Lansley’s NHS reforms will undermine fairness

Another organisational shake-up does not surprise doctors, but this is a much bolder move towards pr

Andrew Lansley has launched a white paper that has been heralded as the biggest shake-up of the NHS in a generation.

The key proposals are:

  • Abolishing ten strategic health authorities by 2012 and scrapping the 152 primary care trusts by 2013. This would mean that up to 30,000 managers face being cut or redeployed.
  • Replacing these management structures with about 500 GP "consortiums" (not optional), meaning that family doctors will have control of £80bn of public money.
  • Allowing hospitals to leave public ownership to become "not-for-profit" companies.

The first thing to note is that the NHS has been in a state of almost continuous reform for nearly three decades. There has been some form of organisational change almost every year since the early 1990s. Many of these changes resemble each other; 2002's primary care trusts were difficult to distinguish from 1982's district health authorities. The same goes for NHS trusts and foundation hospitals.

The cumulative effect -- apart from the fact that most new structures don't have time to show positive effects before they are changed again -- is cynicism in the medical profession, as evident in this doctor's blog:

As the ministers and commentators observe the effects of their "bold vision" and "strategic planning", I am happy to tell them how much difference this will make to most Jobbing Doctors -- very little. You see, we have seen this all before.

Under the internal market established by Margaret Thatcher, and not-much-changed by Tony Blair, GPs surgeries already operate much like private businesses that commission services from hospitals. Equally, under private finance initiatives, private companies have been involved in building numerous new hospitals.

But what the new plans do amount to is a much bolder and more open step towards privatisation of the National Health Service. As with so many of the coalition's reforms, the move towards less bureaucracy is not matched by guarantees of accountability, which are needed to maintain a consistent standard countrywide.

Oddly enough, Melanie Phillips makes a good point about this:

It also surely runs the risk of fragmenting the service, since GPs will try to look after their own clinical patch rather than the general good. And this gets to the crux of the problem. A national service needs to offer unified provision throughout the country in order to be seen to be equitable.

Yesterday, Lansley spoke of the need for competition and choice, echoing Thatcher's market ideology, ignoring that last time this was implemented, we were left with a hugely unfair postcode lottery. Lest we forget, the much-reviled target culture did produce results, with waiting list figures, among others, drastically improved (LabourList has some numbers here).

The NHS was founded on the principle of fairness. Let's not undermine that by restructuring the system in such a way that it has no mechanisms to help that fairness flourish.

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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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In the race to be France's next president, keep an eye on Arnaud Montebourg

Today's Morning Call. 

Good morning. As far as the Brexit talks are concerned, the least important voters are here in Britain. Whether UK plc gets a decent Brexit deal depends a lot more on who occupies the big jobs across Europe, and how stable they feel in doing so.

The far-right Freedom Party in Austria may have been repudiated at the presidential level but they still retain an interest in the legislative elections (due to be held by 2018). Both Lega Nord and Five Star in Italy will hope to emerge as the governing party at the next Italian election.

Some Conservative MPs are hoping for a clean sweep for the Eurosceptic right, the better to bring the whole EU down, while others believe that the more vulnerable the EU is, the better a deal Britain will get. The reality is that a European Union fearing it is in an advanced state of decay will be less inclined, not more, to give Britain a good deal. The stronger the EU is, the better for Brexit Britain, because the less attractive the exit door looks, the less of an incentive to make an example of the UK among the EU27.

That’s one of the many forces at work in next year’s French presidential election, which yesterday saw the entry of Manuel Valls, the French Prime Minister, into the race to be the Socialist Party’s candidate.

Though his star has fallen somewhat among the general public from the days when his opposition to halal supermarkets as mayor of Evry, and his anti-Roma statements as interior minister made him one of the most popular politicians in France, a Valls candidacy, while unlikely to translate to a finish in the top two for the Socialists could peel votes away from Marine Le Pen, potentially allowing Emanuel Macron to sneak into second place.

But it’s an open question whether he will get that far. The name to remember is Arnaud Montebourg, the former minister who quit Francois Hollande’s government over its right turn in 2014. Although as  Anne-Sylvaine Chassany reports, analysts believe the Socialist party rank-and-file has moved right since Valls finished fifth out of sixth in the last primary, Montebourg’s appeal to the party’s left flank gives him a strong chance.

Does that mean it’s time to pop the champagne on the French right? Monteburg may be able to take some votes from the leftist independent, Jean-Luc Mélenchon, and might do some indirect damage to the French Thatcherite Francois Fillon. His supporters will hope that his leftist economics will peel away supporters of Le Pen, too.

One thing is certain, however: while the chances of a final run-off between Le Pen and Fillon are still high,  Hollande’s resignation means that it is no longer certain that the centre and the left will not make it to that final round.

THE SOUND OF SILENCE

The government began its case at the Supreme Court yesterday, telling justices that the creation of the European Communities Act, which incorporates the European treaties into British law automatically, was designed not to create rights but to expedite the implementation of treaties, created through prerogative power. The government is arguing that Parliament, through silence, has accepted that all areas not defined as within its scope as prerogative powers. David Allen Green gives his verdict over at the FT.

MO’MENTUM, MO’PROBLEMS

The continuing acrimony in Momentum has once again burst out into the open after a fractious meeting to set the organisation’s rules and procedures, Jim Waterson reports over at BuzzFeed.  Jon Lansman, the organisation’s founder, still owns the data and has the ability to shut down the entire group, should he chose to do so, something he is being urged to do by allies. I explain the origins of the crisis here.

STOP ME IF YOU’VE HEARD THIS ONE  BEFORE

Italy’s oldest bank, Monte Paschi, may need a state bailout after its recapitalisation plan was thrown into doubt following Matteo Renzi’s resignation. Italy’s nervous bankers will wait to see if  €1bn of funds from a Qatari investment grouping will be forthcoming now that Renzi has left the scene.

BOOM BOOM

Strong growth in the services sector puts Britain on course to be the highest growing economy in the G7. But Mark Carney has warned that the “lost decade” of wage growth and the unease from the losers from globalisation must be tackled to head off the growing tide of “isolation and detachment”.

THE REPLACEMENTS

David Lidington will stand in for Theresa May, who is abroad, this week at Prime Ministers’ Questions. Emily Thornberry will stand in for Jeremy Corbyn.

QUIT PICKING ON ME!

Boris Johnson has asked Theresa May to get her speechwriters and other ministers to stop making jokes at his expense, Sam Coates reports in the Times. The gags are hurting Britain’s diplomatic standing, the Foreign Secretary argues.

AND NOW FOR SOMETHING COMPLETELY DIFFERENT

It’s beginning to feel a bit like Christmas! And to help you on your way, here’s Anna’s top 10 recommendations for Christmassy soundtracks.

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Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.