The NHS, if you ask me, is pretty much the best thing this country has ever achieved. But it is so woven into the fabric of our lives that we often take it for granted.
So when we hear news of a proposed reorganisation of the NHS there is a temptation to shrug and assume it will all be OK. Of course, any reorganisation won’t do justice to what our NHS needs – reinstatement as a fully funded public service. But the proposals in the White Paper are not this and worse so, contain some damaging steps away. And so I wanted to implore councillors to take a look at the proposals and join us in asking for more consultation. It’s because I am sure that if they looked at the White Paper, they may well find things there which concerned them.
At a meeting of Brighton and Hove City Council on Thursday 25 March, we therefore proposed that the council lobbies government for consultation on the white paper. We also asked for more resources to our NHS, who are stretched now more than ever.
Before I outline a few of the things which concern me, let me say that I don’t think what it contains is all bad, and certainly its recognition of the critical role of local government to the health and wellbeing of our communities is welcome. The White Paper says its proposals build on lessons learned from the pandemic, particularly the closer co-operation and collaboration which has enabled better partnership working across the health and care system.
And certainly the concept of co-operation not competition is key to these proposals, and as such they have been reported as reversing the 2012 Health and Social Care Act’s vision of the NHS as a competitive market place, with all the fragmentation, bureaucracy and expense that has brought. But the White Paper doesn’t reverse the market model. It just removes from it the checks against corruption and cronyism which come into play when there are contracts to be given out.
Transparent tendering for clinical services is to be replaced with a “bespoke health services provider selection regime” which should ring some alarm bells. Perhaps we need to remember that collaboration is not the only lesson our government has learned from the pandemic. There is also a very-well-learned lesson of how to use untendered health contracts to funnel billions of pounds into the pockets of their donors. I would hate to see this lesson enshrined as the NHS norm.
The White Paper sets great store by local, place-based care, but at the same time the raft of new powers it proposes to give to the secretary of state for health and social care amount to a central government power grab. So when the Paper allows what is welcome leeway in the creation of local partnership models I do worry that what we’re actually being told is to arrange the deckchairs any way we like – on a ship with a government iceberg looming over it and ‘bespoke services selection’ sharks circling all around.
And of course, the huge hole in this White Paper is that it still contains no plan for adult social care. On his first day in Downing Street Boris Johnson said he had a plan to fix the crisis. Well, one of the lessons of the pandemic is how vital such a plan would be. But still we haven’t seen it. How is social care to be Integrated? And funded? We’re still waiting.
And why are these proposals being brought now? As the first line of the White Paper says, “We are living through the greatest challenge our health and care system has ever faced.” Yes -still living through it – with a tired workforce, engaged in a mammoth vaccination programme, still to climb a mountain of backlogs and waiting lists. This is not a great time to reorganise. But it is a great time – while no-one has the energy spare to scrutinise or oppose – to push a reorganisation through.
As I said, there are things to be welcomed in the White Paper, but we wanted to assure that our city has a voice in those things that aren’t. We will continue to push for more say in what happens to our NHS.
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Image credit: Number 10 – Creative Commons