The next Tory u-turn – the NHS?

By Tom Keeley

After a U-turn of relatively small proportions on the forests, the press has been full of speculation about the next 180 for this government. Many have said that it will be in health. So what would a U-turn on health look like?

It is unlikely that the whole of the government’s health policy will be reversed. The reforms proposed in the White Paper and the Health and Social Care Bill are so numerous and broad that if they were all simultaneously dropped it would surely spell the end of this government. However there are areas where the government could draw back to more moderate and less dangerous reforms, without the appearance of a complete about face.

The new NHS Commissioning Board

This is the most likely area for retreat. This board is designed to be a lean and arms length body, which oversees consortia and commissions primary health care, maternity care and care in select, complex secondary areas. The chance of a small and centralised organisation successfully carrying out these responsibilities is almost zero. These are huge responsibilities that can best be done by regional experts, working in tandem with frontline services. There is every chance that the NHS Commissioning Board will become a large and hands on organisation or be split into a number of regional boards.

The responsibilities of consortia

A revision of the responsibilities of consortia would be a welcome rethink by the government. Previous efforts of giving GPs commissioning roles have shown them to be ineffective and costly commissioners of hospital and emergency care, but fairly good at commissioning primary and community care services. Lansley could reduce the scope of the responsibilities GPs hold, while at the same time maintaining the idea of consortia

Keeping in place tariff prices

The reforms announced that the NHS tariff prices, which encourage competition on quality, are to become maximum tariff prices. This will encourage hospitals and clinics to compete on price, possibly at the cost of patient care. A climb down on tariff prices is thought likely. An option might be the setting of tariff price brackets, allowing limited price competition within that range.

Any willing provider

This area has got many on the left whipped up in a fog of uncertain anger. But, a change in policy here could happen without attention being drawn. The health market is not a market that fosters competition. Huge sunken costs and consumer uncertainty makes it hard for companies to enter it and compete. The role of Monitor could be muscled up to limit entry to the market and ensure that competition is largely between existing providers.

The Labour response

For any of these climb downs to occur, the position and disposition of the Labour Party is vital. We have a choice. We can pursue the highly unlikely massive political victory on health care: the complete destruction of the reforms, with ministers Lansley, Burstow, Burns and Milton in disorganised retreat. Or, we can work towards a neutering of the reforms in a more bipartisan manner. The right choice, for the NHS and for the Labour Party politically, is the second.

The Health and Social Care Bill in its current format represents an unprecedented threat to the NHS. However, the danger is not in the basis of the reforms, rather the extremes that Lansley takes them to. They will mean health care in areas on this country being put back 10, 20, 30 years. But, giving select commissioning responsibilities to GPs, producing some flexibility in the tariff price and allowing a degree managed competition are not bad, or particularly conservative ideas. If the Labour Party could play a part in changing the reforms back from the current dangerous format of complete commissioning responsibility, total tariff price flexibility and total competition it would be a job well done and something to be proud of.

Secondly, the prospect of a Labour Party trying to defeat these reforms in their entirety is politically questionable. Between 1997 and 2010 the Labour Party built an internal market all of our own, pushed commissioning responsibilities closer to front line primary care clinicians and encouraged competition. Many MPs now with shadow health portfolios supported these reforms. A full-frontal opposition to everything in the Health and Social Care Bill is going to look at best confused, and at worst hypocritical. It would cause us to become a Labour Party with a 1992 or 1997 health policy, which, despite being ideologically acceptable to many, would not serve the people of this country well. A nuanced approach is vital.

The chances of a full U-turn on health are small. Senior managers and staff are leaving the SHAs and PCTs in droves. Each month that passes means that these organisations are less fit to do their job. GPs are already taking on commissioning responsibilities. The coalition is tied to the reforms and has the votes. The health reform tanker is heading for the shore, the best the Labour Party can do is to help steer it to a port.