After someone on the Liberal Democrats Facebook page asked what my view was on pushing ahead with the cuts to and the reform of the NHS, I decided to read the whitepaper Equity and Excellence: Liberating the NHS and the Health and Social Care Bill.
My first impression is that the whitepaper shows none of the weasel words and compromise often seen where there is serious disagreement and feels like a coherent whole. So I think Andrew Lansley and Paul Burstow share a common vision for the NHS. As a consequence of this, the bill is far more radical than anything in either party’s manifesto!
This will be a series of posts, as there is a lot of material to digest. In this first post, I’m going to focus on the intent of the legislation, drawn largely from the summary of the white paper.
Putting patients and public first
It’s difficult to argue with any of this. What I think is noteworthy:
- Strengthens localism, based around local authorities
- Clear intent to reduce inequalities
Improving healthcare outcomes
- Great shift from process oriented targets to outcomes!
- Nice focus on openness, responsibility, and above all outcomes
Autonomy, accountability and democratic legitimacy
This feels like one of the key sections to me. It seems clear there has been a meeting of minds over the need to remove the NHS from political interference and put healthcare into the hands of patients and clinicians.
- Devolution to commissioning consortia. This is great in principle but I have concerns that finance isn’t a core skill of clinicians. However, addressing this is a question about mechanisms – the intent is great.
- Intent on legitimacy is good, but the single statement on the responsibilities of local authorities feels a bit weak. There is no statement on legitimacy of consortia, which is an issue: patients must have an input.
- It’s not clear that making all NHS trusts become foundations is either good or bad. However, I’ll roll with this for now as simplification feels good.
- The clause on the Monitor has a problem: the duty to promote competition must make it clear that quality of outcome is prime not cost. I’m also slightly worried about the mention of “efficiency” though it is subsidiary to “effective”
Cutting bureaucracy and improving efficiency
This section feels like standard stuff that every government paper includes, but the intent is correct. In particular, it feels like there is a good shift towards localism versus centralised Whitehall control, which might for once translate to real savings.
Overall, I like the intent of the white paper, with the caveats given above. That is, I’m concerned that:
- Financial management isn’t a core skill of clinicians so they’ll need financial advice.
- It feels like there is too little on democratic accountability. In particular, there is no statement on the accountability of the commissioning consortia.
- While promotion of competition is good, at present there is nothing that makes it clear that competition over quality of outcome is more important than cost.
In summary: apart from the caveats above, I like the intent of the bill: patients-first, clinician-run, devolved from Whitehall, with patient choice. My gut feel is that my caveats will be (at least partially) addressed in the next few weeks during the “natural break” in the legislative process!