The NHS and Labour – after the bill

The Health and Social Care Bill has passed and fundamentally changed our NHS, moving it to a regulated market rather than a managed system based on competition. The one genuine chance of defeating it came with the attempt to unite all the NHS professional bodies in opposition – it was close.

Services will no longer by delivered by genuine publicly owned NHS bodies; the blue logo outside the buildings will be misleading. The planning (commissioning) of services will be in the hands of unelected and weakly accountable quangos. There will be no strategic bodies looking at services at regional or sub regional levels (for the first time ever). Worst of all the relationships will move from being basically cooperative to being defined by legally enforceable contracts open to the full force of competition law. The “N” is taken out of the NHS. Nobody voted for this.

Only the election of a Labour Government can limit the damage and put the NHS back onto its traditional standing as a public service based on social solidarity.

Implementing the huge reorganisation coincides with the worst ever period in terms of funding and alongside the collapse in social care provision. But the NHS will cope and a very real problem is that in the run up to the next general election the Coalition might be saying – we told you so, nothing terrible has happened, waits have not gone up, nobody is being excluded, there are no new charges, and there is more choice and patients and Doctors are now in charge of the NHS. It will be a powerful message to counter.

Those who predict meltdown or chaos underestimate the ability of the NHS to cope and flex, and put patients first even in the midst of this dangerous reorganisation. It could be years before patients realise what has happened – in the short term their experience of our NHS will continue to be very positive. There will be failures and local difficulties but then there always has been.

Despite the Bill there is still a very powerful top down bureaucracy (the National Commissioning Board) mostly staffed by NHS traditionalists who will try and preserve the values and ethos of the NHS – it is a bulwark against the forces of competition led by the new Economic Regulator (Monitor). In the short term this will deter widespread outsourcing and privatisation – but not for long.

Over the next year much will happen. New bodies such as the Clinical Commissioning Groups, Health and Wellbeing Boards and Healthwatch have to be established. Big, powerful new national bodies like Monitor have to gear up for their role. Vast amounts of secondary legislation has to be passed to bring in regulations and guidance. Nobody knows how the new structures will actually work.

So implementation will be a long and difficult road to travel and politicians and activists of all kinds have many opportunities to get involved in the new structures, to challenge, ask difficult questions and to ensure issues such as reconfiguration, outsourcing, competitive tendering, and privatisation are all properly scrutinised. And local authorities which are active can intervene and drive local wellbeing strategies and challenge local commissioning aberrations.

In parallel there needs to be a clear articulation of a Labour alternative. Not a utopian construct but one that is credible and which accepts that the starting point for further change will be a difficult one as many of the existing structures will have been destroyed. We need the widest possible consensus about an alternative, like that broad coalition that Labour built prior to the NHS Plan in 2000. Not detailed policies as it is the wrong time in the electoral cycle but some statements of principles.

Some difficult issues have to be addressed. How are public health, social care and health care integrated – should we even have three separate concepts? What ownership model is best – do we allow some private provision (always been some), how are NHS bodies like Foundation Trusts made genuinely locally accountable, and do we favour social enterprises of any sort? Do we need integrated commissioning/planning across the whole public sector (not just health)? Can we leave GPs as independent contractors? What role, if any, is there for competition – and what sort of competition? Who decides – do we make healthcare commissioning/planning genuinely politically accountable (never has been)? How do patients and the public get to genuinely influence services? How many regulators and what do they regulate?

Many questions.

Getting a broad consensus in favour of a policy position is a lot harder than a broad consensus against the Bill and even that proved to be very hard to achieve.

To try and address policy development and to test new and emerging idea the Socialist Health Association is running a series of events to look at how Labour Party policy might develop. This can inform and support the Party’s own Policy Forum process. Events will be interactive and participative but each will have contributions from acknowledged experts too. Details are on the SHA website.