The NHS Bill will be substantially changed – that was the message from Liberal Democrat MP and Health Minister Paul Burstow at Lewisham Liberal Democrats on Friday night. It won’t just be changed, he said, it will be changed in a distinctively Liberal Democrat direction.
At the heart of the likely changes is the role of Monitor, the proposals for which Paul bluntly said were got wrong first time round. Though he was careful not to directly criticise Andrew Lansley, he did say that the original proposals for Monitor were to adopt the model of regulator used with privatised utilities and apply that to the NHS – and (unmentioned by Paul) Andrew Lansley was previously a civil servant who worked closely on such regulatory plans. The implicit message was that Lansley took a model he was used to and wrongly tried to apply it to the NHS.
Altering the role of Monitor to emphasise integration and collaboration could tackle many of the fears of fragmentation and privatisation, depending on how the details are worked out. Paul Burstow put forward a very upbeat case for this, pointing out how changes in the Bill would in fact end the sort of private provision brought in by Labour that had resulted in private firms being paid for work they did not do.
Paul Burstow gave credit to the spring conference motion in helping to trigger changes to the NHS plans – and was refreshingly frank in saying that what the party is doing in government is changing as a result of the conference vote. I’ve heard many an MP in the past argue for reasons to side-step or ignore or side-line a conference vote; there was none of that from Paul.
The other key influence on the shape of the final plans that he mentioned was the widespread consultation within the health service and with related charities and similar organisations. With over 200 consultation events held in the last six weeks, it is hard to see how the final plans can be ones which do not reflect the widespread views within the health service.
Paul Burstow talked about how the plans for GP commissioning are likely to change, with tighter rules around transparency and more involvement of lay members, including a lay chair for the GP commissioning bodies. As I mentioned in my question to him, the risk is that we end up with PCTs being recreated by the back-door, but Paul was optimistic that the new arrangements would be a substantial improvement on the extremely patchy PCT record due to the central involvement of GPs. In addition, GPs would not be able to delegate commissioning decisions to others, such as external private firms. Commissioning will stay in the hands of accountable public bodies.
Given Paul’s long standing interest in social care, it was no surprise that he also stressed the importance to him – and in the Bill – of integrating health and social care and of giving local government the key role in promoting public health.
The questions at the end showed a fair degree of scepticism of the plans so far, though many people commented afterwards how impressed they were that Paul took the time to answer every question from someone in the room.
Perhaps the best of those was from a member who admitted they aren’t an expert in the NHS and therefore looks to the views of figures they trust to help judge a policy. So his question was “Will Evan Harris be happy with the changes to the NHS White Paper?” In reply, Paul Burstow pointed out that he had to keep many people happy – including also Shirley Williams – but he expected Evan to be happy with most of the changes. I’m sure Evan will tell us if that turns out to be wrong…