Political Freedom for the NHS? Er…. No
Andrew Lansley’s promise that his health bill would depoliticise the NHS is proving as fruitless as trying to depoliticise the economy. The theory is that ‘clinical leaders’ will now run the NHS on behalf of patients while politicians calmly retreat from the fray and let them get on with it. But at PMQs on April 24th, Ed Milliband revisited the Thatcher taunt that the NHS was ‘not safe in Cameron’s hands’. And Cameron responded by rubbishing the NHS in Labour-controlled Wales, before signing off with “that is what you get under Labour: cuts to our NHS, longer waiting lists and all the problems we saw at the Stafford Hospital would be repeated all over again”.
Although Labour should accept accountability for Mid Staffs, as should the NHS senior managers who have glided unopposed into the top NHS jobs under the Tories, it’s absurd not to recognize the extra funding and improvements to the NHS under Labour. It’s also absurd, and very dangerous, to suggest another Mid Staffs would only happen under Labour. In doing so, Cameron is creating the same culture of denial that lead to Mid Staffs.
Don Berwick, Cameron’s newly appointed safety tsar, takes a more cautious approach. He has told NHS staff ‘Don’t think you’re different to Mid Staffs staff. You should not be confident you would have acted differently.’ Some staff at Mid Staff tried to speak up but were shut up, leading the Nursing Times to launch an excellent Speak Out Safely campaign ‘to help bring about an NHS that is not only honest and transparent but also actively encourages staff to raise the alarm and protects them when they do so.’ But as the pressure mounts to make the NHS look good in time for the next election, it’s hard to see how this will become a reality.
The NHS has done remarkably well in the last 2 years given the slow-down in funding, but the wheels are starting to loosen. The dramatic rise in 12 hour trolley waits in A+E was the main thrust of Miliband’s attack but winter has been tough, most of the patients are frail and elderly, and there is nowhere else for them to go. Discharge may be delayed because of a lack of social care beds and so elective operations are cancelled. It’s hard to see how it would have been any different under Labour.
NHS funding may have flat-lined but adult social care has had cuts of £1.89 billion in the last 2 years. The NHS and social care might work better if the services were integrated, and Torbay is trying to merge its services but the Office of Fair Trading now has to assess any merger involving an NHS foundation trust, and to ascertain whether it could be seen as anti-competitive. Don’t expect progress soon.
Competition law in the new NHS seems likely to delay the integration of services and make lots of money for competition lawyers. It could also, in the long term, open the door to whole-scale privatization. Section 75 regulations set the legal framework for NHS competition under the reforms, and a Labour motion to annul them was defeated by 145 votes to 242 in the Lords on April 24th, with Lib Dems siding with the Tories. Many who voted in favour of section 75 have vested interests in private companies which stand to benefit, so the result was unsurprising.
The new laws make it harder to award NHS contracts without competitive tendering, and although in theory some services can be protected from cometition, the commissioners have to make the case that there is ‘only one provider capable of meeting their requirements’. Lawyers will love it, commissioning could become a protracted and very expensive nightmare, and the private sector could cherry pick profitable services and completely destabilise the fragile eco-system of the NHS. That’s what Dr Clive Peedle, co-founder of the NHS Action Party believes, and they will be contesting 50 marginal seats at the next election and trying to force legislation through to make the NHS the preferred provider of services. The NHS will never be politically free, and it’s pointless to suggest otherwise.