FactCheck: The truth about the NHS Reform Bill myths
The claim
“The Department of Health publishes mythbuster on NHS modernisation”
Department of Health, 11 October 2011
Cathy Newman checks it out:
Revolting peers have landed their first blows on Andrew Lansley. Today they’re starting a marathon two-day debate on the health and social care bill, and the government is worried.
Labour peers want the legislation dropped altogether, but it’s an amendment from two crossbenchers, Lords Owen and Hennessy, which is really worrying ministers. They want part of the bill sent to a special select committee.
One minister told me if the two peers get their way the whole bill would fall, as scrutiny by a special committee would drag on for months. So no wonder Mr Lansley has been spotted pressing the flesh in the Lords, and the Department of Health has hit back with a “mythbusting” dossier. Will it succeed? Over to the team.
The analysis
The DoH picked off ten “myths” at speed, but with the Lords debate due to trudge on until the vote tomorrow, FactCheck has the time to stop, listen and learn. Here we tackle the issues causing the most alarm:
Claim 1: The role of the Health Secretary
“The Bill does not change the Secretary of State’s duty to promote a comprehensive health service”
The Department is right to point out that the “duty to promote a comprehensive health service” remains unchanged since 1946, but they’ve dodged the argument, which is all about the next line in the Bill.
Mr Lansley currently has to “provide or secure the provision of services”, which means he is directly legally responsible for delivering healthcare. He wants to replace the “duty to provide” with a subtly different duty – to “exercise the functions conferred by this Act so as to secure that services are provided”.
Critics say that, along with a “hands-off clause” later on in the Bill, it makes the government less accountable. And some argue it’s all about bringing in privatisation by the back door.
Lawyer Peter Roderick says the Health Secretary wants to shirk his traditional legal responsibility to provide care so more power and responsibility is shifted on to Clinical Commissioning Groups.
They will then have the freedom to run things as they see fit – awarding contracts and charging for commercial activities – without interference from Whitehall.
Mr Lansley says the change in wording is all about reflecting the reality of how the NHS works: ministers no longer provide care directly, they just commission other people to do it.
He freely admits it’s a more hands-off approach. A Health Secretary will not intervene in the running of clinical commission unless there is a “significant failure” or a public health emergency, he said.
Claim 2: Bureaucracy
“We are abolishing needless bureaucracy, and our plans will save one third of all administration costs during this Parliament”
Abolishing Primary Care Trusts and Strategic Health Authorities will save admin costs – though Professor John Appleby, chief economist at The King’s Fund points out that “the sheer number of changes being made to the health system as a result of the government’s reforms risk creating additional bureaucracy”.
The Royal College of GPs says the number of NHS statutory bodies is going to climb from 163 to 521. New clinical commissioning groups will be set up, and there will be clinical networks, senates and new arrangements for health and wellbeing boards – all of which could pile on administrative work.
A spokesman for the Nuffield Trust also pointed out to FactCheck: “We would question if the original assumptions for administrative spending for Clinical Commissioning Groups are still valid and whether CCGs will be adequately resourced to discharge these activities.”
Claim 3: Competition
“We are not introducing competition. In fact, we are putting in new safeguards to ensure competition will be used to drive up quality, and not be based on price. Nor will we allow competition to be a barrier to collaboration and integration”
Firstly, as Prof Appleby points out, competition already exists in the NHS and will increase under the government’s reforms.
He told FactCheck: “Evidence suggests that this will be beneficial to patients in some areas of care but not in others, so the key will be to get the balance right between competition and collaboration.”
Health Secretary Andrew Lansley told Channel 4 News that competition should be “in a place where it is part of the tool kit”.
The government has clarified the original wording of the Bill – which would have seen the sector regulator Monitor promote competition where appropriate. Monitor will now have a duty to prevent anti-competitive behaviour, rather than promote competition.
But it’s still not quite clear how far the Bill will open up the NHS to the full force of EU competition law. According to the Nuffield Trust, the lack of relevant case law will mean that in reality the pace of change in relation to competition will be heavily dependent on the policies and behaviour of Monitor.
Claim 4: Privatisation
“Claims that we aim to privatise the NHS amount to nothing more than ludicrous scaremongering. We have made it crystal clear, time and again, that we will never, ever, privatise the NHS”
The King’s Fund and the Nuffield Trust both agree there’s some scaremongering afoot. The NHS is not going to be privatised. However, there’s no denying that the Bill does create more opportunity for the private sector to get involved.
Prof Appleby told FactCheck: “The outcome of this remains to be seen but it is likely to result in an increased role for the private sector in the health system. However the private sector has been involved in the NHS since 1948 and the NHS has bought services from private providers since that time.”
The Nuffield Trust told us the original Bill had some coherent, but radical logic in it – that a fully bottom-up, clinically-owned network of GP commissioning groups would be free to make calls on care. The revised Bill however, puts stronger emphasis on accountability for public funds.
Meanwhile, former banker Lord Howe told an audience of private sector providers last month that though the NHS “will not give up their patients easily”, there were “genuine opportunities” for those wishing to “enter the fray”.
Cathy Newman’s verdict:
Many of the myths have more of a basis in fact than the Department of Health would care to admit. The Health Secretary will still “promote” the NHS – as he and his predecessors have done since 1946. But he no longer has a duty to “provide” a comprehensive health service – ie he’s no longer directly and legally responsible for it. That, say his opponents, leaves the door open to privatisation, if not now then in the future.
