Nick de Bois is the MP for Enfield North
Tim is completely right that the Conservative Party has got itself in a phenomenal political mess over the Health and Social Care Bill, and the concerns that Cabinet Ministers have expressed to him don’t surprise me one bit. Yet his overall conclusion, that we should kill the Bill, is by no means the answer to the problems we currently face and would be a short-term fix to a long-term problem.
Tim’s analysis of the problems we face are undoubtedly correct, and I would go further in suggesting that the prevailing view on the backbenches may be frustration at the situation we’re in, and some may also be tempted to question why we even bothered in the first place. True, we have taken heavy chunks of criticism for bringing forward reforms, but it is also true that the Government will take flak if there are future problems in the NHS whether or not the bill were to go ahead.
It is not a political certainty that quashing the bill would mean the government would gain a better "approval" rating on the NHS that would be sustained until the next general election. Far from it, as to leave the NHS as it was would have been to condemn it to an ever-increasing black hole in efficiency. The Nicholson Challenge was always going to be difficult, but to encourage efficiency and innovation within the highly centralized framework the NHS has had since its conception is literally impossible. To meet the challenge we needed to introduce decentralization and competition, the two catalysts for efficiency. In both of these areas, the legislation is necessary, even in its compromised form.
With regard to decentralisation, all parties argued in the last election that they wanted to put more power on the frontline. The Bill makes it possible to implement key structural changes to do so, removing two layers of management in primary care trusts and strategic health authorities. In transferring power to doctors and nurses the Government could of course have asked primary care trusts to simply involve doctors and nurses more frequently, but that would run the risk of having their decisions second-guessed by the managers running these organisations – and these managers will take their orders from Whitehall. We know this because it’s been tried before through GP fundholding and other such projects, and it simply didn’t work. Finally, and perhaps most crucially, patient voices will be given much more primacy through the Bills creation of HealthWatch, enshrined in law.
Critics of the Bill similarly can't contend that local authorities could be put in charge of public health without a Bill. The plain truth is that without legislation, government can’t transfer powers or money from the NHS to local authorities, therefore limiting a local authorities full role on public health. With regards to competition, we have admittedly changed much during the last few months. For competition to truly flourish we need a system which encouraged the third sector and private sector to compete for public contracts. Reactionary views have prevailed, arguing that competition would open some sort of privatization "Pandora’s Box" – and diluting this aspect of the Bill substantially after last years "pause". As Nick Seddon correctly pointed out yesterday, while our European neighbours are working out how to regulate markets so as best to benefit patients, we are still trying to argue the benefits of diverse provision versus state monopoly.
The fact that a number of medical groups have expressed opposition to the Bill, particularly the Royal College of GPs, is often cited as a reason for the dropping of the Bill. Yet this misses a key point. If GPs genuinely are opposed to the Bill then they could simply take the power it gives them to commission services and do nothing. They could commission all the NHS services already in place under their local primary care trusts. If the critics of the Bill are to be believed and GPs actually do disdain this Bill then this is presumably exactly what will happen.
However, I simply don’t believe this will be the case. GP’s, positioned as they are on the frontline of care, will see that in some areas the third and private sectors offer a better deal for patients. They will begin to commission different services that operate more efficiently and innovatively, and patients will notice this improvement. It is individuals' perceptions of the NHS in 2015 that will decide their verdict on the Government’s NHS reforms. People at present simply aren’t happy with their lack of choices and there are huge gaps in primary care and elderly care, on top of massive health inequalities. As it stands, the NHS can’t face these challenges. What has been put forward is not a top-down reorganisation, it’s a top-down transferal of power. And to reverse this transfer would be to open Conservatives not only to the current charge of political ineptitude, but of joining a long list of administrations that blinked in the face of well organised mounting opposition and lost an opportunity to do the right thing for the future of patients and the health of the nation. That is not something I relish.