9th March 2012 

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Who would vote for this?  

News and Comment from Roy Lilley


I a surprise move and it has to be said, against the run of play, Parliament (with, by all accounts some shoving from Andy Burnham) has decided to do the decent thing and debate the future of the Health and Social Care Bill.  This following the 'People's Petition' inspired by Dr Chand, that attracted over 170,000 signatures.


What will the MPs do?  The Tories will be whipped within an inch of their lives, the Labour opposition will meander down the cul-de-sac of privatisation and the LibDems...  Anyone's guess.  If they are true to their principles, they will vote with Labour.  Unlikely; they have been told by Cleggy-Boy to forget the Bill and move on.


Let's assume there were no party politics involved, no whips, no hubris and no climb-downs.  What would they do.  Well, I guess they might look at the facts.


1.  The Bill ws intended to put GPs at the heart of commissioning.  It doesn't it is now 'clinicians'.


2.  The Bill was then intended to let clinicians commission in small groups.  It doesn't; small groups don't have and can't recruit the talent to do it and they can't carry the financial risk of commissioning.  Small groups of clinicians (CCGS) are being corralled into Commissioning Support Organisations.


3.  The Bill makes no mention of Commissioning Support Organisations; they are outside the purview of the Bill and the reach of Parliament and will be (in the clear admission of the DH) private or third sector organisations who will use NHS money to arrange commissioning, care-pathways, formularies and referral criteria.  They will become the engine room of the NHS.


4.  The Bill makes no provision for the real risk in what happens if a substantial private sector provider goes broke or decides to give up providing services (Remember Southern Cross).  This puts the public at risk.


5.  The Bill claims to create choice for patients.  It does not.  Patients will still have to register with their local GP, who will have to belong to a local CCG, which will be in one of 30 national Commissioning Support Organisations who make every decision about them, without them.


6.  The Bill claims to make the NHS stronger for the future; it doesn't It fragments the supply side and denationalises it.


7.  The Bill claims to address the future health needs of the nation.  It doesn't.  It won't make fat people thin or old people remember who they are.


8.  The Bill claims to cut bureaucracy; it does not.  Roles have been cut (45%) in pursuit of savings but the jobs still need to be done.  The replacement for 3 layers of management is 5 layers of complexity.  A text book management error.


It might be worth mentioning that every professional organisation, Royal College and patient organisation has either asked for the Bill to be withdrawn or opposes it in some way.  Even the organisation that set out as enthusiasts the NAPC and the NHS Alliance now express reservations.


What's gone wrong?  Doing the right thing is what's gone wrong.  The complex Bill, was at the outset, a bad piece of Parliamentary drafting.  In doing the right thing, fixing it, complexity has been piled on intricacy and now we have confusion and muddle.


What's the right thing to do?  The sensible thing?  Stop, take stock, see where the NHS is in its present state; in the grip of trying to save one fifth of its budget and keep going against the tide of demand.  Properly assess the impact of the consequences of the Bill and if necessary start again.


The intention of the Bill is to take the politics out of the NHS.  A good start would be on Tuesday.  Look at the facts not the politics.  Who, in their right mind would vote for this? 


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