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Guest editorial Tuesday 31 May 2011: Drawing Conservative red lines on NHS reform - Nick De Bois MP

This guest editorial by Nick De Bois, Conservative MP for Enfield North, outlines his views on what should be the non-negotiable aspects for his party of the proposed reforms to the Health And Social Care Bill.


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Mr De Bois was a member of the Health Bill Committee, and last week canvassed his fellow Conservative backbenchers by email over the reforms being demanded by Liberal Democrat media leaks. He suggests the Conservatives' key red lines, and their rationale, below.

Belief in the NHS is something that cuts across people of all political persuasions and none. Since its first establishment, the NHS has assumed centre ground in the mainstream of British politics – a service of which we are all justifiably proud; which embodies core national values; and which we all wish to succeed.

Usefully allied to that mainstream consensus is now a broad acceptance that the NHS needs serious reform if it is to survive and to meet the expectations patients rightly have of it.

Indeed, at the last election all three major parties made manifesto commitments to reform – each of them slightly different; but each of them recognising the scale and significance of the task ahead.

It seemed that there was an acceptance that we could not continue treating the NHS as a ‘sacred cow’, immune to all modernisation and innovation as successive Governments tried, and failed, to bring it into the 21st century.

The Bill's core fundamentals are sound
It was on the back of this unified belief in reform that the Coalition Government introduced the Health and Social Care Bill currently going through parliament. Over a seven-week period I have been delighted to serve on the Bill committee, scrutinising its detail. And what is clear to me from this experience, and from the comprehensive submissions of assorted experts, is that the core fundamentals of the Bill are sound.

That is why I stressed the so called "red lines" on which my colleagues should not budge, that have been well-trailed in the press. Of course, that does not mean I cannot see the value of some improvements to the detail of the Bill - compromises that will serve to strengthen and not weaken the principles which run through it.

Some compromises
In the spirit of cross-party working to deliver reform we can all believe in, I accept that there may be some compromises, particularly around greater oversight of, and transparency from, GP commissioners.

I recognise entirely that people become concerned when they see commercial terms and a commercial frame of mind being used in relation to public services. It is right, therefore, that we seek constantly to reassure patients, health professionals, and wider society that an organisation such as the NHS can be more professional in outlook while still being public-spirited and public funded.

Political interference, administrative costs
I would argue firmly that this must be distinct from political and administrative interference that creates large administrative costs, but there are cheap and simple options that would ease concerns in this area.

In the meantime, the 2013 deadline for putting in place GP commissioning will ensure this division of responsibility and establish savings of £5 billion during this parliament for spending on front-line services.

The third sector and the Big Society
We should also welcome considerable  involvement from the charitable organisations and networks that exist already and are keen to offer us the benefit of their knowledge and insight. In pursuit of engaging all who have something useful to offer, it would be sensible to examine how to  enshrine a role for the charitable sector.

Indeed, this should be even more the case given the Government’s 'Big Society' agenda and our belief that the charitable and voluntary sector should be embedded  - where appropriate and desired- in the delivery of the public services on which we all rely.

National service; local authority
I would also welcome greater local authority involvement in health and well-being boards. The Bill provides for a de minimus of one councillor on the board, but in reality more councillors could be invited to be members

I recognise that since health was removed from the remit of local authorities decades ago, something of a democratic deficit has existed in the NHS. That deficit has been present under Governments of every persuasion, and has made the NHS less responsive and less insightful as a result.

I also recognise that Labour tried to address this by giving local authorities a health scrutiny and overview role - and some took up that role with ability and enthusiasm. The Bill does extend further the rights of these committees to examine and hold to account all providers, not just NHS providers - an aspect of the Bill which is not well understood.

A farewell to micro-management
We can use this present period in the life of the Bill to see if we can usefully go further now, in a way that stays true to the principles of the Bill, but meets the legitimate concerns. But this is not an invitation for politicians to micro-manage our health service; a practice which should rightfully end with this Bill.

Finally, nothing in the Bill undermines the principle of a universal, taxpayer-funded NHS. Like virtually all MPs – of every political persuasion - that is the model in which I believe, and it would be very difficult to find substantive arguments against a clause in the Bill that enshrined this. I would support such a measure if it were forthcoming so that future governments could not undermine this principal.

So we should indeed examine and review - and adapt where compromises are consistent and useful with the core principles of reform. But my sincere belief is that the rhetoric of ‘no change’ is unsustainable.

'Of all of my red lines, I do believe that competition on quality is the most important'

If we are to make the NHS fit for 21st century purpose, then it needs reform that embeds quality, choice and accountability. The red lines I called for ensure we have an NHS that, through integrated reform, delivers improved patient outcomes; widens genuine choice for patients and GPs; and creates the opportunity for competition on quality to drive up standards.

Competition on quality: the key red line
Of all of my red lines, I do believe that competition on quality is the most important. We cannot return to the disastrous policy of the NHS as a preferred provider, whereby private and not-for-profit providers had the technology, capability and drive to deliver services at NHS costs to NHS patients desperately in need, but had the doors shut in their faces for no good reason.

'The rest of the developed world has accepted that competition in public services increase efficiency, innovation and patient outcomes: they are simply debating how to regulate the market.'

The rest of the developed world has accepted that competition in public services increase efficiency, innovation and patient outcomes: they are simply debating how to regulate the market. The independent regulator Monitor will serve to ensure that competition benefits the patient, rather than the provider; and that is why I am resolute that it should remain.

If we are able to unite around those two core values – competition on quality and choice, set within the irreversible model of a taxpayer-funded NHS, free to all at the point of delivery- then we can achieve something of true and lasting value.

Nick De Bois is Conservative MP for Enfield North