It’s no shock that the brand new well being secretary has balked at a huge new reorganisation invoice earlier than he had even received his ft beneath the NHS working desk. 5 million folks ready for remedy, a workforce disaster and one other Covid-19 tide already cancelling remedies is hassle sufficient. Sajid Javid’s anxiousness is shared by many, Theresa May a kind of warning of the invoice’s perils. However No 10 blasted forward with the invoice this week, impervious to this political dynamite.
No matter their deserves or follies, all new re-disorganisations are dangerous for Tory governments, who’re by no means trusted with the NHS. How simple it’s for Labour, backed by influential NHS figures, to arouse public suspicion of Tory intentions. Even Margaret Thatcher needed to again off from her radical privatising impulse, to swear between gritted tooth that the NHS was “secure in my palms”. Voters may ignore the fiendishly advanced historical past of NHS restructuring, however they may grasp one easy, sinister level: the federal government is seizing management of the on a regular basis working of the NHS, in what the Well being Service Journal calls “an audacious energy seize”. Any native determination can fall beneath populist political whim from the highest.
Tory MPs ought to recall how Andrew Lansley’s disastrous 2012 Well being and Social Care Act nearly shipwrecked the David Cameron-led coalition, so loud had been the voices of consultants rightly warning towards it. The then NHS CEO, David Nicholson, himself referred to as that upheaval so colossal “it may be seen from area” because it broke the NHS into fragments, placing each service out to tender to anybody, public or personal, enforced by competitors regulation. Each a part of the NHS needed to bid and compete towards others for any service: co-operation was illegally anti-competitive. This expensive bureaucratic nightmare failed on each entrance whereas its privatising intent let Virgin Care and others eat into worthwhile group companies.
Simon Stevens has spent his eight years answerable for NHS England struggling to reintegrate the fragments. This invoice, the sum of his efforts, revokes the cursed Part 75 that forces tendering out NHS companies. As an alternative, it units into regulation England’s 42 built-in caresystems (ICS) designed to unite hospital, group, GP and psychological companies with native authority care and public well being, to cooperate beneath one board with one price range for its native inhabitants.
However No 10 has added a nuclear ingredient: NHS England or any ICS can have its decision-making seized from it by the secretary of state or the prime minister on any pretext, and they’ll management appointments to these 42 boards. Anticipate politically obedient cronies.
This shifts the localising, accountable flavour of this invoice. The place Stevens has reigned supreme, cleverly manoeuvring towards the Treasury over funding, his successor may have no such artistic independence, and shall be subservient to political masters. The phrase is that Dido Harding, she of the £37bn test-and-trace failure, is out of the working, now that her driving pal, Matt Hancock, has gone. The front-runner must be the well-respected Amanda Pritchard, successfully NHS England’s deputy CEO. From exterior the NHS, Leeds metropolis council chief government Tom Riordan is an fascinating candidate, however can the job be achieved with out deep NHS data?
That’s one thing a contentious third contender has: Mark Britnell spent 20 years within the NHS, reaching a director-generalship. However since 2009 he has been KPMG’s senior companion for world healthcare, from the place he sat on the board advising Cameron on these disastrous 2012 reforms. He surfaced in public in 2011 when caught out telling a convention of personal US healthcare executives that: “In future, the NHS shall be a state insurance coverage supplier not a state deliverer,” praising the competitors factor within the Lansley reforms that meant: “The NHS shall be proven no mercy and one of the best time to reap the benefits of this shall be within the subsequent couple of years.”
He claimed these quotes “didn’t correctly mirror the dialogue” however has by no means denied the deadly phrases. Non-public consultants have been on a continuing revolving door with the NHS: administration guide use trebled between 2016 and 2019, regardless of pledges to cut back the observe. To decide on him would sign a defiant tradition battle confrontation, suggesting Sajid Javid actually does lean towards the views of his favorite author, Ayn Rand, from whose e-book The Fountainhead he reads the courtroom scene twice a yr: the NHS is unquestionably Rand’s good image of oppressive socialist statism.
The extremely politicised selectors shortlisting candidates for the brand new head of the NHS are from No 10, the Treasury and the Cupboard Workplace. Bizarrely, candidates get a full day’s psychometric testing. Whereas consultants say fundamental competences want testing – some high-fliers transform innumerate – a full day means character testing, which in such a senior job is as a lot use as phrenology, and much much less use than the Harry Potter sorting hat. Beneath this degree of political management, right here’s hoping the winner has the crafty to appease their political masters in interviews, however as soon as in publish will spring out as a Tiggerishly unbiased NHS defender.
This invoice is a present to Labour: Javid’s leaked letter asking for delay warned of “important areas of competition” to be resolved. You guess. How can the invoice legislate for becoming a member of up with cash-starved native authorities, with no social care plan? The invoice provides ICSs 70 stern efficiency measures to fulfill, however the earlier 18-week ready restrict has vanished, solely measuring 52-week waits. Numbers of sufferers needlessly blocking NHS beds shall be counted towards every ICS, however what can they do when there’s too little social care to launch sufferers? “Selection” shall be enforced from on excessive, however with 5 million ready, the place are the spare beds to permit it?
Labour in energy successfully abolished ready past 18 weeks, typically by utilizing the identical “terror and targets” strategies – however right here’s the essential distinction: that was in return for an NHS price range rising by 7% a yr. Within the final decade, the NHS price range per capita fell in a quickly ageing inhabitants. Don’t count on fiscally robust Javid to demand sufficient from the Treasury to make these new ICSs flourish. He’s proper to concern this invoice is “contentious”: it’s full of ammunition for Labour.