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subscriptions@nationalhealthexecutive.com W
hatever one thinks of the changes to the Govern-
ment’s health reforms – whether they have saved the NHS from ‘pri- vatisation’, represent a distracting bodge job, or are a huge backwards step for necessary reform – most people agree that they do at least do a good job of boosting transpar- ency and accountability.
This was a relatively easy win for those campaigning against the ‘old’ Health & Social Care Bill, tak- en up by the NHS Future Forum and accepted in the Government’s response. Clinical commissioning group governing bodies must meet in public and publish their min- utes, and the groups will have to publish details of their contracts, for example. Foundation trusts will lose their right to choose to hold board meetings in private.
The Health & Wellbeing Boards (HWBs) have also become more powerful – and will very much be council creatures, with local au- thorities being able to insist on the boards containing a majority of elected councillors if they wish. This idea was unpopular with the public and with clinicians, but has made it through.
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The Government held back from giving the HWBs a ‘veto’ over com- missioning plans – to the disap- pointment of the LGA conference in Birmingham earlier this sum- mer, and the relief of the BMA conference held in Cardiff at the same time – but the boards still have some serious infl uence and oversight powers. They will also get more responsibility for doing something that councillors have longed to do – promote integrated health.
Stay informed, stay in front
How this will all work in practice remains to be seen – democratic decision-making and oversight is all well and good, until politics and point-scoring gets involved. If councillors and local authorities are to have a bigger role in health- care, they must be more realistic about budgets and services, rather than just constantly demanding
more money for local facilities and to protect every unit from closure regardless of clinical recommenda- tions. Needless to say, it would be a brave councillor who resists that lure, and local authorities can still “challenge” proposals involving substantial service reconfi gura- tion. We know what that means in practice, and how people tend to react when such reconfi guration proposals leak out.
The general principle of greater patient involvement is a good one – but again, the theory and the practice can confl ict. Patient de- mands can be essentially infi nite – that is the nature of healthcare – while resources are not. Many pa- tients’ groups know this and make informed, sensible contributions; but under the amended reforms, patients, carers and the public will have to be ‘involved’ in commis- sioning decisions that in any way affect patient services, not just those with a “signifi cant impact” as before.
This is all to say that even in one of the less controversial areas of the reforms, there are unanswered questions and things that could go wrong. We have not even touched on the confusing dual (or triple) role of Monitor, or the idea of the national NHS Commissioning Board (well, its ‘local arms’) hav- ing to ‘step in’ come April 2013 in areas where clinical commission- ing groups are unable or unwilling to take on that role once PCTs are abolished. Nor have we mentioned the ever-rising cost of transition, which apparently stands at around £1.5bn without factoring in costs associated with making redundan- cies.
The Government is right that the status quo was unacceptable, and the campaigners were right to question ministers’ prospective solution and get the Bill amended; but what we have ended up with seems to many people to answer the wrong questions.
Editor Adam Hewitt national health executive Jul/Aug 11 | 3
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