Yesterday the MHP Health Mandate team published a 12 point guide to what the Health and Social Care Bill actually does.
Today – and by popular demand – we are publishing our 10 point guide to why it has proved so controversial:
1) The Conservatives (with some help from the Liberal Democrats) are introducing it. The Conservative’s ‘toxic’ reputation on health – a legacy of the 1980s – never completely disappeared. Lansley’s success in opposition was to keep health as an issue quiet: extensive reform has done the opposite
2) The Government failed to provide a compelling narrative for the reforms before introducing the Bill. Using arguments over detailed clauses of legislation as a proxy for disagreements about wider philosophical approach to the NHS was never going to be a winning communications proposition
3) No political party has ever resolved its debates about the role of competition in the NHS. The Bill – and particularly Part 3 – has become a battleground for this ideological disagreement
4) The debate over the role of the private sector in providing NHS-funded services has also never been resolved. The row over how and how much revenue foundation trusts should be allowed to generate from private sources is essentially a re-run of the debates of the early 2000s
5) Structural reform is never popular with NHS staff and there is change fatigue after multiple reorganisations over the past two decades. Having pledged at various points that there would not be “top down” or “pointless” reorganisations, the Coalition Government has yet to convince many that this one is neither.
6) The Bill changes healthcare regulation at a time when it is coming under intense scrutiny following scandals at Mid Staffs and Winterbourne View. With Robert Francis’ review yet to report, some feel another round of regulatory change is inevitable
7) Many stakeholders have a bad experience of primary care and have translated this frustration on to the new commissioning structures, which will be led by GPs. The same stakeholders were often not great supporters of PCTs, but this is beside the point: there remains confusion about how commissioning will work and scepticism about whether GPs will be able to get the support they need
8) ‘Setting the NHS free’ is appealing in principle but the tension between political accountability and NHS autonomy (at both national and local levels) remains unresolved. With accountability often (and understandably) comes interference: whether the two can be reconciled, and what level of variation can be tolerated in the name of autonomy, has occupied considerable amounts of time in the Lords
9) Legislation as extensive as this has opened up the dusty corners of health policy and delivery. Long accepted practices (such as local price setting) have had to be described in legislation, and many have not liked the results
10) The backdrop to the Bill is a tough spending environment for the NHS. Tough spending decisions – which can be confused with cuts – have become conflated with the reforms, when in fact they are quite separate