As Liberal Democrats we are reformist by instinct and as in every other area of our community life we want to see reform of the NHS, not only to enable it to deal with the major resource and demographic challenges of the next twenty years, but also to ensure that it is more clinician-led, patient-centred and outcome-focussed than it has ever been before. That is why our MPs supported the principles of the Secretary of State’s original NHS Bill when it came to 2nd Reading in the House of Commons.
Our very public concerns have centred round whether the precise organizational changes proposed would bring the outcomes we all want to see and as we examined the detail we began to press for modifications in the reform proposals. It is important to be aware that many of these concerns were shared by some of our Conservative colleagues in Parliament.
Our first task was to set down the key improvements that needed to take place in the Bill and at our Sheffield Conference we did this publicly and with some clarity. Nick Clegg then undertook to persuade the Prime Minister that these were genuine, reasonable and widespread concerns which merited a ‘pause and listen’ exercise before taking the legislation on to its next parliamentary stage.
In parallel with the listening exercise conducted by Professor Stephen Field, Nick engaged directly with party colleagues, NHS and professional stakeholders and the Conservative leadership in detailed discussions which not only confirmed that there was widespread public and professional support for our ‘Sheffield stance’ but which resulted in very substantial change and improvement in the Bill.
What has been the broad thrust of these changes?
The responsibility of the Secretary of State for the provision of a universal health service free at the point of need will be entrenched rather than reduced, returning to the principles of the original NHS commitment. The NHS Constitution will be maintained.
The commissioning of health care will be by clinicians – not only GPs but also informed by nurses, secondary care specialists and others; and those who need more time to develop the skills and processes they require to undertake these new responsibilities will be given more time.
The Commissioning Groups will be public bodies with transparent governance structures and accountable through the Health and Well-Being Boards to locally elected representatives. This will prevent conflicts of interest, but facilitate increasing integration of primary and secondary health care as well as of health and social care – an approach we have long championed.
The new proposals also put in place the greater democratic accountability which was an essential element in our manifesto commitment – as was our determination to cut out bureaucracy, something else that is being achieved in the new proposals though now at a more realistic pace than was originally envisaged when the Bill was introduced.
One of our biggest worries in Sheffield was that the ‘utility regulator model’ which was being used to inform the equivalent new NHS body ‘Monitor’ was too simplistic and too focussed on competition for its own sake rather than as a facilitator of improving standards and enabling cooperation and integration of services. These concerns were reflected in the Future Forum Report and the Prime Minister has accepted this hugely important change to Monitor. This will protect the future development of the NHS and prevent unacceptable ‘cherry-picking’ by private providers. But it goes further and repairs some of the damage done to the service by outlawing the practice of the previous Labour Government which often discriminated in favour of private providers over against NHS providers.
There was concern that with removal of the Strategic Health Authorities (something we campaigned for in the last election) and the disbandment of PCT’s some necessary managerial skill and experience would be lost but with the longer period of transition now envisaged, and the National Commissioning Board adopting the PCT clusters as a regional presence, we can achieve our joint aims of reduced management cost and maintenance of regional specialist and commissioning functions.
The rubric “No decision about me without me” was a hugely welcome commitment by Mr Lansley when he presented his proposed reforms however it was puzzling that the original Bill actually said very little about patient, carer and family involvement. This has now been put right and patient and carer involvement is being ‘hard-wired’ into the reforms.
Though we have already seen major improvements to the Bill, more will emerge as it returns to the Committee Stage in the Commons for re-examination by MP’s and then passes to the Lords in the autumn for detailed scrutiny and revision there. In addition there will be much work to be done in the process of implementation especially during a period of profound economic austerity and unprecedented demographic change and increasing treatment costs.
Despite these challenges my Lords colleague Shirley Williams, who has played such a significant role in this process, was surely right to say yesterday in The Independent, “Liberal Democrats can comfort themselves with the realization that one of England’s most trusted and best loved public services will now survive as the framework for our healthcare; the Prime Minister will be able to say with confidence that the NHS is safe in the Coalition’s hands.”
Lord Alderdice is Co-chair of the Liberal Democrat Parliamentary Policy Group on Health and Social Care.