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

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Secrecy and Suppression in the NHS

Why are most inquiries into NHS failings still held in secret? Without scrutiny of the process, there is no way of establishing their independence and we’re forced to rely on blind trust in the integrity and competence of experts, which is generally why NHS scandals occur in the first place. And given that inquiries are paid for out of public money, it’s absurd that patients should be excluded from hearing the evidence and cross-examination, and giving their own evidence.

The Bristol Pathology Inquiry was run by Verita, cost £700,000 and the report was published 18 months after the Eye first published allegations of serious errors in pathology reporting at University Hospitals Bristol (UHB). These had been circulating around the city for some years, and the hospital management, Bristol PCT, South West Strategic Health Authority and Royal College of Pathologists all knew about them without properly investigating. As the report conceded: ‘This Inquiry was only established because of the articles in Private Eye and, had it not been for them, the issues would have continued to be ineffectively addressed.’

The report found that: ‘The culture in the histopathology department at UHB veers towards

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Double dichotomy on the rocks

There are obvious dichotomies in the coalition health policy. While health secretary Andrew Lansley promised ‘no major top down reorganization of the NHS’, his chief executive David Nicholson has been busy telling anyone who’ll listen that ‘the reorganization of the NHS will be so huge you can see it from space.’ Lansley has now admitted that his changes amount to ‘a significant reorganisation of the management of the NHS’, and Nicholson has been rewarded for his impertinence by becoming surprise chief executive of the new NHS Commissioning Board. He will now take the rap if the NHS doesn’t come up with £20 billion of productivity savings by March 2015, an impossible task the Tories have labelled ‘the Nicholson challenge’ to ensure the buck knows where to stop.

GPs were supposed to hold the purse strings in Lansley’s NHS, but the government’s response to its White Paper consultation – helpfully released just before Christmas – has deemed that the ‘accountable officer’ in the new GP consortia doesn’t have to be a GP. This is good news for GPs, many of who were wary of taking on the top jobs knowing they could well be sacked

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Christmas Massage

We all know what’s wrong with the NHS. There are too many hospitals swallowing too much money, and too many patients swallowing too many calories. Labour got NHS funding above £100 billion a year, cut waiting times and improved patient care and satisfaction overall. But they failed to get healthcare closer to home, failed to get people to take more responsibility for their health, failed to spot and stop appalling health scandals and failed to narrow the gap between rich and poor. So now it’s the Coalition’s turn to fail.

There are some good ideas in the White Paper, most notably that clinical staff should have more responsibility for planning services and rationing healthcare, but it’s being done at ridiculous speed. The perceived wisdom of NHS reform is that you spend the first year blowing everything out of the water and then next four picking up the pieces. Abolishing strategic health authorities and primary care trusts may be the right thing to do, but doing it all at once sends NHS management into free-fall just at a time that it’s supposed to be making huge savings.

The NHS budget has increased year on year for decades, allowing

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