The NHS (Private Members) Bill, which once again is looking for a sponsor in Parliament, sets out proposed legislation to return the NHS to the organisational structures that were in place in the 1980s. That was before the purchaser/commission/provider split, before the increase in NHS clinical services being provided by private sector, before the quasi internal external market and before external governance and regulation

It is difficult to debate the value of the NHS Bill. It anticipates the closure of hundreds of existing organisations and the creation of hundreds of new ones, across the NHS and local authorities – with all that implies in terms of transfers of staff, assets, responsibilities and accountability. There is no supporting analysis of the impact; what it would cost, how many jobs would be changed or moved, how assets (and debts!) would be allocated, how long it would take and how a better care service would emerge as a result of changing structures. There would also be implications for the wider care system, especially social care.

However those supporting the Bill know it could never become an Act. No subject as complex and with such far reaching consequences could be dealt with by a Private Members Bill. And Private Members Bills are only (rarely) passed into law when they have wide ranging support – which the NHS Bill clearly lacks. Many MPs who are sympathetic to the aims simply will not back any proposal to have yet another major top down redisorganisation.

Supporters of the Bill say the point is not to change the law but to get debate on serious and important issues. But the arcane and legalistic framework of a Private Members Bill is not a sensible way to facilitate debate – there are far better ways that experienced parliamentarians can explain.

There is however some scope for a Private Members Bill to address the chaos that has been caused by the obvious reality that what is actually happening in the real world of the NHS is at complete odds to the legal framework set out in the disastrous Health & Social Care Act 2012. The NHS leadership and even the Tories in their manifesto have signalled the need for change – maybe even primary legislation to restore some credibility.

So it would be better for all if a more consensual, less complex Bill could be proposed, one which might even have some chance of making progress with the possibility that this could force the government to at least do something. Many of the aspirations of the NHS Bill to push back against privatisation could be met.

Any Bill would need to do two fundamental things. First remove any externally imposed requirements for NHS services to be arranged through a system of competitive tendering and second to allow the NHS to adopt organisational forms to better suit a system based on planning, collaboration and cooperation.

Obviously expert help is needed with drafting but this would appear to require

  • repeal of Section 3 of the H&SC Act 2012 (and with it the S75 Regulations)
  • restoration of the powers of the Secretary of State to direct any NHS body (including Foundation Trusts)
  • and a power for the SoS to approve changes in organisations (mergers, partnerships, acquisitions) including bringing commissioning and providing together or bringing local authorities and NHS bodies together. (This could even allow for Health Boards.)

Concentrating powers again with a SoS legally and politically accountable to parliament for a universal and comprehensive NHS would be achieved but such powers might need to be constrained for example by making the powers to issue directions or introduce regulations being subject to proper public consultation and scrutiny.

The big debate to be had would hopefully then be about accountability and governance and what is “National” in a system where boundaries of all kinds are constantly shifting – what arrangements for service delivery would be variable according to local circumstances.

There could be scope for a much simpler and shorter Bill which deals with the immediate and serious issues widely accepted to be making highly challenging times even worse. Of course it would never pass but it would get a lot of support and so a lot of coverage of important questions which need answers. It would push at a door which is already starting to open and would also pile pressure on the government to do something.

Of course none of this deals with the most serious issue facing the care system which is the chronic lack of adequate funding.

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17 Comments

  1. Wendy Savage says:

    I hate this and realise how the SHA has beetled astray by managerialism
    100s of new organisations what nonsense W

    1. Wendy Savage says:

      Sorry about typo. been led (not beetled) astray. For new members Richard was chair or vice-chair of the SHA family recently W

    2. joseph rylands says:

      I found this article confusing to follow. On the one hand you acknowledge the “disastrous” 2012 health act and then proceed to rubbish an attempt to undo it. As for it creating more bureaucracy this is untrue as 2012 introduced several new roles that were not there before.
      I fully accept that a private member’s bill championed by a member of the opposition is unlikely to be passed into law but the debate is important and building a concensus around a policy that could be implemented come the removal of the conservatives is certainly worth it.
      The changes that you propose do.not seem enough to end the problems we have. I am also very sceptical about the conservatives reducing private input but would love to be proved wrong. Apologies for the long message

  2. Anon says:

    The grammar and structure of the piece make one disinclined to take it seriously, as it reads more like a first draft of something which could become two articles arguing opposite opinions..

