Oh no.

In this world nothing can be said to be certain, except death and taxes. And NHS reorganisations.

The next election could be in 2022, unless the current Tory government falls under the sword of Brexit. So, with all of the current government’s efforts being taken up with exiting the European Union, it might seem intuitively odd at Jon Ashworth might want to think the unthinkable – another redisorganisation of the NHS.

By 2022, some of the ‘integrated care organisations’ might be up-and-running. Or, possibly, by that stage, accountable care organisations might have been killed off in the law courts?

We are all Corbynites now, which means we are all singing from the same song sheet. Jon Ashworth MP is likely to, in reality, want to keep his cards very close to his chest before being forced to ‘reveal his hand’. ‘Labour is socialist in that it’s always had socialists in it’, a saying made famous by the late Tony Benn. And one thing that Labour wishes to be seen to be is democratic.

A wholesale reform might be ‘popular’. Whenever Andy Burnham, as Shadow Health Secretary for Labour, promised to repeal at the Labour Party Conference the Health and Social Care Act, there would always be massive applause.

There would always be huge disdain about the cost of the reforms, occasionally estimated at a few billion, but it’s uncertain whether Labour voters feel the need for austerity any more. After all, George Osborne’s policy in ‘paying off the deficit’ put the economy into meltdown.

The narrative from the Conservatives has been ‘you’ve never had it so good’. Except – one commentator remarked at Question Time, some disabled citizens had been propelled into a premature death. Everyone, it seems, was not awarded the personal independence payment. And there’s always money for foreign wars and things like HS2.

Andy Burnham had always maintained that he would use existing structures to do different things. Whilst Ashworth might want to abolish the ‘internal market’, or abolish the purchaser-provider split, the details are unclear. Will Labour wish to ‘buy back’ some PFI contracts? Would Labour wish to ‘take back control’ of outsourced contracts?

I’ve never heard a politician say that he will strip funding of public services, even if (s) he ultimately does that. But will Labour in real terms be able to increase the funding for physical and mental health as well as social care? Will Ashworth make ‘parity a reality’?

Will Ashworth continue with the ‘personalisation’ agenda? If Ashworth wishes to abolish certain parts of the infrastructure, who is going to administer ‘integrated health and care budgets’? Will the replacement of clinical commissioning groups still have to ‘plan’ services, even if not as such ‘commissioning’ them?

How much of the NHS can Ashworth bring under the State’s ownership? Would Ashworth dare to nationalise social care? How will he rationalise “integrating” a universal, comprehensive, free-at-the-point-of-use NHS with a means-test social care system? Is the ‘divide’ between health and social care tenable anyway, for example for people living with long term conditions such as frailty or dementia?

How much can Ashworth do before being set off course from exiting the European Union? Will ‘taking back control’ unleash millions and billions of ‘state aid’ which only Corbynites had previously dared to dream of? Will it mean that the NHS be rid of those dreadful EU competition directives which the Blairites loved so much?

I have absolutely no idea what Jon Ashworth wants – what he really really wants.

But, if it’s any consolation, nor does Jon Ashworth………. yet.



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  1. Richard Blogger says:

    Good questions Shibs. I do hope those people who are advocating a “year zero” approach to the NHS (“NHS Reinstatement Bill”) ask themselves these questions.

    Andy Burnham said, understandably, that he would keep the current structures (to minimise the disruption) and reform them. I think this is the right approach when it comes to trusts. Removing the market will make CCGs irrelevant, but there is a need for strategic planning organisations on a large population basis.

    On PFI, the “buy back” ideas will leave the public purse at a loss because profit making organisations will not sell their golden goose without a fight. A compulsory purchase scheme could upset the money markets (which the next Labour Chancellor will have to keep sweet). The clever option would be to reform the Lawson acts that enabled PFI by exempting outsourced services from VAT. Osborne proposed closing this loophole, but quickly retreated when it became clear that it would collapse PFI schemes. So we should kill two birds with one stone: close this VAT loophole, and then make the PFI companies (holding assets that suddenly won’t make them a guaranteed income) an offer they cannot refuse. Some trusts have existing “wholly owned subsidiaries” which will be affected by this policy, but they know anyway that such schemes are based on a tax loophole.

    In the case of “take back control of outsourced contracts”, well many will run out anyway, so a “do nothing” option is possible since the market will be removed under Labour. However, there are other things that can be done. CHPI have done excellent work showing how unsafe private hospitals are. The DH could insist that patient safety has a higher priority than “patient choice” and make local commissioners enforce safety rules more vigorously. A new Labour SoS can declare that CCGs will no longer be allowed to “turn a blind eye” to private hospitals when it comes to safety, access and cherry picking of patients. I predict that most private hospitals would then decide that they do not want to do NHS work.

