Support amendment 300A is not as stark a message as Drop the Bill but it offers a ray of hope.  It is an amendment to the H&SC Bill concerning the timing of major changes and offers one last chance to bring sanity to the fractured and polarised debate about the future of our NHS.  It allows implementation of market regulated competition to be deferred whilst other “reforms”, which are far less controversial, continue.

With every passing day opposition to the Bill grows – not from an unrepresentative minority or from vested interests but from the very people who will have to deliver implementation.  Is it too late to avert the crisis?

As John Healey famously stated the more people understand the Bill the more they oppose it.  The greater the examination the worse it looks, incoherent, badly drafted and unnecessary.  In the real world the NHS struggles to make sense of financial cuts alongside reorganisation on a scale never seen before – without anyone understanding why it is necessary.  In the final insult to all who work in our NHS David Cameron now tells us (3 March 2012) that competition with the private sector must be encouraged to address an “invisible crisis” in the National Health Service in England.

Invisible is right – nobody can see it.  It’s about as obvious as the link between claims made by Ministers and what is actually in the Bill.  About as credible as Nick Clegg.

At the heart of the arguments about the Bill is competition – and the role of Monitor as the Economic Regulator (OfSick).  It is pointless to go over all the arguments and all the evidence about how competition works in healthcare or about whether the policies are evolutionary or not or even the argument that despite the Bill other factors will deter competition and limit any role for private providers anyway.  We know nobody in the coalition is listening to evidence or even well argued policy points.

Maybe downright pragmatism may offer a final chance.  There are very good reasons to say that Monitor should keep its current role as independent regulator of Foundation Trusts.  There are sensible people, who are pro competition, but who see launching a new economic regulator from scratch against concerted opposition in times of financial problems as highly risky.  There are those who agree that evolving some of the current framework around competition and cooperation might be best for now. There are many who say lets focus on bringing in a greater role for clinicians in commissioning and on provider reforms, let’s reconfigure provision and ensure all providers meet high standards – such as achieving Foundation Trust status.  In the meantime let’s keep a careful eye out to detect and prevent serious failures like Mid. Staffs or financial meltdown in parts of London.  Lots of sensible people urging caution.

So we get to Amendment 300A to Clause 302.

It says something sensible.  It says let Monitor continue with its current role as the independent authoriser and regulator of Foundation Trusts until that job – of getting the vast majority of providers to an acceptable standard to allow them autonomy – has been completed.  Even the most optimistic agree this will be 2016 at the earliest.

And, do not implement the establishment of economic regulation with Monitor 2 (or OfSick) until that job is finished – until the provider landscape is clear, until the new commissioning framework has been implemented and got some credibility.  Do the enabling work, engage in proper consultation, build the necessary organisational capacity and capability in the meantime.  Park Part 3 for now.

So this buys time for more work and to build an alliance for change instead of concerted opposition.  It simplifies the background against which the NHS has to deliver unprecedented savings.  It leaves open, as now, the issue of what role is right for competition and gives more time for study and evidence gathering.

But most of all it moves the fundamental and irreversible change in our NHS until after the next general election.  There is no mandate for the changes being driven through; the coalition agreement is being ignored.

If the coalition together or each party separately want to campaign for changing our NHS to a market then they should first win an election where they make it clear that is their intention.

Drop the Bill.  If not drop Part 3.  But if neither then pass amendment 300A, park Part 3, and buy some time for sanity to prevail.

Irwin Brown

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