The British Conservative-led coalition government is currently in the midst of a brief “pause” in its efforts to push through their sweeping restructuring of England’s National Health Service. Health Secretary Andrew Lansley’s Health and Social Care Bill (see summary) is based, with minimal changes, on last July’s White Paper “Liberating the NHS.” The bill was published as legislation in mid-January, and whizzed through the first stages of parliamentary procedures with little evidence that any MPs (or journalists) had read or understood it. For example, BBC summaries have for the most part ignored the bulk of the Bill’s content to describe it as “plans to hand greater powers to GPs.”
But Lansley’s reforms have met increasingly vocal criticism and outright opposition from a wide spectrum of individuals and organisations ranging from virtually every professional organisation of health workers, health labour unions, the NHS employers, almost every independent “think tank, approach, Parliament’s own Commons Select Committee, a few Conservative MPs, and even from the Spring Conference of the junior coalition partners, the Liberal Democrats (see more).
The LibDem conference coincided with the final stages of the parliamentary term, and the passing the legislation to the House of Lords for consideration. The ministers are conducting what they call a “listening exercise.” This NHS Future Forum is staffed with officials generally supportive of Lansley’s reforms. This exercise may give the appearance of responding to public opinion, before pressing through the key elements of the plan, with little, if any, actual change.
Perhaps there will be more independence and scrutiny by the unelected House of Lords than by the MPs in the Commons. And maybe the pause will allow health journalists to read the legislation and understand its implications. This is necessary if there is to be any informed debate on the bill–its merits or flaws. MPs are as baffled as the general public about the Conservative plans, and the general public does not recognise the extent to which the legislation would transform and fragment the NHS. Ironically, this turmoil comes just at the point it has delivered its highest-ever approval ratings from patients and public.
The new legislation seeks to sweep away all of the existing publicly-accountable management structures, and replace them with a central NHA Commissioning Board and local “consortia” of GPs (family doctors” which would share responsibility for a commissioning budget of £80 billion to purchase care for their patients from a range of nonprofit and for-profit providers.
The new competitive market in health care would be regulated by an independent body, called the Monitor, whose mission it is to maximise competition. The agency would be responsible for approving a national list of “any willing providers,” and GPs would be required to offer patients requiring hospital treatment a choice of referral to these providers, or perhaps be in violation of UK or even European Union competition law.
Andrew Lansley’s massive and highly controversial 360-page “Health and Welfare Bill” would also lift the restrictions on the amount of money semi-autonomous NHS Foundation Trusts would be able to generate from private medicine. In the context of a standstill in NHS funding after ten successive years of large increases, and three years in which the “tariff” paid to hospitals for treating NHS patients is set to fall, and £20 billion of “efficiency savings” required by 2014, these changes could force the new GP consortia to act effectively as rationing boards, and destabilise many existing NHS hospitals – forcing some with the highest overheads into bankruptcy.
The initial motion tabled by LibDem junior health minister Paul Burstow, who has claimed to have been a co-author of Lansley’s plans, was heavily amended to withhold support of a number of fundamental aspects of the Bill, and place firm conditions on LibDem support for other proposed changes.
They called overwhelmingly and explicitly for Liberal Democrats in Parliament to press for far-reaching changes, including:
- “More democratically accountable” commissioning
- No decision about the spending of NHS funds to be made in private and without proper consultation
- The complete ruling out of any competition based on price
- NHS commissioning to be retained as a public function “using the skills and experience of existing NHS rather than sub-contracting of commissioning to private companies”
- An NHS … based on cooperation rather than competition … “which promotes quality and equity, not the market”.
- New private providers to be allowed “only where there is no risk of ‘cherry picking’ which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases”, and “where the needs of equity, research and training are met.”
Since the private sector has sought to cherry pick specific NHS services-those that are financially attractive—this final stipulation would appear to rule out almost any expanded role for private sector providers. Critics agree this is the crux of the Lansley reforms.