"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Wednesday, 12 October 2011

Silver lining?

I am a pessimist (some would say a curmudgeon) so the votes in the House of Lords does not surprise me, especially since many of the Tory peers who voted probably had not been in the chamber for years and were voting out of mere loyalty to a political party.

The Bill:
  1. will not save money, quite the opposite, it will cost billions to implement and the bureaucratic structures that have been created will slow down any re-configuration that is needed and will cost a pile of money in the process;
  2. will produce a postcode lottery on a scale that England has never before experienced and as a consequence, health inequalities will increase;
  3. will mean that rationing will be rife and people will find that they have no recourse;
  4. together with the financial squeeze and the wasteful bureaucracy created by the Bill will result in a financial crisis
The time to get ill in England was a decade ago, from now on, you'll find yourself more and more on your own.

One could argue that if Labour had won the election last year the NHS would have faced tightening finances too. Labour promised the same flat funding and also promised the £20bn "efficiency savings". However, Labour did not promise a £2bn re-organisation, but whether this extra £2bn of funding would have been enough to avert the financial crisis the NHS will suffer is something we will never know. The forthcoming financial crisis and the rationing inherent in the Bill will mean that the NHS will be the main issue at the next election.

The government know that there will be a financial crisis in the NHS, and they know that if it is not averted we will see patients on trolleys in corridors. Currently, Lansley is backtracking on NHS finances. At the Health Select Committee yesterday he said that the "efficiency savings" were "up to £20bn" rather than strictly £20bn. This will allow him to relax the "Nicholson Challenge" diktat when it becomes apparent that either the NHS cannot achieve a 4% cut every year, or that cutting so deep will push the service into crisis. Further, Lansley is also suggesting that some hospital trusts may be bailed out, something that the white paper last year said the government would not do.This is being done to make sure that there are not too many trust bankruptcies before the next election. Further - to try and persuade Lib Dem and Crossbench peers to vote against the Owen amendment - the government has conceded that the Secretary of State will have responsibility for the NHS (although we have yet to see the actual details, in particular, whether clause 10 will be removed).

So is there a silver lining? On a purely political basis, there is. From this point on the government cannot say that the state of the NHS is the fault of the last government: by passing this Bill they are making the NHS work their way. If this bill is killed then the Conservatives can say that the NHS that Labour bequeathed was wasteful and inefficient and say that this is why it is suffering a financial crisis.

When the Health and Social Care Bill is passed, the NHS will be Lansley's NHS and any ensuing financial crisis will be entirely the government's fault. At the next election Labour will be able to say to the electorate: look at what the Tories have done to our NHS. And hopefully, Labour will promise to fix the postcode lottery and raise funding to curtail healthcare rationing. We will all benefit.


  1. One thing to consider is that health is a devolved matter. It will be extremely important to monitor how things develop in England and then contrast them with Scotland and Wales, who are not going down this disastrous route. Indeed the health unions are predicting the recruitment problems we currently have in Wales are going to be solved over the years as health professionals are going to move here.


  2. @Planeshift

    Yes that is important. We do need a mechanism to show what we have lost. Comparisons with the devolved services will be important, especially if (as I fear) Lansley's changes will lead to co-pay and top-ups, we will be able to compare with systems that have abolished co-pay (prescription charges).

    However, the following article suggests that Wales (not Scotland) is vulnerable to these changes:


    Wales is vulnerable because:

    - arms length bodies are UK-wide and not devolved, so changes here will affect all the nations
    - training is devolved, but due to their relative sizes any changes in England will affect Wales
    - the border is "porous" for healthcare so if a hospital closes on the English side of the border it will affect people on the Welsh side

    It is also important to point out that GP's contracts are negotiated at a national (UK) level rather than devolved. It is rumoured that Lansley will change the contract to introduce a duty to commission and while this may be seen as irrelevant in Wales, Scotland and NI, the duty will be there and eventually it will be introduced.

  3. That is certainly the case for wales, and I'd be particularly worried if I lived on the border. Worth noting that more residents of england are registered with welsh GPs than vice versa though, and I'm wondering what the reasons for that is, and what impact that will have.

    Its probably worth pointing out that the process of devolution of health in Wales has been very slow and piecemeal over the past decade, reflecting wider flaws with the initial devolution arrangements. But the major change in policy direction in wales happend in 2007 when the plaid/labour coalition happened and put an end to the creeping privatisation and centralisation of services (which in wales means services going cross border - a bit crap if you live in Aberystwyth and have to go to shrewsbury for a specialist service). The welsh labour party got stick from the brown government for agreeing to this, but it was popular amongst the grass roots and remains labour party policy here. It remains to be seen whether the budget pressures will force welsh policy to move back the other way.

    OTOH I'm not sure the welsh GP contracts will include comissioning. My understanding is this won't be the case, as GP contracts will become a devolved function by default, with Welsh LHBs retaining the comissioning roles.