The publication of the Health and Social Care Bill today marks a major milestone in the Government’s proposals for reform of health and care provision in England.
This Bill is about implementing the vision of integrating NHS, social care and public health provision. By necessity it is filled with the mechanisms and structures of the new world. It has however an important, totemic significance in that it will be the set piece in this Parliament for debate about the future means and culture of delivering healthcare in England and be a key part of the Government’s overall public service reform agenda.
The build up to publication today has not been easy for the Secretary of State Andrew Lansley. The NHS Confederation, the British Medical Association, the Royal College of General Practitioners and many others have all been prominent in their criticism. Yesterday’s report on commissioning by the cross-party Health Select Committee asked a series of probing questions about the reforms, notably around the intended timetable, and provided a critique from which many in Parliament will take their lead.
Even many of those who support the principles and goals of the Government’s reforms have warned of the ‘pace’. Conservative MP, member of the Health Select Committee and former GP, Dr Sarah Wollaston’s interventions on this issue (and on the reforms more generally this week) have been notable. Similarly, the Committee Chair Stephen Dorrell has promised to play the role of ‘critical friend’ to the Government in the Bill‘s passage – a prospect which Andrew Lansley may not welcome wholeheartedly.
The Prime Minister’s speech at the Royal Society of Arts on Monday this week was a clear attempt to head off these concerns by tying reform to a wider agenda of public service modernisation and framing them as a ”once in a lifetime” opportunity. It was also a marker for his own Party – an indication that he is investing personal capital in seeing these reforms through.
The Prime Minister’s intervention is important. As the Bill progresses through the Commons more MPs will come under pressure as they are lobbied by different patient advocacy and professional groups and start to hear concerns from the public in their constituency surgeries.
In the House of Lords, the Bill will face greater hurdles. The House contains many members who are well-informed and passionate about health and care issues and many have strong links with, and sympathy for, different advocacy groups and professional bodies.
What emerges from this legislative process may look different to what has started today. The detail of the proposals and the planned scale of change have not yet been grasped by many in Parliament. To get the Bill through, the Government may have to strengthen its narrative and communicate a case for change that focuses on easily understandable benefits for patients. It is going to be a difficult process, with negotiation and competition – but given the nature of our parliamentary system and the Government majority, the Bill will pass.
Over the coming months, the debate on the Bill will be crucial in creating clear dividing lines between the parties ahead of the next general election. In such a flagship piece of legislation, which is central to the wider public service reform agenda, the Government may try to manoeuvre the Opposition into a situation where they position themselves against key popular changes.
The Government’s hope will be that reforms – such as choice of any willing provider – will become popular among the public, and in the run-up to the next election, the Government will do all they can to paint the Labour Party as being anti-reformist.