The Government’s NHS and Social Care Bill is now back on track and much improved. The “pause” has been worthwhile and we now have a much better Bill. It was clear to me and to my Liberal Democrat colleagues that while the NHS is in need of reform to respond to the growing societal demands upon it, the approach in the original Bill was not on the right lines. The Liberal Democrat conference in March called for various amendments to the Bill, in particular making it clear that we need collaboration not competition in health care.
I have also been keen to see more democratic local oversight of the planning of health services in Bristol. When I became the MP for Bristol West in May 2005 I was on a steep learning curve to understand how decisions were made about the local NHS. At that time I had to meet with two Primary Care Trusts, two hospital trusts, the mental health trust and the strategic health authority. In the last 6 years there have been numerous reorganisations, chief execs and board members have come and gone. The fact is that if you asked anyone on Gloucester Road who runs the NHS in Bristol they wouldn’t have the faintest idea! So as well as a need to reform the NHS so it can deal with an ageing population, new clinical challenges and rising costs there was also a need to address a democratic deficit.
The changes to the Bill are a direct result of Liberal Democrats working positively within the Coalition Government and agreements made between the Prime Minister, Deputy Prime Minister Nick Clegg and the Health Secretary. The Bill will now recommence its House of Commons committee stage for detailed consideration of the Government’s amendments.
Firstly, the Bill will reaffirm the statement in the original 1946 NHS Act of Aneurin Bevan that the Secretary of State is responsible for securing a comprehensive national health service. This will duty be in line with the NHS constitution and will ensure that the interest of patients remains the paramount consideration.
But I am personally delighted to say that this responsibility will be augmented by a new duty to narrow health inequalities. I chair Parliament’s cross party committee on smoking and public health. For me, tackling the underlying causes of ill health such as smoking, alcohol abuse and other factors is much more important than reform of the bureaucracy of the NHS.
Integration and co-operation within the health service is vital if we are to get on top of the chronic diseases that beset an ageing population. The framework for allowing patients to choose from non-NHS providers will largely mirror the arrangements put in place by the last Labour government but without the cherry picking, price competition and extra payments that they encouraged. The organisation set up by the last government to regulate competition and “contestability” within the health service, “Monitor”, will now be tasked with promoting collaboration and quality, rather than competition. There will be no “cherry picking” of profitable services by the private sector and certainly no “privatisation”, which was never on the agenda but was the subject of much scaremongering.
What will actually happen in Bristol is that a new clinical commissioning consortia will replace the board of NHS Bristol, formerly known as the PCT. The South West Strategic Health Authority will also be scrapped. The new commissioning body will no longer be comprised solely of GPs, as proposed in the original Bill. It will also have representatives of hospital doctors and nurses and will have a either a lay chair or deputy chair to ensure that there are no conflicts of interest when services are being commissioned. The commissioners will also have to make their decisions in public. This is a new level of transparency in the NHS and a welcome reform. In addition the commissioners will be expected to operate within the same local boundary as social services, such as the boundary of Bristol City Council.
Public accountability will be further enhanced by the scrutiny of new Health and Well Being Boards, primarily consisting of local members of Bristol City Council. A third level of accountability will be achieved by Healthwatch, which will replace the existing patient forums. Healthwatch will be the main vehicle for providing patient feedback to the providers of healthcare, which in Bristol are mainly the two hospital trusts, University Hospitals (centred on the BRI and specialist hospitals) and North Bristol (Southmead and Frenchay) as well as Avon & Wiltshire Mental Health Trust.
The revised Bill thus has a new emphasis on local decision making, responsibility and accountability and it is hoped this will allow each area to progress at an appropriate pace towards the goal of a less bureaucratic but more innovative and responsive NHS.
The Coalition Government has listened and has brought forward reforms of the NHS that will enable clinically driven improvements. The revised Bill will promote collaboration not competition and will introduce real local control and transparency. I hope we can all now move forward and concentrate on tackling health inequalities and the conditions that really affect peoples’ lives.