The NHS Reinstatement 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 seeks to address some genuine problems but it is the wrong solution. Nobody believes the Bill can become law but it raises some key issues about the NHS. What is important is that looking at such a narrow and technical issue should not be allowed to drown out more important discussions around social care and funding. There are no solutions any more looking at the NHS in isolation.

Trying to raise public interest in campaigns which deal with NHS structures is unlikely to have any impact.

The claim is that the Bill would prevent privatisation and reinstate the NHS; although few believe we have already lost our NHS – the public certainly don’t. Of course passing legislation cannot prevent anything, any determined administration would just pass its own legislation.

The only way to prevent privatisation is to elect a government that is against it. In Scotland and Wales there is no market but also no need for actual legal prohibition on the use of private providers. In the 1980’s when a structure such as that proposed by the Bill was in place the Tory government imposed Compulsory Competitive Tendering on the NHS; although it chose for political reasons not to extend this into clinical services.

The NHS does not need another redisorganisation. There has been no impact analysis but it appears that implementing the Bill would require the biggest ever top down imposition, far bigger even than the last one or the one in 1990s. 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 over 200 local authorities would also be embroiled and an unknown number of private or semi-private providers. Doing this in stages would just make things worse. Every local authority would have to get engaged in lengthy discussions with all the local existing health organisations about how the new structures would be set up – scope for years of argument.

In reality across England reorganisation is taking place but through local initiatives not a top down imposition. By 2020 the NHS will have undergone a whole series of localised reorganisations under devolution and through vanguards projects. Some 50 odd schemes are already under way all of which flout the existing competition requirements. There is much to commend and much that causes concern about these schemes – and the risks are well worth a proper policy discussion.

There could be some reductions in management and administration running costs from removing the market 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 despite thorough work by bodies such as the Kings Fund looking at the impact of commissioning.

There is also often reference to the experience of Wales and Scotland which have removed the market. In Wales the experience was that the first attempt actually caused much upheaval and increased costs – although the second attempt was far more successful. In both devolved systems the main aim was achieved although so far there is no evidence of major management and administrative cost reductions. But the systems are much smaller and simpler than the fragmented monstrosity that we now have 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 relied on expert advice from those actually currently working in the relevant areas. It 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 has been rightly said many times that there is always commissioning even in Wales and Scotland; it is how it is done that is important. In the non-market system as proposed by Labour the nature of commissioning in England would change 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 Bill will not achieve what is claimed, would be very hard (impossible?) to implement and is not really necessary. There are many policy issues to discuss that should get far more attention.

But – a change in Government is what is actually required.

Trackbacks are closed, but you can post a comment.

7 Comments

  1. “The Efford Bill did not remove the commissioner/provider split, but then it was never intended to do that. It has been rightly said many times that there is always commissioning even in Wales and Scotland; it is how it is done that is important. In the non-market system as proposed by Labour the nature of commissioning in England would change 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”

    Irwin once again gives the game away, his experts proclaim that the Reinstatement bill can’t work, it’s too disruptive.

    But the Efford Bill is workable because it does nothing to change the way things are currently run, anyway the public don’t believe the NHS is being privatised so that’s alright.

    We all know the disaster that the NHS has become, and a little hint was given by the junior doctors who felt the need to take to the streets. The latest OECD report remarks a distinct decline in performance from the NHS since the changes, it also says that compared to other health services it’s costs are lower.

    The only good thing about this article is that does raise the issue of a workable alternative in the 2015 Reinstatement bill, if it fails at all it won’t be because of it’s content, but the deliberate desire of Neo-Liberal politicians to dismantle a cherished institution for personal gain.

  2. “Irwin” says “the claim that removing the market would reduce NHS expenditure by £10bn pa is not supported by any evidence or by any rational analysis despite thorough work by bodies such as the Kings Fund looking at the impact of commissioning.”

    I’m afraid “Irwin” is mistaken or misleading here. The Kings Fund haven’t done any thorough work into the impact of market reforms/commissioning on NHS expenditure. In fact they’ve been remarkably uncurious about it.

