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

Saturday, 9 April 2011

Four Simple Changes

In a letter to the Indy Prof Martin McKee, from London School of of Hygiene and Tropical Medicine lists four changes that must be made to the Health and Social Care Bill:
  1. Restore the duty of the Health Secretary to secure or provide a comprehensive service and be the only person, subject to Parliament, who can impose extra charges for NHS treatment.
  2. Commissioning bodies must be public authorities responsible for a geographically defined population, ideally coterminous with local authorities. 
  3. Commissioning bodies must have a statutory responsibility to ensure that their decisions do not threaten the viability of existing NHS services, unless there has been an explicit decision to close them.
  4. Foundation Trusts must not act in any way that leads them to be considered "undertakings" under competition law.
Remember them, and when Conservatives tell you that the Bill simply needs clarifications, challenge them on these four points.


The first clause of the Bill replaces the phrase "The Secretary of State must for that purpose provide or secure the provision of services" in all previous NHS Acts of Parliament with "The Secretary of State must act with a view to securing the provision of services". This is recognised as abolishing the duty of the Secretary of State to provide a comprehensive health service. (Bad Medicine shows how this amendment is made.) The Bill (clause 22) allows GP consortia to charge for some services, and clause 150 allows Foundation Trusts to charge for accommodation.

Lansley's policy is sloppy, he has no idea about how big consortia should be or what populations they should cover. (A consortium could, for example, cover a city, including the wealthy suburbs, but exclude the practices in the inner city deprived areas.)

The Any Qualified Provider policy is designed to bring in the private sector at the expense of existing NHS services, Lansley expects this to create a market and he expects market forces to provide the services we need. But we all know that market forces work on profit, not need, and such a healthcare market will result in those with the need for healthcare taking a poor second place to profits.

In the future all hospital trusts will be Foundation Trusts, and if they "engage in economic activity", that is, they offer of goods or services on an economic market, with the potential to make a profit, then they are treated as "undertakings" and are subject to EU competition law. Lansley tries to reassure us that hospitals will not be subject to competition law, but others (Health Policy Insight have an excellent overview here) disagree.

Liz Kendal MP (@LeicesterLiz) points out that the simplest way to achieve these changes is to delete section 3 ("Economic Regulation of Health and Adult Social Care Services") of the Health and Social Care Bill. This section sets out the responsibilities of Monitor, explains how providers (NHS and Any Qualified Providers) are licensed so that they can bid for NHS work, defines how prices are determined and introduces competition law into the NHS.

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