10th April 2012 

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Lost for words

News and Comment from Roy Lilley

Well, I've done it. I got the wet towel, the bucket of builder's and did it. I have read every one of the 473 pages of the Health and Social Care Act. I am a fully qualified, anorak.

Here's the story; each year the SoS must provide the new NHS Commissioning Board with a 'Mandate' of the objectives that the Secretary of State considers the Board 'should seek to achieve'. Note 'should' not 'must or I'll kick yer backside all the way to Leeds and back'. 


By the way, he is not permitted to tell them how. Instead, there is a labyrinthine procedural palaver about publishing business plans, writing annual reports, letters of assessment and documents laid before Parliament. Effectively, we now have two Departments of Health. One DH with a Board of executives and non-executives would have done nicely, wouldn't it? It's barmy but it was in the Bill.

The Commissioning Board is really a carbuncle on the backside of the DH. Annualised plans like the Mandate are too short a time scale, don't align with three year funding cycles and anyway; it takes a year to find out that something's gone wrong, a year to fix it and another year to be sure it's working. The Carbuncle adds nothing to modern, streamline, single layer, nimble, responsive management. It's barmy but it was in the Bill.

Clinical commissioning groups can be comprised of two or more providers of a PMS contract. In effect GP practices. We all know two coming together would be too small to be authorised, too small to carry risk, too small to manage themselves and too small to support a governing body, provide a needs assessment, liaise with their local authority health-watchers, have an audit committee, a remuneration committee, declare a register of interests, promote the NHS constitution, improve the quality of services and do the day job. So why not define a population this is big enough to enable CCGs to do all that by themselves? I know, it's barmy but it was in the Bill.

To be a CCG you have to be authorised. To be authorised you have to have a constitution. A constitution is a complex legal document that can bind practices to a form of behaviour and dismiss them if they err. Effectively put them out of business. The Carbuncle authorises CCGs, provided they have a constitution. So, to save messing about with 250 different constitutions they have produced a template. Just fill in the banks for your CCG. This document describes what you would recognise as a PCT. It's barmy, but it was in the Bill.

What about choice, no decision about blah, blah? The Carbuncle must make arrangements 'to secure that individuals to whom the services are being or may be provided are involved whether by being consulted or provided with information or in other ways'. That'll be a leaflet then? Even if I am consulted I may not get what I want as; 'Each clinical commissioning group may arrange for the provision of such services or facilities as it considers appropriate'.  Please note;  'It considers', not what I chose. It's barmy, yes, but it was in the Bill.

Monitor? Main duties; protect and promote the interests of people who use health care services which are economic, efficient, effective, maintain or improve quality, prevent anti-competitive behaviour, enable integration, provide fair access, reduce inequalities, ensure the best use of resources, promote cooperation, research, achieve high standards in the education and training of health care. Plus, publish guidance under the Competition Act 1998, consult on the national tariff and write an annual report.

Oh, and 'where Monitor considers that any of its general duties conflict with each other, it must secure (it) is resolved in the manner it (Monitor) considers best'. Monitor considers best......... 'Avin' a larf? No it was in the Bill.

It was all in the Bill and now it's in the Act. I do not know how sensible, educated people with an ounce of common-sense could have voted for it. There is so much more but I only have room for 700 words and frankly, I'm lost for words


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