This is a brief blog to put down a marker. I hope there will be a meaningful debate.
The backdrop.
The Tory gov't has just announced they will shortly be releasing a "white paper" setting out proposed changes in the way the NHS is organised. (White papers are policy documents produced by the Government that set out their proposals for future legislation. White Papers are often published as Command Papers and may include a draft version of a Bill that is being planned)
This is the rationale in precis form :
Health and care services will work more closely together under plans to reform the NHS in England, the government has said.
Health Secretary Matt Hancock will set out plans for a "more integrated, more innovative and responsive" NHS.
He said he wanted to target "burdensome bureaucracy".
The shake-up will see the law changed to reverse reforms of the NHS in England introduced under David Cameron in 2012.
The full white paper - which sets out the proposed future legislation - will be published later.
Ministers believe the changes will put the NHS in a better position to cope with an ageing population and a rise in people with complex health conditions.
One-in-three patients admitted to hospital as an emergency has five or more health conditions, such as diabetes, obesity or asthma, up from one-in-10 a decade ago.
Those working in the health service said many of the rules in place were time-consuming, frustrating and stressful.
Nigel Edwards, of the Nuffield Trust think tank, said the changes would be a "re-wiring behind the dashboard" and should not be too noticeable to patients.
While it was not a "magic bullet", it could help different parts of the system work more closely together, he added.
The reforms by Mr Cameron's government in 2012 saw the creation of NHS England - to run the health service - and the scrapping of primary care trusts in favour of GP-led clinical commissioning groups to organise local services.
Under the latest proposals, there will be "enhanced powers of direction for the government" to "ensure that decision makers overseeing the health system at a national level are effectively held to account".
Instead of a system that requires competitive tendering for contracts - sometimes involving private companies, the NHS and local authorities will be left to run services and told to collaborate with each other, says the draft White Paper, designed to set out proposed legislation.
There will also be more focus on GPs, hospitals and social care services working together to improve patient care.
The paper stresses that the Covid pandemic "demonstrated plainly that this broader approach to health and care is not only desirable, but essential".
This is what I want to say on this issue at this time.
1) In my opinion competitive tendering made sense because NHS managers (as most public services) are wasteful, not businesslike and get ripped off too easily. Encouraging them to seek out value needs to remain part of the process in my view.
2) However the tendering process is bureaucratic and time consuming and possibly taken too far.
3) If various parts of the NHS/Social Services have their own budgets it can follow that there can be issues over who picks up the bill. This is a real problem. For instance it led to the bed blocking issue - hospital managers wanting to move elderly patients off the ward asap and social services managers not wanting to take them. (because of the impact on their respective budgets).
4) The covid emergency has shown what is possible. The need to establish Nightingale Hospitals is perhaps the best example. The gov't took charge. They cut through the red tape. A job that might have taken months even years - took just weeks.
5) It is also clearly understood that many patients need multi dimensional care and that requires barriers to be broke down and everyone working together in common purpose. What might be happening now is they are competing with each other.
SO it is legitimate that these issues are tackled and resolved but this is where the politics start. This is where so much time and energy is potentially lost. This is where petty politicking is likely to be seen at its worst. This is where we get exasperated!
To avoid my immediate exasperation I have copied and pasted an article written by Allister Heath 10/2/21 Daily Telegraph. AH's article covers the points I would wish to make but in much better prose - ha!
Here it is :
There is a gigantic, corrosive lie at the heart of British politics, an untruth so great, so debilitating that it all but guarantees that we will remain unprepared for the next calamitous pandemic. This falsehood, propagated principally by Labour but in which the Tories have been complicit out of cowardice, is that any criticism of the NHS’s performance or administrative structure is tantamount to attacking doctors and nurses.
In this nonsensical, binary world of the Left-wing imagination, you either believe that the NHS is the best possible healthcare system, improvable only by increasing its budget, or you stand accused of hating the very people who have put their lives on the line, working night and day in ICUs, and in vaccination centres. You either worship at the altar of NHS orthodoxy, insisting that it has nothing to learn from any other country, or you are an ungrateful monster, secretly obsessed with importing America’s dystopian healthcare system into Britain.
There is no space for those of us who are in awe at the selflessness of medical professionals, who believe that NHS workers are heroic and often underpaid by international standards, who reject the insane US mish-mash and yet who believe we need to improve the way we deliver, manage and finance universal healthcare in Britain, for the good of patients, the country and medical staff.
