The collection of articles in the book NHS SoS edited by Jacky Davis & Raymond Tallis adds to our understanding of the Health & Social Care Act saga provided by the journalism of Nicholas Timmins in Never Again.  The articles from Jacky Davies & David Wrigley and Charles West in Chapters 4 and 5 were particularly interesting.

However, one of the opening paragraphs almost put me off the rest.

“Without the active collusion, passive acquiescence or incompetence of all these players (politicians, journalists, the unions and the leaders of the medical professions) it would hardly have been possible for the Tories – to succeed in getting the nightmare vision for the NHS enshrined in Law.”     [All in it together?]

It was obvious that the intent of the White Paper/Bill/Act was to change the whole character of the NHS – in shorthand from a managed system to a regulated market, bringing with it a greater role for market competition and so for non-NHS providers. The whole Bill was written around what became Part 3 of the Act.  Only the major trade unions and the Labour party said this at the start and resolutely opposed the whole thing consistently throughout the saga.  Many who should have known better at various times welcomed parts or principles and were later to have their “support” played back to them.

From the summer of 2010 the opposition from the few was resolute and the mauling the initial version of the Bill got in the first Commons Bill Committee showed that.  But it was never going to be enough for Labour and the unions to oppose a Tory led change in the NHS.  Opposition got little or no coverage.

Labour won all the parliamentary arguments but did not have the votes; they forced but lost over 100 votes just on the first pass in committee.  The trade unions actually understood what was happening and did a great job but against the usual problems of an unsympathetic media.  The TUC was not going to call a national strike and bring down the government. The LibDems did not ever look as if they would risk their role in the Coalition – none of those involved ever believed they would do more than protest from the sidelines and claim meaningless concessions; their shameful record is set out in the book.

So, it was always clear that the only way the Act could be defeated was by united resistance from clinicians; in particular the GPs.  We got the Act not because of “active collusion, passive acquiescence or incompetence” but because of the vested interest of some clinicians.  At two points a fatal blow could have been struck. During the pause GPs collectively should have made clear they would not be part of the CCGs (as they had become) and could have repudiated the position of some vocal GPs who were basically the cheerleaders for the changes.  And later, the Academy of Royal Colleges could have signalled that NONE of their constituent bodies would support the Act. The book explains very well why neither did happed so we got the changes almost nobody supported.

The Act survived the political process as the coalition never reached the view that the political damage of getting it through outweighed the damage of being weak and withdrawing it.  There was also the usual arrogance (based on profound ignorance of the NHS) that they knew best and that Lansley knew what he was about.

So, in the end the Act got through, badly mauled, but with Part 3 still in it, because the Tories and LibDems (bar one) voted for it, and thanks to a couple of Royal Colleges and a caucus of pro competition GPs.

The good news is that the unprecedented scale of the resistance to the passage of the Act, with so many excellent blogs, posts, articles and speeches based on so much evidence, will make implementing it much harder.  Every step along the road that the Act built will be contested by well informed and well supported resistance – and those in charge of our NHS (who they?) know this.

Maybe in 2015 the damage will have been limited and we can restore our NHS.

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  1. Shibley says:

    I think this, apparently fair, article by Richard raises a strong argument. The lack of opposition of the Royal College of Surgeons is significant. Also, is the mess of the GPs’ approach to commissioning – it was always clear that CCGs were state insurance vehicles which were not reliant on the input of GPs, and I feel that this aspect should be visited in English health policy.

    It’s in no way a ‘let’s bash the GPs’ type argument. ‘Entrepreneurial GPs’ are mobilised left-right-and-centre – I was at the receiving end of meaningless memes about innovation from one yesterday in fact.

  2. Gold Price says:

    Perhaps an even bigger threat to the NHS is the involvement of the private sector in primary care, specifically GP surgeries. In 2006, huge multinational corporations started to take over GP services. This is the result of a new contract, negotiated by the government, which brought a dramatic shift towards a commercial business model in general practice. Already, the performance of some corporate GP surgeries has been poor. Companies have to make profits for their shareholders and that can lead to corners being cut, care being compromised and the doctor-patient relationship suffering. The government’s latest vision, set out in reports by health minister Lord Darzi, is for GPs to be grouped together in new ‘polyclinics’ which will offer patients a range of treatments in one building. If the scheme goes ahead, the worry is that the government will favour private companies to build and run these polyclinics, as has been the case with Private Finance Initiative (PFI) hospitals. This method of building hospitals has proved astronomically expensive – taxpayers will have to fork out £53bn over 30 years for hospitals that only cost £8bn to build, and £23bn of that is profits and interest to the PFI companies and banks. We could end up with the same situation in primary care, again giving private companies a great deal of influence over how our local services are delivered. Elsewhere in primary care, PCTs have begun to outsource the services that they provide directly, like district nursing and health visiting. The government has made clear that it wants PCTs to become organisations made up only of managers, concentrating on buying care from other organisations. But PCTs employ thousands of health-workers, whose futures are now uncertain. In some areas, like Central Surrey, community nurses have been encouraged to leave the NHS, form social enterprises (non-profit companies) and sell their services back to the PCT. Again, this takes responsibility away from a public body.

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