It’s such a toxic issue that the Tory health minister Lord Howe has just hinted at a U-turn, saying: “I am aware of the concerns around this area and we are ready to listen to such concerns and make any amendments necessary to put this issue beyond all doubt.”
And what of the other so-called “myths”? Bureaucracy is alive and well in the reformed NHS: the number of statutory bodies will more than triple, if you believe the Royal College of GPs. And as for competition, the Health Secretary has himself admitted that it should be “part of the tool kit”.
Finally, although it is true that the NHS will not be privatised, one of Mr Lansley’s colleagues has admitted there will be big opportunities for the private sector. FactCheck finds it can’t give the government’s mythbusters a clean bill of health.
The analysis by Emma Thelwell and Patrick Worrall
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There are 12 comments on this post
What scares people is not so much the wording, it’s the subterfuge. If the bill was in our interests, why was it not in the manifesto, why the explicit promises NOT to re-structure, why the desperate haste once announced, why the extra peers created? That speaks louder than words. As does the fortune paid by Healthcare companies to get the Conservatives elected.
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“As doctors in England, we are writing to you to express our conviction that the Health and Social Care Bill will irreparably undermine the most important and admirable principles of the National Health Service, and to appeal for its rejection by the House of Lords.
Because it is universal and comprehensive, and publicly accountable, and because clinical decisions are made without regard for financial gain, the NHS is rightly regarded all over the world as the benchmark for fairness and equality in healthcare provision.
The transfer of services to private, profit-making companies will result in a loss of public accountability and a damaging focus instead on low-risk areas that are financially profitable. A confused patchwork of competing providers will deliver a fragmented and inequitable service, and any reliance on personal health budgets or insurance policies will further increase inequalit
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Devolution C4, The changes are largely to the
English NHS… Why not make this clear?
mancman
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Absolutely agree with Brainy Stafford. Would add that the failure of political leaders to espouse or appear to understand the basic principles of constitutional liberal democracy, – as witnessed by the host of scandals in recent years, terrifies and appalls me. it seems that those who elect are no more than pawns in a game being played to no rules by a ruling elite.
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Surprised not to find mention in your article of the fact that the PCT’S are ALREADY subject to European competition law as discovered by 38 degrees. So that particular aspect seems a bit of a non-issue.
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Brainy, as far as I’m aware no party has ever put comprehensive policy info on the NHS in their manifesto, Labour made huge changes without even bothering with listening exercises or listening in general, against the advice of medical experts and without union support.
Tbh no manifesto ever has any detailed policy info on anything anyway, and this could easily be worm-worded to fit with the idea of no top down reorganisation, as it is a bottom up reorganisation
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Alex. The Conservatives’ pledge was specifically not to re-structure the NHS. That’s different from not going into comprehensive detail, that’s an intentional deception. It’s not even ‘worm worded’, as you put it-though that would be bad enough. But think about it. Bottom up re-organisation does not describe the current bill. The top down/bottom up get-out is a linguistic deception and the hallmark of a con-man. As I say, it’s not the bill. it’s the subterfuge. That’s why people are scared.
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Cathy/Emma/Patrick,
You missed out an important bit; the Tory controlled Department of Health simply lied its head off.
You would have to be a naif of the first order not to recognise that it is a Tory wet dream to privatise the NHS. Then it would be handed over, as were public energy organisations, to their neocon chums in Europe and the USA.
This bill is part of Tory “salami” tactics since they will not dare make a full blown proposal to abolish one of Britain’s greatest civilised institutions.
The prime thrust of this proposal is to create a separate, profits-seeking social class of General Practitioners. Once that is achieved, the tactics will move to consolidating them over time into a neocon voting body. The rest is entirely predictable.
And of course the “bureaucracy” claim is as ludicrous as ever. It’s the same old tripe and BS the Tories trot out every time they want to steal something of value from the nation.
So get yourself and your kids ready for ambulance crews searching prone street casualties for credit cards and millions made bankrupt to pay hospital bills. That’s the way it is in the USA and that’s what the Tories want here.
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I am always suspicious of Labour politicians complaining about Conservative changes to the NHS
I remember the rows when Mre Thatcher altered the pole of ambulence crews. Before Mrs Thatcher, the job of the ambulence crew was to pick up the casualty, and get them to hospital for treatment as quickly as possible. Mrs Thatcher said that it would be much better if the ambulance crews were paramedics, who could stabilise the patient before getting them to hospital. There were screams of derision at the idea. The Labour party, the unions, and large parts of the media were outraged. Mrs Thatcher was proved right. No one would go back to the old system now. There is too much party political kneejerk reaction about the NHS, and not enough quiet rational thought on how to improve it.
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Thia is all very unsettling for the general public. The NHS should be removed from the political agenda. I am sceptical about giving patients a stronger voice-is this just a tokenistic gesture
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Just looking at dignity in basic care.The BBC have just shown a clip of supposed dignity . I was annoyed .. call that dignity.
A chap in a postion not supported enough , a sister leaning over him feeding from a large spoon in full view of the rest of the ward.
He should be sitting up in a position to aid swallowing , the feeder should be sitting by his side at the same height, he should be asked whether he wants the screens closed or open.Moreover it was being filmed.!!!
Then some comes along shouting “does anyone want a cup of tea.” Each individual should be approached and asked their preference in beverage in a polite manner ensuring the choices are followed up by help where needed.These people obviously have swallowing and speech difficulties.Respect for persons please.
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According to Private Eye, some of the firms keenest to provide services to the NHS ie make a lot of money out of us are branches of US firms in serious trouble with the law in their own country. Or is that just another myth the DOH wants to bust?
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