The NHS Bill is expected to have its second reading in March 2016.  It would replace the current NHS architecture with a return to Regional and District Health Authorities.  It may seek to address some genuine problems but it is the wrong solution.

Its supporters say the Bill would prevent privatisation and save the NHS.  Passing legislation cannot do that.  Any determined administration would just pass its own legislation.  The only way to prevent privatisation is to elect a government that is against it.

The NHS does not need another redisorganisation.  To implement the Bill would require the biggest ever top down reorganisation, far bigger than anything we have ever seen before.  Every part of the system would be affected.  Over 500 organisations would have to be wound up and the assets (and liabilities) transferred to the new Authorities – that alone would cause enough arguments to remove any focus on delivering care.  Then over 1 million staff would have to be transferred into new organisations; tens of thousands of senior staff would have to compete for new jobs in new organisations; tens of thousands of contracts would have to be re-negotiated.  Other organisations such as the 150 local authorities would also be caught up in the exercise and an unknown number of private or semi-private providers.  Doing this in stages would just make things worse.

Once things settled there could be some reductions in management and administration running cost but the claim that removing the market would reduce NHS expenditure by £10bn pa is not supported by any evidence or by any rational analysis.

There is often a reference to the experience of Wales which removed the market from its NHS.  Their experience was that the first attempt actually caused much upheaval and increased costs – a second attempt was far more successful.  The aim was achieved although so far there is no evidence of major management and administrative cost reductions.  But the Welsh system was much smaller and simpler than the fragmented monstrosity that we now have in England.  Scotland never had an internal market, but it’s not noticeably cheaper to run than the NHS in England.

Labour is committed to a policy to stop the privatisation of care services and where possible to reverse it.  That policy was constructed in a way which ensured that decisions about how services were provided could be made without any external interference by procurement or competition law; domestic or EU or beyond.  This was set out in the last parliament by Clive Efford’s Bill which gave a solution which cost virtually nothing to implement and required little in terms of any reorganisation.

The Efford Bill did not remove the commissioner/provider split, but then it was never intended to do that.  It would have changed the nature of commissioning to one that was not driven by competition between providers and by market behaviour, so commissioning becomes more like planning and the internal market is removed.

So the NHS Reinstatement Bill will not achieve what is claimed, would be very hard (impossible?) to implement and is not really necessary.

A change in Government is what is actually required.

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6 Comments

  1. Martin as ever you seek to support the current disorganisation by saying that this re-organisation would be bigger than the last one, in fact if we are to save the NHS, it is absolutely necessary.

    Listen to what professor Noam Chomsky has to say about:

    https://www.kiltr.com/KILTR/1782211471

  2. lallygag26 says:

    The NHS as is, is in utter chaos. With foundation trusts about to disappear into chains, staff contracts either being TUPE’d to the private sector, or imposed by government diktat causing a potential exodus of experienced staff, community hospitals disappearing fast and devolution on the near horizon it can hardly be said that the re-dis-organisation has stopped already – or that it is less monstrous than any other could possibly be.

    The question is do you want a reorganisation into a publicly owned, publicly run, publicly funded and publicly accountable organisation or not?
    Whether or not the Bill’s supporters have chosen the right mechanism or not may be debatable, but their intention shines through as clear as day – and there isn’t any better offer on the table.

    The legal issue of the threat to the NHS by TTIP is directly dealt with by Allyson Pollock’s Bill. The same cannot be said for Labour’s efforts to date. Waving a letter saying ‘the EU has promised we’re safe’ doesn’t quite cut it in the same way as legislation does.

    The SHA supported Jeremy Corbyn in the leadership election. Is he aware of quite how flaky you are when it comes to private involvement in the public sector?

    Of course we need a new government to implement a new Act. Highlighting the Bill should give the electorate a clearer understanding of that – this isn’t a simple cuts agenda we’re fighting. Perhaps Labour should concentrate on getting that message across – that public service is truly being lost across the country and why it matters. Although from the SHA’s ruminations on the subject it’s not clear that we’re in agreement about that.

  3. Robert Jones says:

    Given the Bill stands little if any chance of success, and that by the time of the next election there may be very little left to reorganize anyway, this does seem to be an unnecessary way of dividing ourselves – the principles in the Bill are clear and could form the basis for a programme to return the NHS to full public ownership and control, but the specific measures contained within it are too prescriptive in the situation we’re actually in and fail to provide the flexibility needed. Has the Bill not been overtaken by events – specifically, the result of the general election? It had relevance in that context, but does it retain it now?

    I fear that to cling to the Bill in its present form as the only way forward is likely to lead us with no way forward at all by 2020: but do not wish to see one of the principal aims of the Bill – the end of the internal market and all it entails – fall away. I hope therefore that the Labour front-bench, the unions, and the SHA will assemble a practical and achievable set of short and medium term proposals, leading to an answer in the long term that doesn’t depend on private finance and the continued separation of commissioning from provision.

  4. Martin Rathfelder says:

    In DevoManc the proposals appear to involve abandoning the internal market, certainly in the form it has developed.

  5. Nico says:

    The only question is:

    Which direction to take the NHS in?

    1)Further along it’s current destructive path, or

    2) back towards a state-run public service based on the human right to health?

    That’s it. “Leaving it is as it is” just means 1.

  6. irwin says:

    How does passing this Bill (which will never happen) prevent a future Tory administration simply reversing it as they did in 1990?
    You do not need a reorganisation of this kind to make healthcare publicly funded or publicly accountable. Never been sure what publicly owned and publicly run actually means (GPs, pharmacy, eyes, teeth etc) but taking it to mean the situation as applied before era of marketization – then that does not require a reorganisation either.

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