Editor's blog Thursday 26 May 2011: The Battle Of The Bill: Committee Take 2; Clegg translated; Healey debated
The Battle Of The Bill has been a long campaign. It's ironic that as the listening pause draws to a close, there has been a morning of political action.
Click here for details of 'Lansley: the NHS is not a mobile phone; I am not Henry V', via subscription-based Health Policy Intelligence.
The headline issue was in neither the speeches of Deputy PM Nick Clegg or shadow health secretary John Healey, not in the latter's recommittal amendments.
It was in the Q&A following Nick Clegg's speech.
Clegg (wearing a Labour-Party-red tie) told journalists and delegates that "I don't think it would be right for us to hold this listening exercise – to make big changes to the legislation – and then to seek to bounce it through parliament. It is very important that MPs, who represent millions of patients up and down the country, have the opportunity to really look at the details that we are proposing.
"I think we will need to send the bill back to committee. I have always said that it is best to take our time to get it right rather than move too fast and risk getting the details wrong".
The DH, however, is telling enquirers that their intention is to await the reports of the Future Forum before deciding whether the Bill should return to committee stage. Aah. Sweet, isn't it?
Clegg has pulled the classic trick of simply announcing the outcome he wants to pre-empt further discussion. That statement, taken in association with Labour's above-mentioned tabled amendemnets, means that the Bill is going back into Committee whether Secretary Of State For The Time Being Andrew Lansley likes it or not.
And Our Saviour And Liberator does not like it. But the rest of us will get more heir time - heir-apparent time, that is, assuming (as we must fervently hope) that special Simon Burns will again be in charge of the Coalition committee team.
Has Clegg acted without Cameron's consent here? Possibly. Cameron did it to Clegg two days ago, over asking the controversial Lord Ashcroft to review overseas defence bases. What goes around ...
"The detail will have to wait" - Nick Clegg's key lines (and what they really mean)
"We now need to make changes – in some cases, significant ones".
I was only kidding when I signed the Bill and voted for the first two readings in the Commons.
"The detail will have to wait. We’ll be setting out the changes to the Bill more fully once the listening exercise is complete. However I can tell you that the right kind of reform starts from the patients’ point of view. Not bureaucrats, not unions, not Ministers, not political parties – patients".
A nice GP in every living room; an A&E and maternity unit on every street; antibiotics for a cold on tap.
"Care, free at the point of use, based on need and not ability to pay. No government worth its salt – certainly, no government of which I am a part – will ever jeopardise that".
Unless you want prescriptions, or dentistry, or co-payment-expensive-not-very-effective drugs.
"There will be no privatisation of the NHS. The NHS has always benefited from a mix of providers, from the private sector, charities and social enterprises, and that should continue".
I'm pretending someone thinks that wasn't going to continue, for no good reason.
"People want choice: over their GP, where to give birth, which hospital to use. But providing that choice isn’t the same as allowing private companies to cherry-pick NHS services. It’s not the same as turning this treasured public service into a competition-driven, dog-eat-dog market where the NHS is flogged off to the highest bidder".
Please, nobody ask me where the extra capacity is going to come from - or why the private sector does only a little of the most complex kinds of care.
"Competition can help drive up standards but it is not an end in itself".
If I say something ridiculous about competition not being an end in itself, perhaps this debate will go away?
"That’s why, as Andrew Lansley confirmed earlier this week, the main duty of Monitor, the health regulator, will not be to push competition above all else. Especially not at the expense of integrated services and collaborative practices like clinical networks. Monitor’s main duty will be to protect and promote the needs of patients instead using collaboration and competition as means to that end.".
Watch my words here - "duty will not be to push competition above all else"; "competition and collaboration".
"We’re getting GPs and other healthcare professionals to take more responsibility for the overall picture. That’s the point of clinician-led commissioning".
We've fired a lot of managers.
"The Secretary of State will continue to be accountable for your health services. This is your NHS; funded by your taxes and you have a right to know there is someone at the very top, answerable to you. With a public duty to ensure a comprehensive health service, accessible to all".
Goodbye, Andrew. Close the door on the way out.
"Finally, we’re making sure that our reforms protect your rights, as set out in the NHS constitution. Like the right to treatment within a specified waiting time."
We have realised that the NHS Constitution has no binding force in law.
"The right to drugs and treatments recommended by NICE for use in the NHS, if your doctor says they are appropriate for you".
