King’s Fund boss Richard Murray has continued in the inglorious steps of his predecessors in tail-ending government policy and rejecting any real challenge to the status quo, urging Labour not to press for a repeal of the Health & Social Care Act which the Fund itself conceded back in 2015 was “damaging” – John Lister writes

Murray’s defeatist blog argues that now is “not the right time” to deal with the legislation that has fragmented the NHS into thousands of contracts and privatised sections of it: “It is unwise to begin a re-fit of the NHS ocean liner in the midst of a hurricane.”

So what could be the right time for bold action? How long does the King’s Fund think it is right for the NHS to follow down a “damaging” path rather than attempt to secure a sound basis for longer term progress? 

If it’s not right to change course when the NHS is failing on so many targets, short of over 100,000 staff, deep in deficit and beset by crumbling buildings and clapped out equipment, when would it be right?

Murray’s blog also ignores the potential imminent danger of the NHS being thrown into post-Brexit trade deals. 

Disruptive

He asserts it would be disruptive for the NHS to face a new reorganisation: but few of the changes that are most important would disrupt the work of most front line staff.

Five key issues must be addressed: 

  1. Restoring and clearly stating the duty of the Secretary of State to provide a comprehensive and universal health service. 

This is not at all disruptive for front line staff, and can easily be achieved by legislation

  1. Revoking and repealing all the regulations, clauses and sections of the 2012 Act that require local commissioners to put clinical and other services out to tender and made the NHS subject to competition law.

This is not controversial or disruptive. It reduces existing levels of disruption and disintegration, reassures NHS staff that they will not be forcibly transferred to a new employer, and reassures local people that services will be secure. 

  1. Beginning the process of rolling back the outsourcing and privatisation that has taken place, to reinstate a publicly provided NHS, in which all future services are governed by service level agreements rather than contracts and clearly excluded from public procurement regulations.

Contract failures

The case for this has been made by the repeated and widespread failures of private contracts: many managers will welcome it. Where it has been done, most notably in Wales, it has been shown to have beneficial impact on the quality of services and morale of staff. 

  1. Ending Foundation Trust status would nullify the provisions of the Act that encourage Foundation Trusts to generate increasing shares of their income from private medicine and private commercial activity.

This is disruptive only in the handful of FTs that have already expanded their private beds and services. 

  1. Establishing new, unified NHS bodies at local level that will bring together purchasers and providers in a single, publicly accountable NHS body. This will end the costly, wasteful and divisive purchaser/provider split instituted by Margaret Thatcher and entrenched by subsequent government “reforms” despite the lack of any evidence it has improved services or benefited patients.

This is also the area in which the 2012 Act created the greatest dislocation, with the scrapping of PCTs and establishment of CCGs. 

However NHS England’s Long Term Plan is already proposing to bring CCGs and trusts into so-called ‘Integrated Care Systems’: the disruption is already happening. 

Under the current Act these bodies lack any democratic accountability or legal status: and without the changes listed above could be a step towards further privatisation. 

New legislation is vital to ensure that integration is a process of rebuilding our NHS as a public service, publicly funded, provided and accountable.

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John Lister
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