Nick Clegg claims that he has secured eleven of the 13 changes demanded by his party at its spring conference in March. This is Labour‟s analysis of how well he has performed according to his own goals.
1. More democratically accountable commissioning. Secured say Lib Dems.
Failed. There will be no elected members or councillors on commissioning consortia boards, while Health and Wellbeing Boards are only able to give their opinion to consortia – consortia are under no obligation to abide by that opinion. (Clause 23 – 14Z12)
2. A much greater degree of coterminosity between local authorities and commissioning areas. Secured say Lib Dems.
Fallen short. Consortia will be more coterminous with local authorities than previously planned, but the populations for whom consortia will be responsible will be based on the practice lists of the GPs not the consortia‟s geographic boundaries. These practice lists don‟t have to bear any relation to local authority boundaries. (Clause 10)
3. No decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed GP consortia. Secured say Lib Dems.
Fallen short. Consortia will not be as transparent as PCTs are currently. PCTs have to abide by the Nolan principles on public life and the Public Meetings Act, while consortia do not. It is left up to them to decide what business to conduct in private and not in public. (Schedule 2 – 5B)
4. The complete ruling out of any competition based on price to prevent loss-leading corporate providers under-cutting NHS tariffs, and to ensure that healthcare providers 'compete' on quality of care. Secured say Lib Dems.
Fallen short. There will continue to be a number of NHS services not covered by the tariff. With greater competition from private providers, this means that price competition for those services is not ruled out.
5. New private providers to be allowed only where there is no risk of "cherry picking" which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases, and where the needs of equity, research and training are met. Secured say Lib Dems.
Failed. The Government amendments addressing cherry-picking (now in the Bill as clause 108) only required that a provider be “transparent” in how they chose their patients. It said nothing about actually preventing providers from picking the easiest and most profitable patients. Furthermore picking patients is only one part of cherry-picking. Private providers will also be able to pick the easiest and most profitable types of treatment to provide, for example elective say surgery, while leaving the NHS to do the expensive, loss-making treatment, like emergency inpatient care. Nothing in the Government‟s amendments prevents this, and therefore risks destabilising those NHS services. Labour has tabled an amendment to achieve what the Government has failed to do (Amendments 42 and 43)
6. NHS commissioning being retained as a public function in full compliance with the Human Rights Act and Freedom of Information laws, using the skills and experience of existing NHS staff rather than the sub-contracting of commissioning to private companies. Secured say Lib Dems.
Failed. The Bill does nothing to prevent consortia outsourcing their entire commissioning function to private companies, and only having a limited oversight function. There is no compulsion for consortia to employ any NHS staff. (Schedule 2, 3(3) and 10)
7. The continued separation of the commissioning and provision of services to prevent conflicts of interests. Secured say Lib Dems.
Failed. The Bill gives power to GPs to commission services, and allows GPs to have a stake in health companies that provide services that the consortia might commission. Furthermore the GPs‟ surgeries themselves might be providing community services that the consortia might commission. The provisions against conflicts of interest are very weak – consortia only have to make provision “for dealing with conflicts of interest”. (Schedule 2, 7(2))
8. An NHS, responsive to patients' needs, based on co-operation rather than competition, and which promotes quality and equity not the market. Secured say Lib Dems.
Failed. The Bill gives extensive competition enforcement powers to Monitor, the new economic regulator, including powers to fine hospitals up to 10% of their turnover for anti-competitive behaviour, and powers to investigate and direct commissioning consortia on competition. Monitor has a new duty to promote integration, but that is less undefined, whereas the scope of anti-competitive behaviour is well defined in existing UK and EU competition law.
9. Uphold the NHS Constitution. Secured say Lib Dems.
Fallen short. Consortia and the NHS Commissioning Board have new duties to promote the NHS Constitution. But there are no regulations placed upon them to determine how they should do this, or penalties if they fail to do so. Nor are there any regulations placed on them to ensure they have to treat patients with 18 weeks, as mandated under the NHS Constitution.
10. Ensure full scrutiny, including the power to require attendance, by elected local authorities of all organisations in the local health economy funded by public money, including foundation trusts and any external support for commissioning consortia; ensuring that all such organisations are subject to FoI requirements. Secured say Lib Dems.
Failed. There is nothing in the Bill that ensures that private companies carrying out commissioning functions will be covered by the FoI Act. Their decisions will be stamped „commercial in confidence‟. (Schedule 2, 3(3))
11. Ensure health and wellbeing boards (HWBs) are a strong voice for accountable local people in setting the strategic direction for and co-ordinating provision of health and social care services locally by containing substantial representation from elected local councillors; and by requiring GP commissioning boards to construct their annual plans in conjunction with the HWBs. Secured say Lib Dems.
Fallen short. Consortia are under absolutely no obligation to abide by the views of Health and Wellbeing Boards. All a Health and Wellbeing Board can do if it is dissatisfied with the consortia is pass its opinion on to the NHS Commissioning Board, which has no power to intervene and force changes on the consortia. (Clause 23, 14Z12)
12. Ensure commissioning of health services has some degree of accountability by requiring about half of the members of the board of commissioning consortia, alongside GPs, to be local councillors appointed as non-executive directors. Alternative Secured say Lib Dems: Instead, they say they will strengthen the accountability of commissioning through health and wellbeing boards (which will have a majority of councillors if that is what local councillors want). This has the support of the movers of the conference amendment.
Fallen short. The Health and Wellbeing Board does not have powers to influence consortia. See point 11 above.
13. Offer additional freedoms only to foundation trusts that successfully engage substantial proportions of their local populations as active members. Alternative secured: Monitor, rather than the foundation trusts themselves, will retain a supervisory role.
Failed. Monitor is an independent quango, with no democratic accountability, and cannot be expected to be a local voice for patients at each Foundation Trust. Furthermore if FTs get into trouble there will be no mechanism to turn them back into NHS Trusts, as now.
Nick Clegg claimed to have secured 11 of his Conference‟s 13 demands. The reality is he has failed on 7 of their demands and fallen short on 6.
Original scorecard published here: http://www.guardian.co.uk/politics/2011/jun/12/nick-clegg-health-reform
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