Speech on the NHS – opposition day debate
House of Commons
March 13th, 2012
Mr Speaker, I rise today to make a simple point to Ministers and their supporters: there is no question that it would be embarrassing to give up on the Health and Social Care Bill at this late state, but that embarrassment pales into insignificance compared to the trauma and cost – financial and political - if this Bill is the Government’s template for health service reform for the rest of this Parliament.
This Bill and its convoluted passage through Parliament has achieved a remarkable feat.
On the one hand, the Bill has taken the government hostage. It is the political equivalent of the Stockholm Syndrome – falling in love with your captor. The Prime Minister insists in one breath that he must have the Bill to save the NHS, and in the next breath claims at PMQs, that 95% of the change has already happened.
On the other hand, in the real world, the world where Ministers many moons ago said they wanted an unprecedented consensus between politicians and professionals, this is a Bill without friends. And most remarkable it is a Bill which has lost friends at every stage of its passage through Parliament. Every compromise, every “concession”, far from diminishing anxiety levels, every retrofit, has cost the Bill coherence, cost the Bill support, and raised concern about it.
The reason why confidence has been lost goes to the core of the case that the Prime Minister, and Deputy Prime Minister, and Secretary of State have made. Again and again they insist that the status quo is not an option, that reform is essential, that opponents of reform don’t understand that if the NHS stands still it will wither. The Secretary of State is at it again today.
These are enjoyable speeches to make and articles to write. I should know – I have written them and made them.
But the problem with the argument is that it is not true that the opponents of the Bill, the doctors, the nurses, the Labour Party, are arguing for the status quo. It is just not true. HMs opposite should actually read what the Leader of the Opposition, the Shadow Health Secretary have actually said about reform.
Everyone knows that there is more reform already underway in the English health service than in any other health service in the world. That is one reason why in the last decade it has been the fastest improving.
The choice is between good reform and bad reform. And this Bill is bad reform; it gives reform a bad name; in fact it threatens to set back the case for reform for a generation. Let me explain why.
In June last year, just before the report of the Future Forum, the Prime Minister said it was right to take time because “this is too important to get wrong”.
But in key areas, as amendment has been piled upon amendment, this Bill has gone from being wrong to being the most half-baked, quarter thought out shambles the NHS has ever seen. I want to highlight three issues:
First, and most important, managing major service change. Most important because everyone agrees that the health service has to change to deal with the challenges of demography, drug costs, medical technology, and this mean changes in the way services are organised.
The biggest changes we need are the shift to community based, personally managed and preventative care, with health and social care for individuals managed in an integrated way.
Yet in its hatred of planning, and confusion about competition, this Bill makes change not more likely but less.
Yet the levers for change have been neutered. CCGs are too small and weak as replacements for PCTs; the Commissioning Board is too remote and gargantuan; and as the Palmer Study of reorganisation in South East London shows, market forces on their own will not reconfigure services in a coherent way.
So far from driving the system towards a clear vision of the future, we are left with the prospect of frenetic gridlock as hard pressed NHS professionals seek to do best for their patients.
Second, promoting efficiency. The Health Select Committee Report could not be more stark: “The reorganisation process continues to complicate the push for efficiency gains.”
They are of course right. The story today that senior GPs are spending four days a week coping with new structures not serving patients is I predict the first of many.
And the price will be paid by the Chancellor, who will have to bale out the NHS, but above all by patients, as the 18 week commitment fades into memory and services suffer.
Third, accountability. If there was a germ of an idea at the outset of the Bill, when the Secretary of State conceived it, it was to align clinical and financial responsibility. In May last year at the King’s Fund he said there was a straightforward answer to the question of how you get the best health service in the world: “You put the right people in charge”.
But a year on it is completely inexplicable who is in charge. Not GPs, because they are overseen by the greatest behemoth of them all – a National Commissioning Board. Not hospital trusts because they are answerable to Monitor and the competition authorities. Not the sectoral replacements for SHAs, because they are only temporary. Not the managers because they are being sacked – and then reapplying for jobs with new titles. Not the Clinical Senates, because their purpose has not yet been defined. And certainly not the patients.
In truth the new system is utterly byzantine. In fact it doesn’t deserve the word system. The issue is not just that few people in the NHS support the plans; it is that even fewer understand them.
And here is the real danger for the NHS. A perfect storm of rising expectations, limited resources, and multiple, over-lapping, incoherent structures of decision making.
The Prime Minister and Secretary of State promised clarity but have delivered complexity. They promised devolution to GPs but have ended up with power in the National Commissioning Board. They promised efficiency but have delivered bureaucracy.
The result will be that at the end of this Parliament we will once again be back into a debate that I thought we had buried - whether tax based health care free at the point of need is the right basis for health provision. That is the last debate we should be having, but it will be product of this Bill.
I believe the Secretary of State when he says he supports the NHS. But by the end of this Parliament, when the structural flaws are clear, he is not going to be around to defend it.
That is the true danger of this misconceived and unloved Bill, and that is why in his last act of kindness to the NHS the Secretary of State should kill it.
