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.