    On CCGs future, I do hope there isn’t one, and I hope that they will wither and die. CCGs were an experiment that failed, and in this area I would like to see wholesale reform. The ICSs should be like the Welsh Health Boards, there should be no adversarial “commissioner” and this will make CCGs irrelevant.

    Another failed idea is moving Public Health to local authorities. The first issue is that this has led to a cut in public health budgets at a time when improving public health is vital. Yes councils have suffered big cuts, but their priorities are not health, so they have allowed public health to suffer considerably. However, Public Health was a dimwitted definition, there is no way that you can describe school nurses, health visitors, sexual health services, vaccinations and screening as anything other than healthcare: they belong in the NHS, so they *must* be returned to the NHS. However, many determinants of ill health are covered by LA services: planning, transport, housing, sports facilities, licencing. Can *anyone* say that moving PH into local authorities has improved health? Has PH made sure that social housing is fit to live in? Has PH changed local authority licencing policies or made people more active? Instead, we need to move back to a situation where the Director of Public Health is independent of the local authority, and we need to give that role statutory powers to override local authority policies if they will be detrimental to health. If necessary, the DPH should be able to impose the ‘cost’ of the ill health on the council.

    Your other points are very valid and I concur with your last statement “I have absolutely no idea what Jon Ashworth wants”. I am not even sure if he knows, this is something that you could not say about Lansley before the 2010 election, and this does worry me.

  2. Mervyn Hyde says:

    When I read comments like, we must not do another re-organisation because that will mean more turmoil, I immediately ask myself, how do you bring about change if you don’t change anything? Change is necessary if we want to reverse the marketisation of our NHS.

    The Reinstatement Bill was not created by thoughtless uncaring renegades driven by lust for power or wealth, but a highly professional pair of experts that well understand the intricacies and nuances involved in returning the national health service back into the world beating system that provides care from the cradle to the grave, free at the point of use and fully funded by the state as a matter of right

    In order to cut through the dis-ingenuity of the argument.that says we must avoid any further disruption to the NHS, suffice it to say the whole market system disrupts the NHS on a daily basis by the actual operation of the market itself, and is in a constant state of flux, we also know that the private sector is solely concerned about profit, and where patient care is concerned as soon as it has problems readily dumps it back on to the NHS to sort out, indeed due to the inefficiency of private hospitals, their botched operations are not solved by them but again dumped on the NHS, we also have evidence of 800 unexpected deaths in private hospitals within the first four years of the Tories privatisation plans, due of course to understaffing and poor safety records.

    The long process of dismantling the NHS persists to this day, so to think we will reverse this overnight is amateurish thinking which is beyond comprehension.

    The processes by which the state will reclaim the NHS back into the public domain will happen by professional people who work both in the private sector and the publc, meaning people will reorganise the NHS just as they dis-organised the chaos we have today, the difference will be less bureaucracy because the institutions put in place to manage the market will be dismantled and patients will not have to go through a plethora of organisations to end up receiving treatment or care.

    Those who resist the Reinstatement Bill do not do so from a perspective for either returning the NHS back into public hands or for ensuring the NHS is effective, rather they still pursue the misguided view that the private sector has a place in the NHS. The idea that companies supplying needles or specialist equipment are fundamental to the NHS is to forget the human factor of how such things are made and could even be made cheaper. Just an obvious example, people create drugs through working in industry, those drugs are then sold at highly inflated profits to the NHS, the NHS of course being the prisoner of the industries capacity to produce and the price they choose to charge. Hence when Penicillin was introduced Beechams charged in excess of 500% profit on that drug alone. You will of course hear all sorts of excuses about of development and research costs.

    In short we need to reinstate the NHS as carefully and quickly as possible, the private sector has no place in the NHS, This government has deliberately underfunded the NHS as part of the Neo-Liberal agenda, Neo-Liberal New Labour introduced the market into the NHS for exactly the same reasons, Tony Blair and Gordon Brown both made Margaret Thatcher their first guest to number 10 downing street, signalling to the establishment that it would all be business as usual, that has turned out to be a disaster not only for the NHS but the country as a whole.

    Lets get back into government and reverse the damage that is being done on a daily basis, the reinstatement Bill is the only game in town, we have all the money we need to return the NHS back into the world leader it always was, and even better in the future, failure to understand this, will allow the American model to predominate, and become the worst health system in the world.

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