  3. P F Cooney says:

    In 2004, the then Labour / Lib Dem coalition govt in Scotland brought in legislation which removed the commissioner provider split and reinstated regional health boards with responsibility for the planning and provision of healthcare needs in their areas. What it took was the political will to do it. This is what we need in England.

  4. Geoff Barr says:

    Essentially the NHS was most efficient when it was closest to a Weberian bureaucracy. Every step away has reduced efficiency. A return to a more linear structure would allow the staff to get on with the jobs they trained for. It would need the supplement of a structure of local democratic supervision. Then the complexity can be transferred to the medical work and away from the morass of overlapping and competing organisations. Cost would fall massively. The article points to the limits of a private member’s bill. Yes at this stage we are working on a propaganda statement for a new Labour government. The advantage of the bill is that it offers a vision not merely a critique.

  5. lallygag26 says:

    The author proposes something which could well fit the American Accountable Care Organisation structure currently being introduced. Not what is wanted at all. As for the reinstatement bill introducing hundreds of new organisations – nonsense. It streamlines, it doesn’t complicate. The ‘debts’ of what are currently competitive businesses would become, once again, the responsibility of the DoH. Public services don’t have profit and loss accounts. I agree it will take time to restructure – but it will be a restructure to a system designed to deliver first class population wide healthcare, not a ‘personalised’ service designed to maximise the transfer of responsibility from the public purse to private wallets. It will be cheaper to run. The further we have moved from Bevan’s principles in a faux-drive for ‘efficiency’ and ‘integration’ the more has been spent on maintaining the system itself and the more difficult it has become to deliver collaborative joined up care. As for propaganda – we need more propaganda on behalf of public delivery of public services, every bit we can get.

  6. Steven Carne says:

    A very disappointing and curiously timed piece when public mood is shifting so radically against the commercial market running of the NHS and indeed the realisation that all public services are under threat from commercial enterprises in search of revenue and NOT with society’s wellbeing at heart.

    The ethos of the NHS (Reinstatement) Bill is about simplifying and bringing the once successful and sustainable (if govt. will is there to fund) NHS back into the ownership of the people through the government of the day and out of the hands of corporate management that insists on and needs extra and unnecessary layers of administration to create profit.

    Surely a Private Members Bill (PMB) is just one way into the Commons arena – if campaigners and politicians alike saw the opportunity and stood behind it with full force instead of accepting defeat before it has even begun its journey, a PMB could become something very powerful. Once into the Committee Stage it ceases to be a PMB but a very real opportunity to have this “honest debate” that Labour seem so keen on. So the question has to be asked – why aren’t they seeking the opportunity and getting behind the NHS Reinstatement Bill 100%? Therein lies the rub…

    Labour accepting the internal market as inevitable, knowing that the moves currently being introduced by NHS England and Dept of Health are part of the most EXTREME TOP DOWN RE(dis)ORGANISATION of the NHS is a problem.

    Labour knowing that Simon Stevens’ 5 Year Forward View is the final leg in a long race for privatisation and not openly opposing it is a problem.

    Knowing (as dear Angela Eagle told campaigners last week in Liverpool) “Simon Stevens is a good man he’s a Labour man” – THAT is a problem.

    The NHS Reinstatement Bill is an opportunity for the supposedly new progressive Labour Party to dig into its roots and make a bold move. The public are ready for it. The word ‘renationalisation’ is no longer scary to them. What is scary is the thought of losing the NHS to the hands of profit making companies who will smile and pretend to offer a health service.

    999 Call for the NHS is calling on all campaigners and politicians with any conscience to back this opportunity to have a real debate with the nation. We’re surprised to see the SHA take a strange different approach.

    Does this piece represent the vast majority of its members?

    1. Geoff Barr says:

      You are right Steven. We should be promoting this bill as one of many ways of hammering the Tories on the NHS. It has the advantage of laying out a positive vision. A lot of Labour MPs are like mine (Ben Bradshaw) who do not support this bill. Is Simon Stevens still Labour? I have no idea, but United Healthcare, his last employer was not socialist nor even decent.

