Guest editorial Saturday 26 March 2011: Time for a break

Irwin Brown of the Socialist Health Association thinks it is time to park the Health And Social Care Bill.

The Health and Social Care Bill is due to finish its committee stage next week, but it is obviously in serious trouble.  There is a compelling argument to simply park it for a while.

There has never been any compelling case for urgent change. The misguided and misleading attempts by Ministers to portray the NHS as second rate have been debunked by evidence.  Suppressed research shows the NHS's highest-ever levels of public satisfaction.

The rhetoric has now changed to guff about securing the NHS for the long term.

There is no mandate for change; nether coalition partner campaigned for this.  It is based on the ideological belief that increasing competition must be a good thing as it worked for gas, electricity and rail services.  A huge body of evidence challenging this view was simply ignored.

Bogus savings
The claimed “savings” are entirely bogus; the major reductions in management costs were already planned under the QIPP programme before the Bill was published.  The Impact Assessment suggests rightly that the reorganisation could add costs as market based systems have high transaction costs; and there is a cost for implementation of between £1.4bn and £3bn depending who you believe.

The risks to the NHS have been widely accepted, not least by the Health Select Committee.  The most complex programme in NHS history - to deliver unprecedented 4% pa savings for 4 years - is being derailed by the biggest reorganisation in NHS history.  

The Bill proposals have obviously not been worked out properly. The work in committee has shown that important questions cannot be answered; issues have not been thought through.  The Government is making hundreds of changes to its own Bill, because it was so badly drafted. Swathes of regulations will be required as a result, but their scope and scale is unknown.

Scale and complexity of bureaucracy
The scale and complexity of the new bureaucracy is beginning to emerge, as we see even GPs caught up in the web of designation, regulation, licensing and competition.  We see more bureaucracy but less bureaucrats; presumably the nurses and  GPs will do the administration!

No proper evaluation has taken place of the proposals.  The Impact Assessment is laughably bad, and did not look at any other options.  Ministers are now contradicting what is in the assessment and in the Explanatory Notes to the Bill.

And perhaps because of the above, we can add that the Bill has no friends or supporters of any note; just a few cheerleaders in the GP entrepreneurial camp.

A serious case for watchful waiting
A serious case can be made for delay.  In that time, the details of proposals around social care and public health will be published, giving a more rounded picture of the strategy.

Stopping the upheaval already taking place because of the reorganisation would increase the chance of realising the planned savings across the NHS.

The progress with the major cost savings programme which will have its greatest impact next year could be evaluated. More of the thinking around implementation could be worked up, and some genuine pilots could be run and evaluated.

More effort could be put into genuine consultation with the clinical bodies, so their hostility was at least reduced.

The guff being put about by LibDems that they will be able to persuade LaLa to make serious changes is hardly consistent with the fact that it was their Minister (forgotten his name) who voted with the Tories to block every single amendment and supporting every Clause, hardly a realistic basis for opposition to anything.

Nobody doubts that the NHS can be improved - and the programme of change already being implemented to secure productivity gains alongside improving quality is already a major challenge.

It is not reform which is wrong, but the Bill sets out the wrong reforms - and, as almost everyone agrees, it does so at the wrong time.