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Editorial Tuesday 25 October 2011: To catch a falling knife

It has long been clear that the Health And Social Care Bill and its associated White Paper and policy development process will be taught in schools of government as a 'how not to do it' case study for many years to come.


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The case for the Bill is pitifully weak.

The case for serious and far-reaching change in the NHS is strong; but the case for what this Bill wants to do and how it is trying to do it exemplifies 'the political syllogism' from Yes, Minister: something must be done; this is something; therefore this must be done.

Never mind the Coalition's obvious issues over Europe, if there is an ounce of political intelligence in either Coalition party, it should frankly be shitting itself over the issue of the NHS.

The Coalition arrived into office on a wave of public understanding that the UK's economic problems needed to be addressed.

Gordon Brown's cuts denial strategy had firmly convinced the average non-partisan voter he should not be given another opportunity.

Despite significant efforts to detoxify the brand, David Cameron's Conservatives (for that is how they were sold) did too little to convince voters that it could have the job.

The Coalition was what we got.

And it made an agreement about policy. Which claimed "In the NHS, take Conservative thinking on markets, choice and competition and add to it the Liberal Democrat belief in advancing democracy at a much more local level, and you have a united vision for the NHS that is truly radical: GPs with authority over commissioning; patients with much more control; elections for your local NHS health board. Together, our ideas will bring an emphatic end to the bureaucracy, top-down control and centralisation that has so diminished our NHS".

It also said, "we will stop the top-down reorganisations of the NHS that have got in the way of patient care".

It also said, "we will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed by the relevant local authority or authorities, and the Chief Executive and principal officers will be appointed by the Secretary of State on the advice of the new independent NHS board. This will ensure the right balance between locally accountable individuals and technical expertise. The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations".

Almost every single bit of that turned out to be untrue.

At the end of the high-spending Labour era, the NHS had been getting record ratings of public satisfaction, in a poll which we exclusively revealed the Government will discontinue.

The Coalition is pressing ahead with a reform of the NHS that has attracted no broad constituency of support. It is walking into the Valley Of Blame for all that goes wrong in the NHS - whether caused by the Bill or otherwise.

Tonight, Paul Waugh of Politics Homereports on information that Lord Mackay's amendment on the SOS duties may be given a fair wind by the Government.

Labour's chief whip in the Lords Steve Bassam tweets that "Govts 244-212 win suggests scope for more amendments on Health Bill. Big slump in Govt Lords usual 80+majority".

I remain unconvinced that the SOS duty is the worst thing about this Bill. It is emblematic, and I get the point seeking to be made, but it lacks political reality. We pay for the NHS through taxes that are set by politicians: ultimately, we will inevitably see politicians as answerable for the NHS's performance.

The problem arises, though, that with the reforms under way well before the Bill is passed, there are now figures on board who think accountability is theirs.

Chairman Mal has been sold the job of chairing the NHS Commissioning Board on that basis. And his own words to the health select committee bear re-reading: "Clause 20 ... requires the Secretary of State to prepare a mandate for the Board. That mandate sets out the Secretary of State’s objectives for the Board and also its future financial arrangements. The mandate should not be for a single year but for two years, and possibly three years if we are going to have the Board running properly and strategically.

"The mandate needs to be discussed with the Board before it is published. It needs to be laid before Parliament and it is a public, clear document, which, for the first time, establishes accountability.

"In so far as the matter is within the mandate of the Board, it is not within the jurisdiction of the Secretary of State, except that he has power to revise the mandate with the consent of the Board or he may revise it in exceptional circumstances.".

If there is movement now on the SOS responsibility role, Professor Grant could well feel that he has been mis-sold a job.