COMMENT
Neil Churchill, chief executive of Asthma UK, is chairing the inquiry into the NHS reforms held by the Smith Institute think tank. Here, he explains the key questions.
politics out of the NHS. It has surprised many, therefore, that the Health and Social Care Bill has become the biggest political controversy of the legislative programme. As Bill Moyes, former chairman of Monitor has said, the heat of opposition is probably unprecedented and the Government’s vision has been lost in the fl ames.
O
Part of the debate has been whether the proposed reforms build on those initiated by former health secretaries Ken Clarke, Stephen Dorrell and Alan Milburn,
or
represent a break with the past. Confusingly, the Government has described them as both evolution and revolution. Both Conservative Stephen Dorrell and Labour’s Lord Warner see the continuities; Alan Milburn sees both logical progressions and breaks with past policy. Andrew Lansley, meanwhile, points out that the majority of his proposals were contained in the White Paper and manifesto the Conservatives published before the General Election.
Opposition
The opposition to reforms, however, is a broad church. There are those genuinely worried about the speed, scale and extent of reforms and the fact that they are being introduced with little evidence. There are those who question whether the details of the Bill will actually deliver the principles of the White Paper. And there are those who are against elements of the reforms which are already present in the system, such as the internal market or the mixed economy of providers. The opposing views includes those who want different reforms, those
22 | national health executive May/Jun 11
ne of the aims of the Government’s health reforms was to take the
Ministers have promised that they are ‘listening’ - but are they hearing properly?
who do not want reform at all and those who want more detail on implementation to be sure the reforms will work.
The task of navigating these murky waters now falls to Professor Steve Field and his Future Forum, who have been asked to review aspects of the reforms. Meanwhile, there is widespread speculation that Nick Clegg will seek to negotiate substantive changes, following his party’s rejection of the reforms at their spring conference.
In this context, people working in the NHS really do not know what to expect from the next couple of months. On the one hand, David Cameron has spoken of making ‘tweaks’ to the details of legislation. On the other, Clegg has now signalled that the Bill itself is fl awed. Expectations which were at fi rst quite limited are now being raised that substantive changes will be made to the Bill. From a policy perspective, The Smith Institute’s inquiry into the strengths and weakness of the health reforms is more timely than we could have possibly imagined when we launched it at the beginning of the year. So far we have organised events in Leeds and Bristol with more to come in Manchester and London.1
The inquiry
Our aim is the get beneath the surface arguments of the debate and focus on the policies and their likely impact. When we launched the inquiry, we identifi ed a number of questions, which still appear highly relevant.
First, we asked if the reforms will deliver the principles they set out to achieve. The
Health and Social Care Bill promises that it will liberate clinicians to do the right thing, free from political interference, and put patients at the centre of their care, with information and choice driving quality improvement. It also establishes new mechanisms to deliver those principles: including an NHS Commissioning Board; Outcomes Frameworks for the NHS, Public Health and Social Care; GP commissioning consortia and a new regulatory landscape.
But there has been considerable debate, so far, on whether these mechanisms deliver improvements in quality and productivity, how uniformly might they do so and over what time. For example, the White Paper promised patients that there would be ‘nothing about us, without us’ but there is no role for patients on the boards of GP Consortia, and not until recently were patient representatives included in David Cameron’s new health advisory group.
Another major question concerns competi- tion, collaboration and regulation. Compe- tition and choice play prominent parts in the new NHS vision set out in the Health and Social Care Bill. But is the balance right between competition and collabora- tion? And what does ‘good competition’ look like and how should it be introduced and regulated? Is there a danger of ‘bad competition’ undermining the economic viability of foundation trusts and is the proposed approach to extending and regu- lating competition fi t for purpose?
Is the proposed inspection regime suffi cient to guarantee patient safety and effective safeguarding? In
a thoughtful recent contribution to the debate, former health
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