After the Health and Social Care Bill
Reform roundtable seminar introduced by Lord Warner of Brockley, Former Health Minister, on Wednesday 18 April.
By Nick Seddon
After all of the noise surrounding the NHS reform Bill – or to give it its official name, the Health and Social Care Bill – which recently received Royal Assent and became law, you could be forgiven for having forgotten what it was all about. So we convened a lunch, led by Lord Warner, a former Labour Health Minister and Bill expert, to examine some of the detail and see if the Government can use what is in the Bill to achieve positive reform. The lunch was held under the Chatham House Rule, but these were the headline points.
Firstly, the clauses relating to the failure regime and amendments including the “pre-failure failure regime” (i.e. a black list of trusts which will flag up early warning signs and create a pressure to improve or be dealt with) are good news. Dealing with failing hospitals will either be through outsourcing, radical reconfiguration, or closure. All will require local and national political will. The role of the tariff will be important: the Independent Commissioning Board (ICB) will define the currency (e.g. episodes of care or bundled), while Monitor will set the cost.
Secondly, the Health and Wellbeing Boards may turn out to be an effective catalyst for greater integration between health and social care. There is already evidence of HWBs carrying out joint strategic needs assessments, which is good. Joining up the silos will probably require financial and legal tools, which are not currently in place, but there was optimism all the same.
Thirdly, the Bill is so ambiguous that much will rely on interpretation. The Secretary of State will not be able to let go and – to use the phrase in the original white paper – “liberate the NHS”. This is not only because power resides where the money is raised and spent, but because there will need to be constant political pressure if either competition or integration are to be achieved.
Fourthly, when it comes to competition, the Bill will not push change, but its provisions might permit change. The interpretation by Monitor of the relevant clauses will matter. Right now, the signals about the private sector have been hostile and the Government rejected a review of barriers to entry for new entrants, which is negative. The investor community hates uncertainty, but there is a lot of that around. Ministers must send out clear signals and be unwaveringly in favour of new entrants.
Finally, rationing will become a big issue – and a matter of public debate. There was a strong sense that real, radical reform of the system has been deferred, but remains necessary.