Andrew George MP: ‘Happy Birthday NHS?’

On the NHS’ 63rd birthday, Andrew George, cautioned fellow MPs against believing that previous concerns had been resolved.

He warned that an integrated NHS had become subordinate to a new ‘choice mandate’ and that the job of promoting competition appears to have been quietly shifted from Monitor to the new NHS Commissioning Board.

Mr George said, “The ‘pause’ was a great triumph for those who opposed the Bill. The Future Forum report was a significant step forward. The Deputy PM should be congratulated for that.

“However, if the Government had been listening it would have scrapped the Bill. Instead it looks as if they’ve just massaged and tweaked it a bit.”

GOVERNMENT HEALTH POLICY: SMOKE AND MIRRORS

For those who, like I, had strongly criticised the Government’s Health and Social Care Bill and campaigned against the Government’s plans, the unprecedented “pause” and “listening exercise” was an encouraging success.

Last week’s Future Forum report represented a welcome step forward.

However, what is emerging from the Government’s response is disappointing.  It leaves many of the previous concerns – about the risk of a marketised NHS, missed opportunity to better streamline health and social care and lack of accountability – still unresolved.

Whether it is the intention of Ministers or not is unclear, but it seems that the Government will perpetuate rather than resolve the risk posed by the private sector to core NHS services.  In particular: although Monitor will not, as before, “promote” competition, the new NHS Commissioning Board will have an enhanced role in driving it, the proposals weaken the ability of Commissioners to treat core NHS services as their “preferred provider”; it enhances the opportunities for private sector providers as “choice” gains pre-eminence over integration; and although commissioning bodies will not be able to delegate their responsibility for commissioning decisions to private companies, all other aspects of their role in managing and delivering those decisions can be.

In addition, some of the core issues which helped to persuade the Government to “pause” are still not resolved. The Government’s proposals do not go far enough in strengthening the ability of clinical commissioning groups to better coordinate health and social care; and enhance democratic accountability.

1. NHS COMMISSIONING BOARD DRIVING COMPETITION

The NHS Commissioning Board will be given a mandate by the Secretary of State to “set clear expectations about offering patients the choice: a ‘choice mandate'”.

The NHS Constitution has seven key principles (comprehensivity, equal access based on need, safe/effective care, to reflect needs and preferences of patients and carers, integration, cost-effectiveness and accountability). Integration is given an at least equal status with that of patient “preferences” (i.e. choice).

It seems that what we have successfully done to block Monitor from doing has simply been switched to the NHS Commissioning Board and can be ‘mandated’.

2. NHS AS PREFERRED PROVIDER

The Government’s response to the Future Forum states that it will “prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of favouring the private sector over existing State providers – or vice versa.”

The reference to “vice versa” ditches the possibility of preferred provider status applying to NHS services and hospitals. It also potentially contradicts the claim of ensuring the integration of services and the ability of, for example, NHS hospitals to provide a range of specialties, case volume and income to run safely emergency, complex and A&E services.

3. CHOICE OVER INTEGRATION

Choice will now have a “mandate” whereas integration will not. HealthWatch will be told to establish a Citizens Panel to look at “choice and competition” whereas there will be no such instruction for integration, etc.

4. PRIVATE COMMISSIONERS

The Government’s proposals for Clinical Commissioning Groups seeks to reassure by stating that these will be “public bodies” and will not have the power to “delegate their statutory responsibility for commissioning decisions to private companies or contractors”. So, the decisions may not be delegated, but everything else could be.

5. INTEGRATION OF HEALTH AND SOCIAL CARE

The Government’s proposals only require the NHS Commissioning Board to have “taken properly into account” objections from Health and Wellbeing Boards regarding the boundaries of Clinical Commissioning Groups. Objections on the grounds that there is insufficient coterminosity between health and social care would not in itself be sufficient to stop any proposed Clinical Commissioning Group proposals from proceeding.

6. LACK OF DEMOCRATIC ACCOUNTABILITY

There is no further enhanced role for Health and Wellbeing Boards, nor for elected representatives on Commissioning Groups.