Well done Nick Timmins. The ex-Financial Times public policy editor has written a corking account of the Health and Social Care Act, from its Ken Clarke origins over 20 years ago to the incorporation of the Blair reforms and onto the political train crash it’s now become. And it’s free. Much is old news to political junkies, except the extent to which Lansley was apparently gagged by George Osborne before the election. As Lansley claims: “I can remember it being said explicitly to me that ‘our presentation will be radical reform on education and reassurance on health’. And the reassurance was about spending.” According to some of his advisers, when Lansley protested that “he was not being allowed to set out his stall and that might lead to trouble,” he was over-ruled.
The justification for this lack of political honesty and mandate is beautifully encapsulated by an (unnamed) senior health department official: “Talking about reform almost seals its fate. The public hate this discussion. Going on the Today programme to talk about commissioning or economic regulation of health, is a) fundamentally boring, and b) not what people want to hear … people don’t want you to talk about the wiring.”
The extent of the subsequent public and professional opposition to the Bill suggests this was a bad call, as voters don’t enjoy having the largest structural changes in NHS history forced on them when the pre-election pledges were to end continuous top-down reform. Again, Timmins argues that the massive and pointless disruption of the reforms isn’t entirely Lansley’s fault. His white paper became a victim of the coalition, as Danny Alexander and Oliver Letwin – neither of whom have the faintest idea how the NHS works - rewrote key pieces of it while Lansley was too loyal/ cowardly/ arrogant to protest.
NHS reform is like sex. Its success depends on the responsible use of power. If you get consent and do it slowly, communicating as equals and paying attention to feedback then it can go well. But in the current reforms, it feels like the NHS has been swiftly gang raped by coalition politicians with different agendas who care more about their own, and their party’s survival, than the welfare of patients. Primary Care Trusts and Strategic Health Authorities are being abolished with indecent haste, huge health responsibilities are being handed over to local authorities and GPs, many of whom lack the resources, desire and expertise to cope, and some very good NHS managers who might make sense of it all have instead decided to take very generous redundancy packages than stay to pick up the pieces.
The Commissioning Support Groups (CSGs) who sit above Clinical Commissioning Groups (as SHAs do to PCTs) have struggled to attract talented managers with NHS experience – hardly surprising since CSGs didn’t even feature in the Health Bill and have been invented by chief executive David Nicholson to ‘land’ senior managers rather than pay the exorbitant redundancy costs. But most are taking the exit money.
Timmins interviewed everyone bar Cameron and Clegg (too busy, apparently) and the consensus view is the reforms will probably fail, and at many levels. Politicians often claim to want to stand back from the day to day running of the NHS, but never do. Shadow health secretary Andy Burnham has already gone on BBC Look North to claim the decision to stop child heart surgery in Leeds is wrong. His ignorance and naked self interest is trumping the safety of babies. There isn’t the staff to keep all of the units open and expertise needs to be concentrated in fewer centres. After extensive consultation, the one in Burnham’s constituency is earmarked to close. He should grow up and move on. Similarly, Lansley will find it hard not to over-react when Mid Staffs reports to save his political skin.
The NHS has to make impossible savings to break even and the money, corporate memory and expertise already lost from unnecessary restructuring will take years to recover. GPs in Clinical Commissioning Groups are waking up to the vast complexity of legislation they have to master on a management shoestring, while trying to cope with the increasing demand in their own practices. The government is wrong. Patients care passionately how Bevan’s Baby became the Coalition’s Creature, and how it will struggle to survive.