What do we do now the NHS bill looks like becoming law?

Given the lack of Liberal Democrat support for voting even for amendments from members of their own party on March 13th, it looks as if the NHS bill is likely to become law. I hope I’m wrong on this, as I’ve provided lots of reasons here why I think that’s a bad idea, but it looks like the fat lady may be singing on this one.

So what do we do now?

One thing that seems to be clear is that the the coalition government are confusing law with implementation. Just because something is law, it doesn’t mean it will be implemented. Remember internal market one from the 1990s? What happened there was that Ken Clarke got the medical profession so angry that even Thatcher moved him on, and put in place more conciliatory figures to actually implement the legislation. As a result, remarkably little happened.

I don’t believe that Cameron is a fool. I think what he’ll do now is get the Health and Social Care bill on the statute book, slap Lansley on the back, and move him on. He’ll put someone else in charge who will say things like ‘start with a clean slate’ and try and defuse things.

But to make sure this happens, the clinicians have to keep making it clear that they do not support the NHS bill – but that if the government will give ground, so will they. But the government must make the first move, and I think it will do so after the bill becomes law, and Lansley is moved on.

So action point 1 – it is crucial that the health organisation bodies keep up the pressure and make clear that the government needs to listen to them if they want this bill implemented.

A second point is that the implementation of the bill is in the hands of health workers up and down the country. You have the power now to decide how to deal with this mess, but deal with it you must. As my colleague Bob Hudson pointed out on March 7th (http://www.guardian.co.uk/healthcare-network/2012/mar/07/nhs-reforms-what-happens-bill-passed?INTCMP=SRCH), it is perfectly possible to take the government as part of their word and organise locally to foster co-operation, increase patient involvement and commission in a collective way to prevent any private cream-skimming. I’m afraid though, this will be in the hands of CCGs – it is therefore crucial that GPs and other health professionals get involved here to make sure that the worse elements of the bill can be mitigated.

Action point 2 – health professionals have to get involved in CCGs in order to mitigate against the worst effects of the bill

Third, we need to acknowledge that it will be necessary to behave in anti-competitive ways to sort out a range of long-standing problems in the NHS in England. We already have a fragmented system, notably between health and social care, and between acute and community health services. If we take the government at their word and try to drive genuine bottom-up change we will far greater collaboration across both of these boundaries. We can’t possibly meet adult social care outcomes frameworks without greater collaboration and more clearly defined care pathways that work directly against the grain of competition. Equally we have to go back to planning community services in such a way as to minimise unnecessary acute admissions. We will need CCGs to take a lead in driving service improvements across these boundaries to prevent even greater fragmentation.

Action point 3 – health professionals in CCGs need to take a wider view and look across their local health areas to work across the boundaries that have dogged us in the 2000s.

What we face potentially now is a tragedy of the commons. If all health organisations go into their bunkers and try and compete, we will see national framework goals missed, and an extension of the beggar-my-neighbour approach we’ve already seen far too much of between community and acute health services.

We need our GPs and other health professionals, through their roles in CCGs, to show us some serious leadership. It will take them away from their role with patients, and I still believe this a really bad idea. Our health professionals will have to work against the grain of a bad bill to make it work for their patients. They will need all our support in doing so.


12 Responses to “What do we do now the NHS bill looks like becoming law?”

  1. Patricia Farrington Says:

    An excellent piece in you usual exemplary style!
    I have enormous admiration for your ability to jump up again after being bashed! Keep it up! My spirit is dashed…..I’ll have an early night and hope for some inspiration tomorrow.

  2. Martin Rathfelder Says:

    We need people to stand for election as governors of foundation Trusts and members to vote for them. They are the big boys in this game

  3. Christoclifford Says:

    This is excellent advice. I am a volunteer on a LINk Health now pathfinder for HealthWatch. Our CCG has written to the Prime Minister asking him to drop the bill.
    We discussed this very issue and decided that if if the bill was passed we had to subvert its implementation by being a very good Health Watch and support our CCG to ensure the best patient care. Also to remember that in 2015 it will change. So the pressure and challenge is with us until at least then.
    Thank you and a those health professionals with you for the fantastic fight you have been leading

  4. Alex Smith Says:

    Just like the miners in Wales had penny subscriptions, local communities need to buy into the CCGs. If we can convince local communities to subsidise, in a minimal sense, their NHS services, it may stem the tide of the large private healthcare companies undercutting existing local NHS services. It will also put local people in the driving seat of their services, just as the miners were in Wales.

  5. John Hully @PutneyDebates Says:

    Use all available data including FOI (while it applies) to get baseline of NHS on key H&C Bill points (such as private income) and then monitor changes.

    Putting ourselves onto whatever governance bodies we can, as suggested above, is crucial.

