I haven’t read the Health and Social Care Bill (soon to be Act). More pages than a Harry Potter novel, and qualified by a thousand amendments, I’m not sure reading it would throw much light on my darkness. However, there are aspects of the bill I am aware of.
I know, for instance, that the NHS Bill was in no one’s manifesto, and I know there wasn’t the slightest hint of its major elements in the coalition agreement. The government has absolutely no mandate for NHS reform at all. It all seemed so clear … and then I made a foolish mistake. I went back to the three party manifestos, and the coalition agreement, and looked at what they said.
If you’ll excuse a little over-simplification, it seems that the two most significant changes proposed by the bill are the dissolution of the current bodies that commission healthcare (Primary Care Trusts) and the handing over of these powers to GP consortia, and the opening up of healthcare provision to ‘any willing provider’.
Let’s have a quick peek at the Conservative manifesto.
‘…we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers … We will strengthen the power of GPs as patients’ expert guides through the health system by … giving them the power to hold patients’ budgets and commission care on their behalf … putting them in charge of commissioning local health services’. To be honest, that looks rather like the two main elements covered.
The Labour manifesto: ‘All hospitals will … be given the freedom to expand their provision into primary and community care, and to increase their private services … We will support an active role for the independent sector … Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.’ Hmm. Not much about commissioning powers, but a distinct whiff of encouraging private provision – more of the marketisation and competition that dominated NHS reform throughout Labour’s time in office.
So – what about the Lib Dem manifesto? Not much there, actually; there’s the promise that if patients do not get diagnosis and treatment on time, ‘the NHS will pay for the treatment to be provided privately.’ And there’s a pledge to ‘scrap Strategic Health Authorities …’ (top-down re-organisation?).
So – all three parties were in favour of privatisation, to a certain degree, and some re-organisation. And there’s no getting away from the fact that GP commissioning was writ large in the Tory manifesto.
The Coalition Agreement has both the ‘any provider’ element and GP commissioning straightforwardly cut-and-pasted from the Tory manifesto.
I don’t like the NHS Bill, and I don’t understand why the coalition partners have been so desperate to see it enacted; but we do ourselves no favours if we simply condemn it as undemocratic and claim the coalition has no mandate to bring it before Parliament.