Health Lexcomm: The Listening Is Over. It’s Back To Business.


The two month pause is over. The Future Forum has reported and the Government has set out its response. Now it is time for action.

In a joint press conference the Prime Minister, Deputy Prime Minister and Health Secretary joined forces to put the trials of recent weeks behind them and state in no uncertain terms that the Government had listened. The NHS reform agenda is officially back on following wholesale changes prompted by Professor Steve Field’s NHS Future Forum report published yesterday.
Following months of unrest from political audiences and healthcare stakeholders, the Government has made a spectacular climb down on some of the more controversial elements of its flagship Health and Social Care Bill. The concept of promoting competition is top of the hit list, with Lansley’s ideological vision ‘significantly diluted’ to instead focus minds on the founding principles of the NHS, as expressed in the NHS Constitution.

Crucially, Monitor’s primary duty to ‘promote’ competition has been removed and the Bill has been amended to require support instead for choice, collaboration and integration. Whether this will be enough to face down the Government’s critics remains to be seen. 

Since yesterday’s report presentation, Nick Clegg has been in a buoyant mood, claiming victory on 11 out of 13 areas of concern expressed by his Party at its Spring Conference. However, behind the scenes many believe that the significant concessions won by the junior partner in the Coalition have been achieved in a blunt and counterproductive way – with the Deputy Prime Minister unwilling to stick to his brief or avoid making ambitious claims in public that have put the plans in an impossible position.

The devil in the detail

Whilst Lansley was at pains today to be clear that the fundamental principles of his vision remain intact, he also tacitly accepted that the developments do constitute a significant rewrite of the Bill.  Outlining few details on what exactly these changes constitute, the Health Secretary followed Cameron and Clegg in accepting the vast majority of the recommendations made by the Future Forum and signalled the Government’s intention to make ‘improvements’ to the Bill. A subsequent policy document released by the Government illustrates the extent of these changes which capture all of the spirit, if not all of the precise detail, of the calls made by the Future Forum.

Nick Clegg was handed perhaps the most significant announcement of the day when he confirmed that to ensure Parliament is given sufficient opportunity to scrutinise the proposed changes the Bill will be “recommitted” to a Public Bill Committee, with exact details to be announced in due course.

Are the Government’s NHS woes over?

For Andrew Lansley today’s piece of political theatre was the culmination of a hard few months of climb downs and public humiliations at the hands of his political masters. However, it did not draw a line under the difficulties faced by the Coalition as difficult questions emerged over the bureaucratic nature of the new structures agreed on.

Cameron, Clegg and Lansley are right to feel a sense of satisfaction at successfully pausing, listening and engaging but their ease in accepting the changes demanded by the Future Forum leaves all three in a delicate position.

Cameron called today’s announcement a ‘show of strength’ but the Government’s stomach for a fight has been called into question. By backing down so publically, Cameron has opened up cracks in his resolve. Will he now seek to retreat on other tricky aspects of healthcare reform: the Nicholson Challenge, pledges on waiting lists and the ubiquitous fight against the postcode lottery? Or will all of these now become impossible to achieve and come back to haunt him come the 2015 General Election?

Professor Paul Corrigan said today that if the Government is to regain the initiative it must establish and own a “powerful post-pause narrative for change even more than pre-pause.” For Cameron the time to act is greater than ever. He cannot walk away from the personal responsibility for the NHS he has assumed over the last 10 weeks. And crucially, he cannot afford to leave the sales pitch up to his Health Secretary.
From now on the Government must strive to bring the public and the clinical community on side in every step of NHS reform. Failure to make the argument for how the reforms will improve value for money and patient’s experience in the NHS could yet prove fatal for the Coalition. The time has come for the infighting to cease and for the collective fight to achieve real reform to commence.

Key changes announced today

A shift to ‘clinical commissioning groups’:
A wider range of experts, patients and members of the public will be given the right to make decisions about health services. Gone are GP consortia and in their place sit clinical commissioning groups, mapped to the boundaries of Health and Wellbeing Boards. New clinical senates will be established and bodies such as cancer networks will be retained and expanded.

Stronger safeguards against a market free-for-all:
Monitor’s core duty will be to protect and promote patients’ interests. It will not promote competition but will instead focus on integration. The ‘cherry-picking’ of profitable NHS business will be avoided through the use of prices that reflect complexity in the tariff.

No fixed deadline for change:
Clinical commissioning groups will take charge of commissioning in April 2013 if they are ready, but will exist in shadow form if they are not. SHAs and PCTs will still be abolished in April 2013. There will be a more phased introduction of any qualified provider.

Greater information and choice for patients:
Commissioners will have a duty to promote patient choice. Following current pilots, the Government will make it a priority to extend personal health budgets across health and social care.

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