Yet in the secular, intolerant religion propagated by Labour’s cultish fundamentalists, anything other than unconditional, total adulation of the status quo must be punishable by cancellation. The double-standards are staggering. Patriotism is generally taboo for the Left: they keep telling us how much better Europeans are at everything, from making cars to the generosity of their welfare state. Yet the NHS is the one exception, their own cricket test: to suggest that we could learn from Germany, which has suffered fewer Covid deaths, where 60 per cent of hospitals are private, where citizens choose between a hundred competing insurers, each with different healthcare plans, is to commit an act of heresy. When it comes to healthcare, Labour are nationalistic little Englanders – particularly when the party is struggling in the polls.
Take the character assassination meted out to Kristian Niemietz of the Institute of Economic Affairs think tank. His rather mild report on how healthcare systems coped with the pandemic concludes that “there is nothing special about the NHS”. It fared worse overall than many, but not all, other countries. He concludes that, when it comes to its performance relative to others, “there is no rational basis for the adulation the NHS is currently receiving, and no reason to be ‘grateful’ for the fact that we have it [rather than a different kind of health system].” This triggered a maelstrom of confected fury: Labour’s deputy leader Angela Rayner claimed he said “NHS staff don’t deserve our thanks”, a scandalous misrepresentation of what Niemietz actually argued.
But why are the Tories allowing this madness to continue? They have successfully made the NHS their own again, most spectacularly with Vote Leave’s co-opting of the health service. They ought to be spending some of this capital now: to ensure we don’t implode again come the next pandemic, Tory policy cannot just be about centralisation – including the reversal of previous reforms – and cash.
Tragically, the party seems not to fully grasp the power of its own history in this area. There is an intriguing black and white portrait hanging on the wall of Matt Hancock’s Whitehall office: it is of Henry Willink, a long-forgotten Tory MP the Conservatives ought, by rights, to be talking a lot more about. As Winston Churchill’s health minister, he is the true inventor of the NHS: it is he, rather than Labour’s Nye Bevan, who should be a household name. Willink’s white paper, a National Health Service, was published in February 1944. That plan was far superior to the version Labour eventually delivered.
In his Five Giants, Nicholas Timmins recounts how Willink’s plan backed a mixed economy for hospitals: some would be public and others private, though working for the NHS. Crucially, it was “in the most embryonic of forms... an outline of the internal market that the Conservatives finally introduced into the NHS in 1990.”
In fact, the proposal was even better than that: while municipal hospitals would be taken over by 30 or so boards, “voluntary hospitals” would have been free to contract with them for services. We would have ended up, like in Germany and other nations, with the majority of hospitals privately owned and the NHS the main purchaser; care would still have been free for patients. Willink’s overall vision was imperfect, but it was far less rigid and monolithic than what we ended up with. It would have allowed evolution over time, been far more resilient and open to private sector ideas, money and technologies, and many of today’s problems would not exist. The private-public partnership that did so well with vaccines would have been the norm, rather than an amazing exception.
Yet Bevan dismissed Willink’s brilliant compromise as “no scheme at all” when he became health secretary. He decreed that all hospitals should be nationalised, an idea occasionally floated since the Thirties but that had never been part of any government or party proposal. This was a socialist putsch by Bevan which, together with a deal he struck with the Royal Colleges, was to lock in a one-size-fits-all system almost no other nation adopted. Willink slammed the hospital nationalisations in the Commons in May 1946, warning that they “will destroy so much in this country that we value” and be a great loss to local communities, to no avail.
The other great, intolerable lie in British politics, therefore, is that the Tories have never believed in the NHS. They obviously do: they commissioned its original blueprint. But there must be more than one way to be pro-NHS and pro-universal healthcare: it is morally right to reform a system that doesn’t work as well as it could.
The conspiracy of silence, the bullying, the dissembling: all must end. We need to be able to have an honest conversation on how to improve the NHS. It could be through a Royal Commission; perhaps there could be a referendum. But Covid has shown beyond any possible doubt that change there must be, and that demagogues must no longer be able to halt it.
At this point I can feel I have contributed at least something to the debate and I can do little more. I believe in the principal of the NHS. Surely we all want what is best for the NHS to enable it to uphold its wonderful principles. For that we have to open our minds and be objective.
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