The Health Bill Balls

David Cameron described the Health and Social Care Bill, published on January 19, as a ‘once in a lifetime change’ of the NHS. This is the third ‘once in a lifetime change’ we’ve had in twelve years: Tony Blair and Labour health minister Lord Darzi made the same claim for their reforms. So either we’ve been lied to, or life expectancy is set to fall to four years. The Bill weighs in at 367 pages, even bigger than the 1948 Bill that created the NHS, and it’s an unbelievably tedious read. But there are some surprising changes from the July White Paper.

In the White Paper, it appeared GPs were taking over the NHS with 75 mentions. In the Bill, they get just 2. That’s still 2 more than consultant or nurse, but the consortia they were originally in charge of get 623 citations. Consortia will be controlling most of the NHS budget but now –thanks to the lobbying of large private health companies – the accountable officer doesn’t have to be a doctor. Indeed, consortia aren’t obliged to have a board or any patient representation. But they will be tightly regulated by the NHS Commissioning Board, which can set standards for their creation, direct them, have them taken over, fire their accountable officer and abolish them altogether.1It’s as if GPs are being set up to fail so corporate healthcare can step in.

Pathfinder consortia have set the trend by giving themselves ridiculously corporate names. Fortis Group, The Red House, Bexley Clinical Cabinet, Cumbria Senate. None of these sound remotely NHS. They’re not yet statutory bodies so it’s hard to find out what goes on in their meetings or where the money goes. Some are succeeding in improving care by cooperating with hospital and social care to join up services for patients. But you can integrate care without massive reorganisation, as Scotland has proved. The success of its collaborative approach in improving outcomes and reducing inequalities stems largely from avoiding major structural upheavals over the last 25 years.
The NHS has never succeeded in making the 4% efficiency savings it now needs to hit the £20 billion 5 year target, so it’s hard to see how consortia can succeed in the short term. They will take over explicit rationing of healthcare from NICE and PCTs, and patients are supposed to lobby GPs directly if they don’t like it. And if consortia fail to balance the books, as many surely will, the Commissioning Board can hand them over to UnitedHealth, CareUK or Kaiser.

Foundation hospitals have far more independence than consortia, but are in an equally parlous financial state. Many new buildings look fantastic but typically have a £17-£20 million annual PFI debt to service. Consortia can now go to ‘any willing provider’ prepared to undercut NHS hospitals so many will struggle for business. As compensation, the Bill allows them to do as much private work as they like. Great news for the balance sheet, but not for NHS patients or staff who disagree with a two tier system. And as waiting times rise, as they inevitably do when money is tight, the demand for private treatment rises and compounds the NHS wait.

Labour’s attack on this is weakened by its own clumsy attempts to introduce an NHS market. Private companies were paid above the going rate to cherry pick easier operations, and the money was guaranteed no matter how few patients they treated. Labour too dabbled with the idea of out-sourcing commissioning to large private companies. The Health Bill is far more an extension of the Blair reforms than a retraction. As for patients, Lansley pledge of ‘nothing about me without me’ is looking thin. Like PCTs before them, most patients won’t have the faintest idea what goes on in a consortium. But they will notice money drying up and service cuts. And when they try to complain to Dr Clark, he’ll be down the Red House, up the Fortis Group or in the Senate.

MD 1 Health Service Journal, Essential Guide to the Health Bill, January 21