The NHS bill is political dynamite and a gift to Labour – The Guardian

Its no surprise that the new health secretary has balked at a gigantic new reorganisation bill before he had even got his feet under the NHS operating table. Five million people waiting for treatment, a workforce crisis and another Covid-19 tide already cancelling treatments is trouble enough. Sajid Javids anxiety is shared by many, Theresa May just one of those warning of the bills perils. But No 10 blasted ahead with the bill this week, impervious to this political dynamite.

Whatever their merits or follies, all new re-disorganisations are risky for Tory governments, who are never trusted with the NHS. How easy it is for Labour, backed by influential NHS figures, to arouse public suspicion of Tory intentions. Even Margaret Thatcher had to back off from her radical privatising impulse, to swear between gritted teeth that the NHS was safe in my hands. Voters might ignore the fiendishly complex history of NHS restructuring, but they will grasp one simple, sinister point: the government is seizing control of the everyday running of the NHS, in what the Health Service Journal calls an audacious power grab. Any local decision can fall under populist political whim from the top.

Tory MPs should recall how Andrew Lansleys disastrous 2012 Health and Social Care Act almost shipwrecked the David Cameron-led coalition, so loud were the voices of experts rightly warning against it. The then NHS CEO, David Nicholson, himself called that upheaval so colossal it can be seen from space as it broke the NHS into fragments, putting every service out to tender to anyone, public or private, enforced by competition law. Every part of the NHS had to bid and compete against others for any service: co-operation was illegally anti-competitive. This costly bureaucratic nightmare failed on every front while its privatising intent let Virgin Care and others eat into profitable community services.

Simon Stevens has spent his eight years in charge of NHS England struggling to reintegrate the fragments. This bill, the sum of his efforts, revokes the cursed Section 75 that forces tendering out NHS services. Instead, it sets into law Englands 42 integrated caresystems (ICS) designed to unite hospital, community, GP and mental services with local authority care and public health, to cooperate under one board with one budget for its local population.

But No 10 has added a nuclear ingredient: NHS England or any ICS can have its decision-making seized from it by the secretary of state or the prime minister on any pretext, and they will control appointments to those 42 boards. Expect politically obedient cronies.

This shifts the localising, accountable flavour of this bill. Where Stevens has reigned supreme, cleverly manoeuvring against the Treasury over funding, his successor will have no such creative independence, and will be subservient to political masters. The word is that Dido Harding, she of the 37bn test-and-trace failure, is out of the running, now that her riding friend, Matt Hancock, has gone. The front-runner should be the well-respected Amanda Pritchard, effectively NHS Englands deputy CEO. From outside the NHS, Leeds city council chief executive Tom Riordan is an interesting candidate, but can the job be done without deep NHS knowledge?

Thats something a contentious third contender has: Mark Britnell spent 20 years in the NHS, reaching a director-generalship. But since 2009 he has been KPMGs senior partner for global healthcare, from where he sat on the board advising Cameron on those disastrous 2012 reforms. He surfaced in public in 2011 when caught out telling a conference of private US healthcare executives that: In future, the NHS will be a state insurance provider not a state deliverer, praising the competition element in the Lansley reforms that meant: The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.

He claimed those quotes did not properly reflect the discussion but has never denied the lethal words. Private consultants have been on a constant revolving door with the NHS: management consultant use trebled between 2016 and 2019, despite pledges to reduce the practice. To choose him would signal a defiant culture war confrontation, suggesting Sajid Javid really does lean toward the views of his favourite writer, Ayn Rand, from whose book The Fountainhead he reads the courtroom scene twice a year: the NHS is surely Rands perfect symbol of oppressive socialist statism.

The highly politicised selectors shortlisting applicants for the new head of the NHS are from No 10, the Treasury and the Cabinet Office. Bizarrely, candidates get a full days psychometric testing. While experts say basic competences need testing some high-fliers turn out to be innumerate a full day means personality testing, which in such a senior job is as much use as phrenology, and far less use than the Harry Potter sorting hat. Under this level of political control, heres hoping the winner has the cunning to appease their political masters in interviews, but once in post will spring out as a Tiggerishly independent NHS defender.

This bill is a gift to Labour: Javids leaked letter asking for delay warned of significant areas of contention to be resolved. You bet. How can the bill legislate for joining up with cash-starved local authorities, without a social care plan? The bill gives ICSs 70 stern performance measures to meet, but the previous 18-week waiting limit has vanished, only measuring 52-week waits. Numbers of patients needlessly blocking NHS beds will be counted against each ICS, but what can they do when theres too little social care to release patients? Choice will be enforced from on high, but with 5 million waiting, where are the spare beds to allow it?

Labour in power effectively abolished waiting beyond 18 weeks, often by using the same terror and targets methods but heres the crucial difference: that was in return for an NHS budget rising by 7% a year. In the last decade, the NHS budget per capita fell in a rapidly ageing population. Dont expect fiscally tough Javid to demand enough from the Treasury to make these new ICSs flourish. Hes right to fear this bill is contentious: its packed with ammunition for Labour.

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The NHS bill is political dynamite and a gift to Labour - The Guardian