House of Commons
March 13th, 2012
Mr Speaker, I rise today to make a simple point to Ministers and their supporters: there is no question that it would be embarrassing to give up on the Health and Social Care Bill at this late state, but that embarrassment pales into insignificance compared to the trauma and cost – financial and political - if this Bill is the Government’s template for health service reform for the rest of this Parliament.
This Bill and its convoluted passage through Parliament has achieved a remarkable feat.
On the one hand, the Bill has taken the government hostage. It is the political equivalent of the Stockholm Syndrome – falling in love with your captor. The Prime Minister insists in one breath that he must have the Bill to save the NHS, and in the next breath claims at PMQs, that 95% of the change has already happened.
On the other hand, in the real world, the world where Ministers many moons ago said they wanted an unprecedented consensus between politicians and professionals, this is a Bill without friends. And most remarkable it is a Bill which has lost friends at every stage of its passage through Parliament. Every compromise, every “concession”, far from diminishing anxiety levels, every retrofit, has cost the Bill coherence, cost the Bill support, and raised concern about it.
The reason why confidence has been lost goes to the core of the case that the Prime Minister, and Deputy Prime Minister, and Secretary of State have made. Again and again they insist that the status quo is not an option, that reform is essential, that opponents of reform don’t understand that if the NHS stands still it will wither. The Secretary of State is at it again today.
These are enjoyable speeches to make and articles to write. I should know – I have written them and made them.
But the problem with the argument is that it is not true that the opponents of the Bill, the doctors, the nurses, the Labour Party, are arguing for the status quo. It is just not true. HMs opposite should actually read what the Leader of the Opposition, the Shadow Health Secretary have actually said about reform.
Everyone knows that there is more reform already underway in the English health service than in any other health service in the world. That is one reason why in the last decade it has been the fastest improving.
The choice is between good reform and bad reform. And this Bill is bad reform; it gives reform a bad name; in fact it threatens to set back the case for reform for a generation. Let me explain why.
In June last year, just before the report of the Future Forum, the Prime Minister said it was right to take time because “this is too important to get wrong”.
But in key areas, as amendment has been piled upon amendment, this Bill has gone from being wrong to being the most half-baked, quarter thought out shambles the NHS has ever seen. I want to highlight three issues:
First, and most important, managing major service change. Most important because everyone agrees that the health service has to change to deal with the challenges of demography, drug costs, medical technology, and this mean changes in the way services are organised.
The biggest changes we need are the shift to community based, personally managed and preventative care, with health and social care for individuals managed in an integrated way.
Yet in its hatred of planning, and confusion about competition, this Bill makes change not more likely but less.
Yet the levers for change have been neutered. CCGs are too small and weak as replacements for PCTs; the Commissioning Board is too remote and gargantuan; and as the Palmer Study of reorganisation in South East London shows, market forces on their own will not reconfigure services in a coherent way.
So far from driving the system towards a clear vision of the future, we are left with the prospect of frenetic gridlock as hard pressed NHS professionals seek to do best for their patients.
Second, promoting efficiency. The Health Select Committee Report could not be more stark: “The reorganisation process continues to complicate the push for efficiency gains.”
They are of course right. The story today that senior GPs are spending four days a week coping with new structures not serving patients is I predict the first of many.
And the price will be paid by the Chancellor, who will have to bale out the NHS, but above all by patients, as the 18 week commitment fades into memory and services suffer.
Third, accountability. If there was a germ of an idea at the outset of the Bill, when the Secretary of State conceived it, it was to align clinical and financial responsibility. In May last year at the King’s Fund he said there was a straightforward answer to the question of how you get the best health service in the world: “You put the right people in charge”.
But a year on it is completely inexplicable who is in charge. Not GPs, because they are overseen by the greatest behemoth of them all – a National Commissioning Board. Not hospital trusts because they are answerable to Monitor and the competition authorities. Not the sectoral replacements for SHAs, because they are only temporary. Not the managers because they are being sacked – and then reapplying for jobs with new titles. Not the Clinical Senates, because their purpose has not yet been defined. And certainly not the patients.
In truth the new system is utterly byzantine. In fact it doesn’t deserve the word system. The issue is not just that few people in the NHS support the plans; it is that even fewer understand them.
And here is the real danger for the NHS. A perfect storm of rising expectations, limited resources, and multiple, over-lapping, incoherent structures of decision making.
The Prime Minister and Secretary of State promised clarity but have delivered complexity. They promised devolution to GPs but have ended up with power in the National Commissioning Board. They promised efficiency but have delivered bureaucracy.
The result will be that at the end of this Parliament we will once again be back into a debate that I thought we had buried - whether tax based health care free at the point of need is the right basis for health provision. That is the last debate we should be having, but it will be product of this Bill.
I believe the Secretary of State when he says he supports the NHS. But by the end of this Parliament, when the structural flaws are clear, he is not going to be around to defend it.
That is the true danger of this misconceived and unloved Bill, and that is why in his last act of kindness to the NHS the Secretary of State should kill it.
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