  6. Dave Neary (@DaveNeary1) Says:

    A twin track approach seems to be the best option to me. Firstly, got to try to make the best of a very bad piece of legislation in terms of increasing accountability for the reconfiguration of services. When decisions about any qualified provider are made then they have to be in the local public domain. It is still our money that is being managed in the NHS so if it is going to for-profit providers then they have to be held accountable. Secondly, the duty to reduce health inequalities along with the changes in the public health system need to be constantly in the news. I want Directors of Public Health to be shouting about how health inequalities are increasing due to the wider social determinants of health and the regressive effects of Coalition policies. There are bound to be major difficulties in the transition to the new system and I want the costs of this unnecessary re-organisation to be high profile for the next year and more. I want CCGs making bizarre/odd/dubious decisions on which treatments to fund to be held up to scrutiny so that the variation and fragmentation of services is apparent. I WANT TO TOXIFY THE NHS FOR THE COALITION FOR THE NEXT FOUR YEARS SO THAT EVERY DECISION TAKEN LOCALLY IS LIKE A BEDPAN RATTLING THROUGH THE HALLS OF WESTMINSTER.

  7. Dr Dean Jenkins Says:

    Excellent points Ian. I have just emailed my local CCG – Kernow CCG about action points 2 and 3!

  8. carolinemolloy Says:

    1) http://38degrees.uservoice.com/forums/78585-campaign-suggestions/suggestions/2634311-organise-a-huge-march-against-the-health-social if you only have 30 seconds, vote here for 38 degrees to call a big NHS demo, such visible protest is essential to give health workers the confidence to act in some of the ways suggested above – and spread the word about this poll.

  9. Dr Helena McKeown Says:

    Pragmatic advice alongside Maritn Rathfelder’s top five. Don’t forget we need honest MPs too – they need to engage with shift of NHS resources from hospital to NHS community care . We need an open debate on health care priorities not a lottery depending on your ability to use your sharp elbows or top up money. We need an open dialogue about who and how we pay for social care. We shoild recognise and reward good care eg write thank youis naming individuals & exemplars of good care as well as knowing how to report poor care, and if ignored, have protection to whistleblow.

  10. Sean Parlor Says:

    What do we do now? Simple find out the business money donors to the Conservative and Liberal Democrat Party and Boycot those businesses. How about a Blue Watch and a Orange Watch such has the Red Watch in the 1980’s and 1990’s. Paint a Blue NHS sign on Tory and Lib Dem business supportors.

  11. julie Says:

    Thank you for this excellent piece.

    I’m a young medical practitioner unable to practice ATM due to health problems with plenty of time on my hands to have followed the evolution of this ill-begotten legislation since it’s inception. So, I’m a doubly interested party.

    I don’t think you will be surprised to hear that I seem to have a much better understanding of the complexities/risks involved with respect to this bill than my new peers in the OPD waiting room who are already feel overwhelmed by what life has thrown at them.

    It seems to me that this whole business has been meticulously planned over many years and quite deliberately hidden from critical examination and democratic debate. So, that the weakness of any campaign or course of action will remain the enforced ignorance of ‘the general public’ = the patients = all of us who can’t afford private healthcare. In addition to the relentless propaganda/dis-information/avoidance emanating from HM government and their paymasters in the healthcare industry via the media and publicly-owned broadcast services.

    Whats more, the shrill accusations of ‘vested interests’ made against healthcare professional bodies and unions resisting the legislation only complete the desired picture of self-interested resistance to change. ”Well they would say that wouldn’t they” and ”BMA=consultants mouths’ stuffed with gold” mythology/ garbage.

    So, I would like to see every household in England leafletted with a clear simple explanation of what the HC&S bill has been changing already [without electoral permission], what the bill intends to do in it’s final form, how much this will cost in financial terms, and what are the likely risks and benefits. A bit like an election flyer but with more ‘punch’

    I’d also like to see the same information presented in an eye-catching formula on billboards [virginmedia-size] and adverts on TV, Facebook, national and local media etc etc.

    I’d like to hep in finding a long enough spoon for the RCGP to sup with the devil cos they’re going to need it, in co-operating with the forces of darkness/ the fait accompli and avoiding all the blame wh will surely come.

    Any ‘industrial action’ by anyone remotely connected to healthcare professionals will run the risk of turning this debacle into a miners strike moment rather than a reprise of the poll tax fiasco. Tories have long memories and are still smarting from their last run-in/defeat by the medical profession. So maybe, looking fwd to a showdown?

    I’m a patient now -not really well /feeling quite vulnerable. Who will hear my voice.

  12. marielouiseirvine Says:

    We should test the government’s rhetoric about local decision making and no forced privatisation by asking our local CCG to sign the following pledge:

    “This CCG will uphold the principle of “first do no harm”: we will take no action and adopt no policy that might undermine our patients’ continued access to existing local health services that they need, trust and rely upon.

    In the spirit of clinically-led commissioning, we reserve entirely the right to decide who we contract with to provide services for our patients. We will take those decisions on the basis of the best interests of our patients and wider local communities.

    Among other priorities, and in the interests of offering the best care for our populations, we shall increase the integration of services between different parts of the NHS and between the NHS and social care. We shall not be diverted from this by concerns about anti-competitive behaviour.

    In the interests of transparency we will not engage in any contracts or negotiations which impose conditions of commercial confidentiality: will consult local communities before implementing any changes that affect them, and our Board will make all major decisions relating to services in public session.”

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