After the Bill
Health secretary Andrew Lansley gave a surprisingly chipper performance at the Nuffield Trust Summit on February 29. The audience of health policy experts was divided as to whether he was demob happy or just convinced that his Health Bill will be voted through by May 9th, despite the final twitchings of the Lib Dem corpse. Lansley had the confidence of a man who’s brought his own power point slides, a luxury rarely afforded to him on Newsnight, and he proceeded to drown the opposition in detail. He is truly the health secretary who knows the most and listens the least.
Very few policy experts felt the legislation was necessary and many felt it would be counterproductive, imposing yet more bureaucracy from the centre. This view was echoed by the board of NHS Tower Hamlets Clinical Commissioning Group, who have written to the Prime Minister and asked him to withdraw the Health and Social Care Bill. The government has already ignored the objections of 27 professional bodies, but this CCG is lead by Dr Sam Everington, an innovative GP who was Lansley’s special guest at the Conservative Spring conference in 2010 and who’s practice in Bromley by Bow was Lansley’s venue of choice for his first major speech as Health Secretary on 8 June 2010.
Everington, a former adviser to Robin Cook, is bang on the money: ‘Your rolling restructuring of the NHS compromises our ability to focus on what really counts – improving quality of services for patients, and ensuring value for money during a period of financial restraint. We care deeply about the patients that we see every day and we believe the improvements we all want to see in the NHS can be achieved without the bureaucracy generated by the Bill. Your government has interpreted our commitment to our patients as support for the bill. It is not.’
Lansley’s stock response – to patients, policy experts or staff having to enact his reforms – is that they misunderstand them and that everything will be marvellous. So while other European countries are commissioning on a large scale to drive strategy and keep costs down, and letting clinical staff concentrate on treating patients, Lansley is passing the buck for buying NHS services to small CCGs, largely lead by workaholic GPs who have little or no commissioning experience. But hey, it’s only £60 billion of public money.
After the Bill, the NHS will still be facing a huge budget crunch with hospitals desperately short of cash but trying to fiddle the figures and hide the scandals because they’re obliged to become Foundation Trusts. There will still be artificial divisions between community, hospital and social care, and huge variations in the quality of care in all three. There will still be an epidemic of obesity, alcoholism, mental illness and chronic diseases. And the Francis report into the Mid Staffordshire scandal (due in May or June) will make hundreds of recommendations for NHS reform and how we care for the elderly that may directly contradict the Health Bill.
As one GP put it: ‘Faced with all these pressures, our CCG is fast turning into Animal Farm. The Napoleons on the board won’t let one GP practice innovate and expand if it’s seen to take business away from other practices. If you do something off your own bat, you’re castigated for ‘not going through the correct channels.’ It’s no different from being under the cosh of the PCT. We have some GPs who are frankly dangerous and out of date, but no one is tackling that issue for fear of upsetting them.’
MD’s guess is that, after the Bill, GPs will pretty soon tire of commissioning and it will move back to the centre. The best hope for the NHS is for hospitals to join forces with community services and provide a joined up service for a large population, with excellent public health. Once services are integrated, they can compete for business if they must, but competition requires extra capacity and there’s precious little of that in the NHS. As Lansley himself said in opening his speech: ‘Coming back to speak to you is a triumph of optimism over experience.’ The same can be said for his Bill.