Government has ignored every opportunity to “pause and reflect” on health bill
We are currently in the pause of the Health and Social Care Bill. We are told that this is to allow the government to "pause, listen, reflect and improve" the Bill. However, although there may be a pause in the Bill’s passage through Parliament, there is no appreciable pause in the changes that health secretary Andrew Lansley is making to the NHS.
The Coalition Agreement pulled together aspects of both the Conservative and Liberal Democrat manifestos, but significantly, it pulled in far more from the Conservative 2008 first draft of the Bill, called the NHS Autonomy and Accountability proposals. It is often stated that Andrew Lansley has been working on the proposals for six years – but his counterpart in the Liberal Democrats, Norman Lamb, had been working on his plans for four-and-a-half years. Both parties had well developed plans for the NHS, so surely the period of merging policy was a time to pause, listen and reflect?
Instead, the government pushed ahead and produced the NHS White Paper. This was scheduled to be published at the end of June, a mere seven weeks after the election. However, the White Paper immediately hit problems. As part of the normal government review process the proposals were passed to the Treasury who expressed their concern over handing a large proportion of the NHS budget to unaccountable GP groups. This delayed the publication of the White Paper by three weeks. On the 12 July the government published the White Paper Equity and excellence: Liberating the NHS.
The White Paper was extremely ambitious. It wasn't just the scale of the reorganisation, it was the timescale: Andrew Lansley proposed to completely re-organise the NHS, top to bottom, in a matter of four years. This was to occur at the same time that the NHS was expected to make productivity gains of 4% every year for five years. Strategic Health Authorities (SHAs) would be abolished by April 2012, Primary Care Trusts (PCTs) would be abolished by April 2013, and their responsibilities handed over to the new NHS structures, principally, the GP commissioning consortia.
The day after the White Paper was published Sir David Nicholson, the Chief Executive of the NHS, wrote to the chairs of all SHAs, PCTs and hospital trusts, and started the process of abolishing PCTs and SHAs. In response, Unison wrote to Sir David saying that they would seek a judicial review to challenge the Secretary of State's action. On 23 September Unison withdrew their demand for a judicial review when it became clear that Lansley had the powers to abolish PCTs and SHAs without consulting Parliament.
The consultation on the White Paper closed on 11 October, just 13 weeks after the White Paper was published. There were 6,000 responses many of which expressed concern over the ambitious timetable and whether GP consortia would be capable of effective commissioning. The government had intended to publish the Health Bill by the end of 2010, but the sheer number of responses put this on hold. Even so, the Department of Health said that it "would not affect the timetable for implementation" and that the changes would continue regardless of opposition from unions and professional bodies.
The Prime Minister, worried about the Bill, asked the Cabinet Minister, Oliver Letwin, to review the policy at the beginning of December. The Financial Times quoted a Number 10 insider: "There is no change in the policy. But Oliver is starting to ask all the important questions that need answers." The insider added: "Andrew [Lansley] has all the answers when he is asked the questions about how the implementation of all this will work. We are just not sure they are the right ones."
Since the Prime Minister was clearly worried about the policy, this was the right time for a public listening exercise to pause, listen and reflect. But the government did not want public involvement – this is clear from its response to the White Paper consultation, Legislative Framework and Next Steps, (15 December) which said that the reforms would continue with the same scope and the same timetable.
The Bill was published on the 19 January and Committee stage started on the 3 February. The Committee stage is the main opportunity to amend a bill. The committee had 28 sittings – the longest of any Bill since 2002 – lasting from 3 February until 31 March. During this time there were 100 opposition amendments to the Bill and not one was passed. There were no amendments suggested by Conservative or Liberal Democrat MPs because the government indicated that the only amendments that would be allowed would be those from the government.
The Liberal Democrat Spring Conference was on the weekend of the 12/13 March, during the Committee stage. The conference passed a motion that opposed key parts of the Bill on competition, privatisation, conflicts of interest and accountability. The government claimed that its intention was never to allow competition on price and amended the Bill to outlaw such competition, describing it as a "clarification" of its position. There were no amendments to address the other concerns of the Lib Dem delegates.
On 4 April Andrew Lansley announced a break in the passage of the bill "to pause, listen and engage with all those who want the NHS to succeed". This was two days before the two week Whitsun recess, when there would naturally be a pause before the Bill progressed to the House of Lords. However, on 14 April the Chief Executive of the NHS wrote to SHA and trust chairs to tell them that the reforms would continue. He said: "I want to stress very firmly that we need to continue to take reasonable steps to prepare for implementation and maintain momentum on the ground. The only apparent affect of the "pause" was that the changes that were intended to occur by April 2012 –abolition of SHAs – would occur by July 2012: a three-month slippage. The other deadlines – abolition of PCTs by April 2013 and all hospitals to be Foundation Trusts by April 2014 – would go ahead.
As you can see, there have been many opportunities for the government to "pause, listen and reflect" on the Bill. The government has even had a consultation process but it refused to address most of the criticisms. Meanwhile, as the Bill progresses through Parliament, all of the substantial parts – abolishing PCTs and SHAs, setting up GP Commissioning Consortia and accelerating all hospital trusts towards Foundation status – continue to be implemented.
Richard Blogger writes about the NHS and social policy at NHS Vault.
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