  7. lallygag26 says:

    Geoff, whether or not he is still Labour there are some – including ex-Shadow SoS Health Heidi Alexander (unsurprising) and John McDonnell (surprising) and current Shadow SoS Jon Ashworth who either support Stevens or will not attack him. And no-one seems to want to examine the uncomfortable truth that whilst extra money is desperately needed to clear the deficits the person who would be determining where that money goes is Stevens – and he has make it clear that he needs more money to make the STPs ‘work’.

  8. Mike Squires says:

    The argument that the Reinstatement Bill will lead to yet another reorganisation of the NHS is now redundant. That is exactly what the STPs are doing, and without even a debate.
    Of course one advantage of the STPs is that they closely mirror the old Area Health Authorities.So be abolishing the purchaser provider split we would already have in place structures that would be workable with no major reorganisation necessary.
    Alternatively, we could just write into every NHS contract that any profit made from the contract be returned to the NHS. Simple

  9. lallygag26 says:

    Sadly, Mike, the accounting systems of global corporations are very good at showing that no ‘profit’ is made from their takeover of public services. The STPs are doing far more than mirroring the old AHAs. They are redefining what the ‘NHS’ is. No longer an on-your-doorstep (accessible) service. No longer comprehensive (denial of care is built in to the system) and no longer universal (registration with a GP provider is mandatory). And the contracts for the Accountable Care Organisations within the STP areas are already going out to international tender. A system run along the lines of Kaiser Permanente by companies like Circle, Virgin, Interserve and United Health of America won’t deliver an NHS which even remotely resembles Bevan’s NHS. (A health system which allows a construction company like Interserve to be a lead provider of clinical services is in itself gobsmackingly difficult to comprehend.) In this system it is inevitable that ‘NHS’ provision, like dentistry, will need to be topped up to get adequate levels of care. Those who can afford it will pay to go privately and the shrinking of service in the STP model will create a much larger space for the private sector to fill than has ever existed since the NHS came into being.

  10. Nicholas says:

    An interesting defence of Tory/Corporate NHS policy, designed, as we know through the SHA, by the multinationals in Davos.

    Wouldn’t it be easier if pro-corporate spokespeople declared their position openly, instead of this laborious use of debunked cliche that fools no-one?

    Of course, that would defeat the purpose.

    Maybe Conservative Home would be interested in posting this article?

  11. John Lipetz says:

    I find it sad that Richard Bourne, previously active on the SHA CC, has sent out this improper statement. It is SHA policy to support the NHS reinstatement Bill. It has been prepared by highly competent experts on both the NHS and the legal process. This is one important method of ensuring that the NHS is brought under public ownership provided by all through taxation. As if the present system for health is not already hugely complicated and dangerous. You should only have to examine the latest threats through the STPs. I don’t need to spell this out. Grow up, Richard!

  12. Eric Watts says:

    I support the Bill as it is a statement of the alternative to the current policies.
    Eric Watts, Chair DFNHS

  13. davidakirby says:

    I like “beetled astray” as a comment on how so many people whose minds have been seriously infected with neoliberal ideology have nevertheless somehow conceived of themselves as socialists in recent decades – Simon Stevens may be one such. This accidental analogy is, however, unfair on beetles – those wonderfully varied creatures which tidy up the world and delight the eye – and which are themselves, like the NHS, under serious threat from the activities of corporations (Bayer and Monsanto in their case) whose activities are dictated by the need for accumulation for shareholders with other consequences of those activities given only secondary, defensive consideration, if any.

  14. Stephen Watkins says:

    A simpler Bill has been drafted by Doctors in Unite and submitted as evidence to the Health Select Committee but the more extensive bill is better and should be supported.
    The only reason for going for the simpler bill would be if it had the support of enough Conservative MPs to pass a contested second reading but the existing bill did not. I am not sure that is the case.
    It is not true that the full bill is a major reorganisation. It reorganises democratic accountability not management and that is essential if we are to restore the NHS.
    What is causing repeated major reorganisations affecting actual services is the combination of underfunding and commercialisation

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