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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Theresa May could live to regret not putting Article 50 to a vote sooner

Today's Morning Call.

Theresa May will reveal her plan to Parliament, Downing Street has confirmed. They will seek to amend Labour's motion on Article 50 adding a note of support for the principle of triggering Article 50 by March 2017, in a bid to flush out the diehard Remainers.

Has the PM retreated under heavy fire or pulled off a clever gambit to take the wind out of Labour's sails while keeping her Brexit deal close to her chest? 

Well, as ever, you pays your money and you makes your choice. "May forced to reveal Brexit plan to head off Tory revolt" is the Guardian's splash. "PM caves in on plans for Brexit" is the i's take. "May goes into battle for Brexit" is the Telegraph's, while Ukip's Pravda aka the Express goes for "MPs to vote on EU exit today".

Who's right? Well, it's a bit of both. That the government has only conceded to reveal "a plan" might mean further banalities on a par with the PM's one-liner yesterday that she was seeking a "red white and blue Brexit" ie a special British deal. And they've been aided by a rare error by Labour's new star signing Keir Starmer. Hindsight is 20:20, but if he'd demanded a full-blown white paper the government would be in a trickier spot now. 

But make no mistake: the PM didn't want to be here. It's worth noting that if she had submitted Article 50 to a parliamentary vote at the start of the parliamentary year, when Labour's frontbench was still cobbled together from scotch-tape and Paul Flynn and the only opposition MP seemed to be Nicky Morgan, she'd have passed it by now - or, better still for the Tory party, she'd be in possession of a perfect excuse to reestablish the Conservative majority in the House of Lords. May's caution made her PM while her more reckless colleagues detonated - but she may have cause to regret her caution over the coming months and years.

PANNICK! AT THE SUPREME COURT

David Pannick, Gina Miller's barrister, has told the Supreme Court that it would be "quite extraordinary" if the government's case were upheld, as it would mean ministers could use prerogative powers to reduce a swathe of rights without parliamentary appeal. The case hinges on the question of whether or not triggering Article 50 represents a loss of rights, something only the legislature can do.  Jane Croft has the details in the FT 

SOMETHING OF A GAMBLE

Ministers are contemplating doing a deal with Nicola Sturgeon that would allow her to hold a second independence referendum, but only after Brexit is completed, Lindsay McIntosh reports in the Times. The right to hold a referendum is a reserved power. 

A BURKISH MOVE

Angela Merkel told a cheering crowd at the CDU conference that, where possible, the full-face veil should be banned in Germany. Although the remarks are being widely reported in the British press as a "U-Turn", Merkel has previously said the face veil is incompatible with integration and has called from them to be banned "where possible". In a boost for the Chancellor, Merkel was re-elected as party chairman with 89.5 per cent of the vote. Stefan Wagstyl has the story in the FT.

SOMEWHERE A CLOCK IS TICKING

Michael Barnier, the EU's chief Brexit negotiator, has reminded the United Kingdom that they will have just 15 to 18 months to negotiate the terms of exit when Article 50 is triggered, as the remaining time will be needed for the deal to secure legislative appeal.

LEN'S LAST STAND?

Len McCluskey has quit as general secretary of Unite in order to run for a third term, triggering a power struggle with big consequences for the Labour party. Though he starts as the frontrunner, he is more vulnerable now than he was in 2013. I write on his chances and possible opposition here.

AND NOW FOR SOMETHING COMPLETELY DIFFERENT

Emad asks if One Night Stand provides the most compelling account of sex and relationships in video games yet.

MUST READS

Theresa May is becoming adept at avoiding defeats says George

Liv Constable-Maxwell on what the Supreme Court protesters want

Theresa May risks becoming an accidental Europe wrecker, says Rafael Behr

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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.