Patient groups and pharma companies who want high-cost or low-effectiveness drugs will have to harass hundreds of local clinicians, rather than PCTs or NICE.
"Family doctors should be more involved in the way the NHS works. But they should only take on that responsibility when they are ready and willing, working with other medical professionals too. We aren’t going to just sweep away tiers of NHS management overnight. NHS managers will carry on doing the commissioning in areas where GPs aren’t yet ready".
We aren't going to just sweep away the tiers of NHS managers we've already sacked.
Healey's steps and mis-steps
John Healey has taken his time to get to know his brief, and has also taken a lot of criticism for not having scored more direct hits on Lansley. It's interesting to speculate whether this has been an attacking competence thing or a tactical thing. I've gone from being of the former view to the latter one.
Healey is not one of nature's j'accuse! shouters: a genre that works quite well for attack. Health Secretary Andrew Lansley has been on the ropes often, and Healey didn't deliver the killer punch. I now think that he's pulled them on purpose.
Lansley has been a massive strategic asset to Labour on health: the real game has been to associate That Nice Mr Cameron personally with then reforms. PM Cameron has now had to 'front' them three times, and so his judgment is implicated. As Healey's speech observed, Lansley told the Sunday Times two weeks ago, “David and I go back 20 years and every step of the way we’ve worked together on this”.
Healey's approach is more analytical, and it showed in his RSM speech: well-delivered, in a measured, quiet tone. Its content still doesn't address how Labour's going to define its red lines on the difference between 'good competition vs. bad competition' going forwards, and it's now time for Healey to start doing this.
Labour can critique the Bill and now the pause effectively, which is fine. That is one of the key tasks of opposition. This section of the speech "This “pause” is unprecedented. The health bill is almost through the House of Commons but the Prime Minister has told his health secretary to stop what he’s doing while he asks anyone and everyone else what he should be doing instead. In the 9 weeks’ “pause” the Government is doing what it should have been doing for the 9 months before – looking at the evidence of what works, listening hard to those who know the NHS and learning from the views they get. This is not rocket science. It’s simply good government and it’s good politics. Both have been totally absent in the health department since last May" is effective stuff.
Likewise, his lines that "The Bill will require Monitor to enforce the Competition Act. This Act technically covers the NHS and has done since 1988, but the Office for Fair Trading have never used it in the NHS because it has always been a publicly managed system. That will change because of the Health Bill. It means the ability to plan properly, commission confidently and co-ordinate services effectively will always be under the cloud of a legal challenge.". It's all competent opposition.
What is needed now is the first signs of an alternative approach to dealing with NHS reform. New Labour had plenty of money and ideas: there is a need to acknowledge that the former gained too little, and that the latter were often over-hasty, under-evaluated - and in the case of various private sector deals, bad value for money. Management consultancy cost a fortune and delivered no measurable benefit.
All this was not Healey's fault, but it was his party's: it needs to be acknowledged.
Taking questions, Healey expressed awareness that Labour's own NHS reorganisations of the past decade "took longer, cost more and achieved less than planned". So he's perfectly up to being candid.
He pushes his luck in stating that the Bill is "making Foundation Trusts commercial bodies ... (and) allows hospitals to close services without public consultation". The 2003 Health And Social Care Act did the former, and the latter is not really the case, as the Bill does not remove Section 242 of the 2003 Act.
Labour's tabled amendments to the Bill insist on the return of the language that the SOS must "provide or ensure the provision of" the NHS; a key point also in Clegg's speech. It correctly picks up on the Bill's "gaping hole" in training planning and provision post-SHAs. And it weighs in behind the health select committee report proposals for greater accountability and governance for consortia.
This document has some key misses, too. It doesn;t acknowledge that NICE guidance or advice was flaunted with near-impunity by poverty-pleading PCTs. The text on GP bonuses and conflict of interest which reads, "Giving doctors a financial incentive will raise the worry that they might make cheaper commissioning and referral decisions, instead of the best medical decisions for their patients" could be more clearly drafted: good care could well be both cheaper and better; and it is disingenuous when it talks about "current bonuses to individual GPs for providing high-quality care" - recent . Ahem -do walk-ins or ISTCs stir any memories?
There is further effrontery with the comment that the all trusts becoming FTs process "is being pushed through too fast". Crikey. In 2003, the deadline was 2008. Doubling the timeline is 'too fast'?