Lord Phil Hunt of Kings Heath is a Shadow Health Minister and Labour’s Deputy Leader in the Lords
As the detested Health and Social Care Act comes in to force, it is becoming clearer by the minute how little thought Ministers have given to its implementation. And experienced people within the NHS, who fully understand the folly of handing out £80bn to untried and untested GPs, are now speculating that the whole thing will have to be torn up by its roots again.
The NHS is already reeling from the impact of fierce efficiency targets of £20bn over a 4 year period. If this is not to impact adversely on safety and health outcomes, radical service changes need to happen so there is much more integration across primary and secondary care. But with Clinical Commissioning Groups (CCGs) likely to take many months – even years – before they are fully established, there is a real risk of paralysis at a time when some big decisions need to be taken.
Part of the problem is that Ministers have still to put a mass of secondary legislation through Parliament. Much of the detail on the operation of CCGs, including their establishment and the all important governance issue, need to be agreed.
The biggest issue will be dealing with potential conflicts of interest. CCGs will have huge budgets and many will want to use them to continue Labour’s policy of boosting local community health services. Many GPs however, have financial interests in the companies which often provide these services. And since the Government so foolishly set up boards of CCGs with a majority of GPs on them, avoiding conflicts of interest will prove to be extremely challenging.
Then there’s the drive for all NHS Trusts to achieve foundation status by 2014. There are over 100 of these organisations, and the National Audit Office has warned that many are not financially or clinically viable.
Even though 50% of foundation status applications are rejected by the regulator Monitor, the Government has insisted on speeding up the programme. There is a real risk here of lowering the barrier for authorisation, forcing unwanted mergers or involving the private sector in management takeovers.
Another major risk is the Tories’ determination to press on with a full blooded market in the NHS, giving the lie to the plaintive pleas from LibDem peers to have tempered the competition ethos of the Health Act. Commissioners are already feeling the heat to let services out to tender under the any willing provider policy. The Department of Health meanwhile, has warned that new procurement rules could make CCGs who choose not to put services out to tender face legal challenges from private companies.
Indeed, this chaotic picture could worsen further if the second report from the Mid-Staffordshire enquiry proposes substantial changes to the new NHS architecture. David Nicholson, the Chief Executive of the NHS, has already warned that the Francis enquiry – now expected in October – could well clash with current government policy.
It is little wonder that the smart money in the NHS is on a further restructuring within the near future.
The Coalition government inherited the NHS in the best condition it had ever been. Two years on, the changes it has pushed through have been incredibly ill-judged and lacking support among NHS staff and patients alike. At a time of unprecedented financial pressure, this is all leading to greater uncertainty, confusion and cost. Yes the controversial Bill has passed through Parliament, but even now Ministers should step back and halt the programme.