A good day to bury bad news? On Lansley’s NHS reforms

Puffles’ Twitterfeed went into overdrive this afternoon as I made my way back from  Christmas in Bristol. The outrage was over the plans to increase the limit of income NHS Trusts can generate from private work from 2% to 49%. I have two issues with this. The first was the timing and manner of the announcement, and the second is with the content. Both of these issue for me go to the heart of why politicians and mainstream politics are so distrusted by the people at large – a situation all political parties bear responsibility for.

Timing & manner

Just before Christmas – a time of year when people are pre-occupied with many other things (or are so inebriated that they are in no fit state to respond properly on the back of hangovers from Christmas parties). Towards the end of parliamentary sessions – in the run up to recess sessions there is a rush within departments to get announcements out before politicians go off back to their constituencies. Accordingly, five secretaries of state tabled written statements on the last but one day before Christmas recess followed by written statements by six secretaries of state on the day Parliament broke for recess.

This does not allow for proper publicity of the issues raised nor does it allow for proper debate. Everything gets buried in the avalanche of ‘news’ – yet by the time Parliament is back, it’s all ‘old’. Whatever drives the news agenda moves onto something else.

In terms of accessing the original source of the news item, I’m struggling to find it. The Telegraph hasn’t (at the time of blogging) picked up on it, while the BBC, The Guardian and the Independent have all managed to find quotations from the Secretary of State (Andrew Lansley) that I’m struggling to find on the Department for Health’s website.

All three news outlets make references to an amendment tabled by the Government’s Health Minister in the Lords – but I can’t find the text of that amendment in the papers associated with the reported amendment.

This is the opposite of transparency. This stinks of ministers and policy advisers wanting to avoid detailed scrutiny of their plans. An announcement like this which could have significant impacts on the functioning of hospitals and healthcare facilities across the country irrespective of its merit should be made in person by the minister responsible for the decision in the form of an oral statement to Parliament. It should not be buried under an avalanche of other announcements in the run up to a period where parliamentary politics switches off for the fortnight.

Merits or otherwise of the policy

I’ve not been following the detailed policy debates, but the failure to meet even some of the most basic principles of sound public administration is quite frankly horrifying:

This whole debacle of a Health and Social Care Bill runs the risk of becoming a model of the failure of parliamentary politics and public administration in the same way that the Poll Tax was for Thatcher.

As for the proposal to allow NHS trusts to increase the amount of income it can generate from 2% to 49%, where are the impact assessments? Where is the evidence base? Which are the facilities that will be used for private sector patients? What will this mean for patient care for NHS patients? How will managers divide healthcare professionals’ time between private and NHS patients? Will we see a ‘financial apartheid’ within our own hospitals with the spruced-up private wards getting the investment at the cost of the NHS wards? What will people’s reaction to this be?

During the early-mid 1990s I used to do a paper round where I delivered the local paper to what was the private Evelyn Hospital in Cambridge – now the private Nuffield Hospital. I saw in layman’s terms the differences between what it was like in a private hospital vs what it was like in an NHS hospital on those occasions where I found myself up at Addenbrookes. What will the impact be on patient care as some NHS trusts inevitably try to upgrade their facilities for this private market? Will they have to borrow money? Who from? What if the income from private patients ends up not being enough to repay the loans plus the interest? Will public funds be diverted for this? What will be cut as a result?

These are just a few ‘off of the top of my head’ questions from someone who isn’t particularly knowledgeable about these things – which is why I follow on social media people who work in healthcare day in day out.

What of Labour’s response?

The challenge for Labour isn’t just about picking apart the policies of the Coalition – they’ll never win the parliamentary votes due to the current nature of the Coalition. But what is their alternative – both in terms of its vision for the NHS and its detailed policy solutions to the problems that any organisation the size of the NHS will inevitably have?

I’d like to think Andy Burnham is one of the more talented of Labour’s senior politicians. No time like the present to prove it. 2012 will demonstrate whether or not he can meet that challenge. Will he succeed or will he be found wanting?

Will the NHS look something like this?


8 thoughts on “A good day to bury bad news? On Lansley’s NHS reforms

  1. Why would they want to? They are claiming to be preserving the essential principle of the NHS – that its free when you need it. They are not planning to force people to pay. They are trying to foster competition – deeply misguided, but a very different prospect from what is described above.

  2. We will see hospitals in the affluent SE aspiring to 49% which will mean that as well as a intrahospital apartheid that NHS patients in the north and those in the south will receive fundamentally different quality of care. The profit from private patients will generate this inequality if it is reinvested in staff etc. No surprise that the south votes Tory and the north not. The biggest concern about this legislation should be the likes of BUPA and the Nuffield. Perhaps they are still eating their turkey, or perhaps they are being bribed into silence by the prospect of being able to takeover “failing” NHS hospitals.

  3. I am not suggesting we should trust them, but the 49% issue is not key. Before it was proposed it would have been possible for an NHS trust to generate 99% of its income from private work. The key issue is about competition, and about the currency – what exactly providers get paid for.

  4. I think the OP presents some valid questions. Indeed, talking to local managers and clinicians I get the impression that private patients are bloody expensive. The (now retired) Director of Medicine of my local trust sarcastically remarked: “if we want to take on private patients we had better buy up the nearby Nuffield hospital”. In fact, if our trust did that it would be good for that Nuffield hospital since it has a poor reputation with local clinicians whereas our trust has a good reputation. (Remember: private is not necessarily better than the NHS.)

    I don’t see 49% as an improvement over 100% for the reasons that Martin gives: it has exactly the same result. Indeed, I think it is *worse* because we will get the same effect while the government can claim that they “did something in response to concerns over private patients” when they haven’t.

    I may be pessimistic but I think the result of the government’s policies will be more people self-paying, I think that is the point of the reforms, but they just won’t admit it. For example, CCGs will have a responsibility to come under budget and will get bonuses if they do. That will be a huge incentive to restrict what their GPs can refer. (Notice I separated CCG and GPs? The GPs will not be in control, the CCG will be, they are two different organisations.) The Bill does not give a guarantee about what treatment the NHS will fund: I am talking about routine treatments like cataracts, hips and knees. Clause 12 of the Bill says that CCGs will decide what the NHS will pay for. I suspect that at some point in the next few years we will see a CCG deciding that NHS patients will have to pay “hotel charges” for stays in NHS hospitals. The SoS will not be involved: it will no longer be his responsibility. Why can’t the government simply say that CCGs have to fund NICE recommended treatments and then tighten up NICE? NICE is evidence based. CCGs won’t have to justify their decisions.

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