Tuesday, 14 June 2011

What do the "u-turns" on the NHS mean?

Today, David Cameron and Andrew Lansley agreed to all of the recommendations put forward by the NHS Future Forum, following a "10 week listening exercise." The Labour Party claimed that he had made "a humiliating U-turn" that left his reform proposals "demolished." However, the reality isn't quite as clear cut as the soft left would have us believe.

It's true that what was agreed today changes the pace and scale of the changes planned to the NHS, but that's just the point. Nick Clegg sums it up when he says "change will happen, but it will happen at the right pace." As if that wasn't clear enough, we have Cameron insisting that "the fundamentals of our plans - more control to patients, more power to doctors and nurses, less bureaucracy in the NHS - they are as strong today as they've ever been." He's absolutely correct.

The report (PDF) from forum leader professor Steve Field argues that "the Government’s stated aim ... is universally supported." This may be because privatisation isn't stated, and instead talk is of "making improvement in quality and healthcare outcomes." But whatever the case, the consultations started by taking the government at its word and implicitly accepting its framework for debate.

Hence, whilst they think it "absolutely right that people should have the confidence that their local services are safe," those running the listening exercise "are clear that choice can help support better quality and more integration between health and social care." Likewise, "the Forum is convinced that [competition] has a place in enabling choice and improving quality." They are "very clear that the NHS should not be ‘privatised’," but at the same time argue that "There needs to be a way of enabling new, innovative services that will offer what the patient needs" and peoples' "fear [of privatisation] overlooks the fact that charities and the voluntary sector will also be able to take advantage of ‘Any Qualified Provider’ and it could allow smaller local organisations to offer services that truly reflect their communities’ needs."

The report's key recommendations include;
  • Reinstating the legal responsibility of the health secretary for the overall performance of the NHS
  • Scrapping the primary role of the regulator, Monitor, to promote competition - and focusing on improving patient choice instead
  • Relaxing the 2013 deadline for new GP commissioning arrangements to be introduced - a National Commissioning Board, based in Leeds, will control budgets until GP groups are "able and willing" to take over
  • Strengthening the power of health and well-being boards, which are being set up by councils, to oversee commissioning and giving patients a greater role on them
  • Retaining a lead role for GPs in decision-making, but boosting the role of other professionals such as hospital doctors and nurses alongside them
In other words, tinkering reforms of the change plans. These have appeased the Labour Party, who were responsible at any rate for the more damaging attacks on the NHS such as the Private Finance Initiative, but as Cameron says the fundamentals remain in place.

The government, at present, are merely playing politics. They have made changes and engaged in consultations in order to appease the Labourites, and in the hopes of quieting down the anger that this issue threatens to unleash. But the NHS itself was originally founded because "if we don't give them reforms, they'll give us revolution." We are a long way from giving Cameron the same ultimatum, and so a long way from making him genuinely back down.