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

Saturday, 9 January 2010

Conservative Draft Manifesto 2010: Dissection Part 6

An analysis of the Conservative Draft Manifesto 2010.

"we will be able to cut the cost of NHS administration by a third"

Well, that is a bold claim. How will they do that?

The 2009 policy document offers no clues, and the "Draft Manifesto" merely says "Our reforms will devolve decision-making closer to patients, removing the need for expensive layers of bureaucracy to oversee the NHS." This needs more explanation from the Conservatives so we can only speculate about how they will do this.

At the moment there are essentially four layers of administration in the NHS: the Department of Health (DoH), Strategic Health Authorities (SHA), Primary Care Trusts (PCT) and hospital trusts. The Conservative plan (see below) involves creating a super-quango called the NHS Board which will take over most of the responsibilities of the Department of Health. Quangos eat money, so it is unlikely that the Conservatives will be able to make significant administration cuts there. SHAs are due to disappear anyway. The Foundation Trust model is the only model for hospitals and all hospitals at some point must become a Foundation Trust (or part of one). Foundation Trust hospitals are independent of SHAs so when all the hospitals in a region become Foundation Trusts the SHA in that region will cease to exist. At this point it is worth reiterating that Foundation Trusts are a Labour policy and the Conservatives strongly disagreed with their creation, so any savings in administration due to the removal of SHAs will be due to a Labour policy! PCTs could be reformed, but the question is how, and would it have such a significant effect (a cut of one third is a serious cut).

The final level of administration is NHS hospital trusts. Is the Conservative intention to cut administration in hospital trusts, and will they do this by cutting one in three NHS administration jobs? Administrators are vital to the NHS: they are receptionists, who ensure the efficient movement of patients through the system; they are surgeon's secretaries (managing the surgeon's time efficiently); they handle patient records to make sure that your records are in the doctor's hands at your appointment; they monitor things like cleanliness and mortality rates, identifying when there may be an issue that needs addressing. The NHS could not function without these people. What would be the outcome of Cameron cutting administrator jobs? For the patient this will mean longer waiting lists, records going missing, standards of cleanliness falling and levels of hospital infections rising and the rise going un-noticed. Ruthlessly cutting administrator jobs (one third is a serious cut) will reduce the effectiveness and efficiency of the NHS.

Perhaps the Conservatives plan to cut administration costs by outsourcing administration overseas? For example, NHS Direct is a call centre, and like other calls centres (for example telephone banking, insurance and technical help lines) it could be based in a cheaper country like India. Or indeed, hospital appointments could be made through a call centre in India rather than to your local hospital. We know that the Conservatives are in favour of outsourcing NHS patients' information to Google, perhaps not unconnected with the fact that Mrs Steve Hilton is a vice-president of Google. Patient notes are vital to treatment, and it is extremely important that they are kept confidential. The EU has far stricter confidentiality laws than the United States or other potential outsourcing countries like India or China. It is always worth paying more to maintain the confidentiality of our patient notes.

"we will create an independent NHS board to allocate resources and make access to the NHS more equal"

The NHS already targets deprived areas: PCTs in more deprived areas get more funding. It is a hollow promise from the Tories that they could make the "NHS more equal". They will, however, create the largest quango this country has ever seen. The NHS Board will be a massive, unaccountable organisation with a budget of over a hundred and twenty billion pounds. The Conservatives talk a lot about localism, yet the policy of creating the NHS Board is a policy in the opposite direction: it is making the NHS more centralised. It is important to understand why they intend to create such a quango.

The 2009 health policy document says that "the NHS Board members will be appointed by The Secretary of State for Health" in other words they will be political appointees, and inevitably politically aligned to the right-wing Conservative party lead by David Cameron. It makes you wonder if someone from Cameron's latest new friends, Nurses For Reform (who call the NHS a "dystopian, Soviet-style calamity" and want wholesale privatisation of the service) will be appointed to the NHS Board? Or maybe someone from the 2020 Health pressure group, who want the NHS to end minor treatments and reportedly close to David Cameron, will be appointed to the NHS Board.

The Conservative 2009 health policy document says that the NHS Board
"will be responsible for setting the commissioning guidelines of NHS care".  Further, the document says: "Commissioning of NHS services will be separate from healthcare providers and overseen by the independent NHS Board." This means that the ability of local primary care trusts to commission NHS services (the services that provide treatment for you) will be constrained and possibly dictated by an unaccountable quango in Whitehall. What sort of commissioning policy should we expect to see from the NHS Board? The 2009 health policy is clear about this: "we will enable any willing provider, who is able to meet NHS standards within NHS tariffs, to offer services to NHS commissioners". That means handing NHS resources over to the private sector and the eventual privatisation of a significant proportion of NHS services.

It is interesting how the Conservatives are inconsistent and somewhat hypocritical over their policy with the super-quango, the NHS Board. The 2009 policy health document says: "To avoid creating political opportunities to manipulate the funding formula, NHS resource allocation should be set by the NHS Board, independently of Ministers" (my emphasis) that is, they specifically say that they want to remove any political control or accountability over the allocation of NHS funds. Yet in their "Draft Manifesto" when describing NICE they say: "The current system lets Ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS" (again, my emphasis). So isn't the concept of the NHS Board also "letting Ministers off the hook"? Won't the NHS board also be "unaccountable bureaucrats"? There is a huge inconsistency here: the Conservatives want to impose political interference in the decisions of NICE who determine which drugs the NHS will pay for, but not in the commissioning of services.

It is quite clear that the intention behind creating the NHS board is to force part-privatisation on the NHS. The NHS Board will be instrumental in this privatisation since they will control how commissioning is carried out and they will tell local commissioners that they must commission a certain percentage from private suppliers (in a similar way to the 1990 Broadcasting Act that mandates that 25% of TV and radio production broadcast by the BBC has to be from non-BBC suppliers). As time goes on the amount of treatment provided by private suppliers will be increased until there will no longer be NHS providers. The policy of creating the NHS Board is the start of the wholesale privatisation of the NHS, and if there is one policy that we must fight the Conservatives on, it will be this one.

No comments:

Post a Comment