Thursday, 15 March 2012

NHS Bill, a revisit: Part 1

In September I looked at the NHS reform bill and decided that, on balance it wasn't a bad situation, as long as some concerns were dealt with...specifically on issues of regionality of commissioning bodies, how competition balances with patient care, and giving watchdog bodies more "teeth".

Since then the government has done it's best to portray this bill in it's worst light, not really answering criticisms, deflecting (quite accurately) on Labour's own history of privatising the NHS, and taking quite bizarre actions that make ordinary people question the government's motives, the main case in point being the refusal to publish a document of the risks involved in the reforms being proposed.

Combine this complete lack of political ability with professional bodies themselves, GP's and doctor's representative groups, calling for the bill to be completely scrapped and my view...previously ambivalent, has turned distinctly negative to the bill.

But does that mean the bill itself is actually as bad as Labour are claiming? Will it actually destroy the NHS, leaving nothing like it in it's wake? Will it mean higher waiting times for the poor as the rich get preference? Will it mean universal healthcare only for those with enough funds or insurance?

Let's see... Warning, this is long.

For a start the bill now explicitly says, for the first time since these reforms started, that the minister in charge of healthcare in this country retains responsibility for the provision of services. This keeps the largely symbolic link of democratic representation in place, the idea that we can demand the government do more on the health service because it is that member of the cabinet who needs to ensure provisions are adequate.

Furthermore there is an explicit legal requirement for the NHS to remain free at the point of delivery, with exceptions. These exceptions are detailed elsewhere (namely dentistry, etc), and is kept open ended for pragmatic reasons. This is exactly the same as it was in the last law, the NHS 2006 act.

So, the government is still responsible to provide a national health service, the buck stops with the Minister for Health. Furthermore, the idea of the NHS suddenly getting more expensive to use as a patient is no more a threat than it was in the past. No-one has made it so that suddenly private companies, or the NHS bodies themselves, can start charging you for your cancer treatment.

So far, so 2006.

Added to the above we have newly defined responsibilities, an added layer of transparency as yet unseen in setting out what the Secretary of State for health should be ensuring.

The most interesting is a new legal responsibility for the Minister, not only to provide for the NHS to run, but also to ensure it improves. OK, it is "woolly" meaningless language, but the intent is clear...the Minister for Health needs to show that he is making decisions that are for the betterment of the NHS. Specifically he needs to make the NHS safer, more effective and of better quality, and the outcomes of those three areas must be measurable.

Does this mean that if the NHS performs inadequately on such issues that legal action could be taken against the Minister and their department? Absolutely! Of course the threshold for proving that proper care hasn't been taken to try to achieve improvements would be very high, but the principle is there.

Then we also have:

  • Adding the Secretary of State for health to the list of people that need to respect the NHS constitution.

  • It will be enshrined that, aside from situations where autonomy detriments the achievement of improved safety, quality or success of the NHS, people providing healthcare must be allowed to do it their way.

  • Research must be provided for, so we must assume the Minister has to make sure it's funded.

  • The buck now legally stops with the Secretary of State for health when it comes to training and educating NHS staff. If people aren't doing their job properly because they haven't had the right guidance, it's the health department that needs to explain why.

  • Finally, the Minister must also make sure no organisation is at a disadvantage when applying to provide supplies to the NHS. Particularly specific this one, and seems to surrounding the issue of VAT for supplying the NHS.

Along with the Minister for Health, there will also be a Commissioning Board set up. They will also share many of the responsibilities above, perhaps sensible when considering the amount of time that a Minister will realistically be spending on a multitude of governmental and parliamentary duties. The board don't share total responsibility on issues such as health emergencies, and local health promotion.

And then there is also, of course, the creation of the "Clinical Commissioning Groups" that will be responsible for "arranging for the provision of services". More on that later...

Local councils also retain a level of responsibility for promoting and funding health beneficial services, as well as providing facilities for healthcare.

So, to recap, centralised responsibility by an elected member of parliament to provide the NHS, free of charge, with specific duties properly and transparently defined for the first time, along with a board to help achieve those aims. Hospitals and clinics are maintained or funded by local authorities.

The gist of this is that a national infrastructure is maintained through our representative governing bodies, while strategic direction is provided at both a national and local level, with key responsibilities detailed further than they ever have been about the duties of the Minister ultimately in charge of it all.

I'll look in to the newer parts of the reforms, commissioning groups, competition, in a further post later...but right now the claim that this bill destroys the NHS, removing the "national" from our health service, just doesn't stack up.