sense at all.
Their aim has been simple. Get the Bill through Parliament.
The last 15 months have been so painful for the Government that they just want it to stop. They think this will now have been achieved by passing the Bill and getting rid of it.
For people in the NHS, especially those against the Bill, this is obviously a bit insulting. If the only thing the Government is worried about is simply passing the Bill and is prepared to amend it in any way to get sufficient votes to do so, then those of us that are worried about the real content of NHS reform are pretty belittled by this political process.
I have posted on several occasions suggesting that the Government are being rather short-sighted in believing that the end of the Bill marks the end of their problems.
One of the certainties that 15 months of political conflict has led to is that the public have definitely noticed that the Government is launching an NHS reform programme. Because the Government have failed to explain what the Bill is trying to do, not many people know much about the precise nature of the row, but they certainly know that there has been one.
For weeks I have been puzzling about why the Government doesn’t understand that they have a problem here – that does not end with the passage of the Bill.
In recent weeks I have begun to find an answer.
David Cameron seems to believe that once the Bill is passed the extreme nature of some of the opposition to it will be shown to have been ‘crying wolf’ – and this will in some way prove his point.
He is right in thinking that much of the opposition to the Bill has been extreme. Some opponents have said that the passage of the Bill would be a defining moment and that it is likely that the NHS will fall apart if it passes. Others have asserted that the Bill will lead to a wholesale privatisation of the NHS that will change it forever. Others have talked about the introduction of an American style private insurance system.
David Cameron believes that the very extreme nature of these claims will not come to pass. He believes that once the Bill is passed the lack of extreme outcomes will somehow make the case for his reforms. He believes that when no US style private insurance system is introduced his promise that this would not happen will have been proved – and that therefore he will be seen as an honest politician.
Because he believes that what he is doing is not extreme he also believes that he will have the last laugh over those that accuse him of so being. He thinks he will be vindicated by the way in which the reforms are carried out.
But he has a different problem. Only very few people are really interested in the detailed cut and thrust of the politics of the NHS and the language used in those rows, and whilst only a few are interested in the politics everyone is very interested in the practice of the NHS.
The public know that there has been a row about the NHS caused by Government reforms. So over the next few years every time when they, or their mum or son, use the NHS the Government’s reforms will be casting a shadow over their experience.
If all goes well it will because the NHS is full of good people. But if something doesn’t go well, then some will link their problems to the 15 months of political fuss caused by the Government NHS reforms.
For the Government the difficulty is that the NHS is a real organisation and not one that operates just at the level of ideas and emotions. There are 1 million people having some kind of consultation with the NHS every 36 hours. This organisation is primarily a delivery organisation having with real relationships with real people.
For the rest of this Parliament those who use the NHS will have two things in their minds.
The first of these will be that there was a Government reform programme which caused a lot of fuss and the second – how is my experience of the NHS today?
It’s not the case that everything that goes wrong with the public’s experience of the NHS will necessarily be blamed on the reforms but if, over the next 3 years, 20% is -that’s a lot of people blaming the Government.
For the next 3 years the Prime Minister may make debating points about our months of discussion of his reforms, but what will have more impact on the public is their daily experience of an NHS that he reformed.
His problem is that the content of the political debate will be forgotten – replaced by actual experience of the NHS.
If that experience is better than it was when he became PM he will do well, and the public will forget the row. But it seems much more likely that what will form in people’s minds will be the association of these reforms – with a worse experience of the NHS.
If the polls are to be believed, the majority (one is tempted to use the cliche ‘vast majority’) of NHS staff are opposed to the legislation. How does the government plan to get them to cooperate fully. Without their cooperation the reforms will not work properly. Does the government care? Professionalism only goes so far.
It;s possible that Cameron may be right in the long term if stability is eventially achieved. I for one advocated from the beginning that opposition to the Bill should not be on the basis that it would see ‘the end of the NHS’. But in the short to medium term he will suffer politically from any report in a drop in the quality or a loss of access to services and there will undoubtedly be turbulence as the market and competition between providers kicks in. There are parallels with the railway industry which saw massive destabilisation after the separation of infrastructure from operating and the introduction of franchaises and new competing providers. The NHS will have its own Connex and Railtrack and the Secretary of State will not be able to escape political accountability. And will fare rises be replicated in the NHS with top-up and co-payments? What’s for sure is that the political problems have only just started for the Coalition.
[...] to the passing of the health and social care bill. On his Health Matters blog, Paul Corrigan asks Why is the government so pleased with itself now that it has passed its health and social care bill? and warns: Only very few people are really interested in the detailed cut and thrust of the [...]
In the original Bill, it was striking how much was left to secondary – undebated – legislation: I can’t see that any of the numerous amendmants – and amendments to amendments – chan ge that: are David Cameron and Andrew Lansley correct in just getting the thing passed by any means, so that the real work of secondary legislation can begin?
I would still like to know where the day-to-day housekeeping – management of registration, performers lists, CRB level 3 clearance of all staff in contact with children or vulnerable adults, GP revalidation, contracts for GP IT Systems and other GP IT (part of the nGMS contract), management of DESs and other enhanced services (also part of the nGMS contract) and OOH services will lie – and how the relevant funding will be mapped from existing sources into the new structures.
If the NHS Commissioning Board is to have 4 regional outposts with 50 local offices it doesn’t sound like a reduction in tiers – or as though the local offices will have the capacity for managing everything.
Will the secondary legislation be published or publicised
After all, this comes into force in 12 months from now!