    The Kings Fund’s 2011 study on the market ‘reforms’ to date merely said the cost was ‘expensive’ but ‘unknowable’.

    And their Chief Economist John Appleby told me recently “One problem is no study yet to test cost-effectiveness of market in NHS”.

    But there are plenty of good reasons to suspect that £10bn wasted on it, is in fact a conservative estimate
    https://www.opendemocracy.net/ournhs/caroline-molloy/billions-of-wasted-nhs-cash-noone-wants-to-mention

  3. Martin Rathfelder says:

    If the internal market generated 10% extra cost you would expect the NHS in Scotland and Wales would be 10% more cost efficient than the NHS in England.

  4. Caroline Molloy says:

    There is a response to this article here https://www.sochealth.co.uk/2015/11/11/response-by-allyson-pollock-and-peter-roderick/. Worth reading – particularly the comments by health workers including Dr Tony O’Sullivan who points out that a huge further reorganisation is underway anyway. The question is not ‘will there be another reorganisation of the NHS’ but ‘is the huge reorganisation currently underway, the right one, or do we need a different type of reorganisation altogether’

  5. Paul Bunting says:

    Abolishing commissioning is the most important element of this Bill. Commissioning and bidding I find are grossly incompetent. I heard repeatedly that commissioners were putting sexual health out for tender when there are patients with co-infections of sexually transmitted infections and HIV infection, at least one of which is complex to treat, and which require to be treated by the joint team of professionals in the same clinic so that any proposal which could split the management or the geographical location of these services would gravely endanger the safety of these co-infected patients. It often turned out that the commissioners did not know their sexual health consultant was also the HIV consultant proving that the commissioners had no idea at all about the services they were dealing with. Secondly, Camden PCT, when it existed, awarded a contract to Virgin Health for running a GP practice. The retiring NHS GP had lessened his workload by reducing the list size down to about 1,000 patients which is not enough to generate a sufficient income for a new NHS GP and the usual resolution of this situation where plenty of other GP practices exist is to write to the patients inviting them to choose another GP practice. Virgin Health naturally found they were losing money so they sold the contract on to Allied Health who also found they were losing money and walked away from the NHS contract 3 months before its end after losing the premises (it is the GP’s duty to provide premises) and only then did the commissioning PCT do the right thing by inviting the patients to choose another GP practice. So here the commissioners were grossly incompetent and so were the bidders for their failure to investigate the NHS contract and its potential income or they would have seen it was too risky to bid. Thirdly, the West Sussex Commissioners awarded the contract for managing the musculo-skeletal service (at least three separate specialties including fractures, orthopaedics and pain control) to a joint bid by BUPA and the Surrey Community Health Services (a not for profit co-operative agency). It was not clear what would happen to the rest of these services so the local 38 degrees NHS Campaign asked to see the impact assessment. It turned out that the commissioners had not done one, so they then asked Price Waterhouse to carry out the impact assessment and their report said that the award of such a large contract to outside the NHS would render financially unviable the remaining associated Hospital Departments and that the commissioners’ proposal had not addressed clinical governance (NHS Hospitals’ method of excluding loose cannons from clinical and nursing practice which is done in each Hospital, not done across more than one Hospital and not done at all in the private sector). At this news the bidders withdrew their bid. More incompetence from commissioners and incompetent bidders who should have used their private sector skills to elicit the hospital-crashing implications of their bid. So why should the NHS suffer this gross and dangerous incompetence in commissioning and bidding? GET RID OF COMMISSIONING NOW!

    1. Martin Rathfelder says:

      The fact that some commissioning is very badly done is not a good argument for abolishing the whole thing.

      1. Paul Bunting says:

        Commissioning was invented by the Tories in 1990 for their internal NHS Market. Markets and competition with their winners and losers is irreconcilable with the aim of the NHS which is to be treated with the same high standards of care wherever one presents

What do you think?

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 451 other subscribers

Follow us on Twitter

%d bloggers like this: