Friday, 24 June 2011

NHS Reform – 'cut and paste' politics

For a few weeks I have been avoiding watching the BBC coverage of proceedings in Parliament because the waffle and posturing by the majority of MPs makes me tense. But as the Health and Social Care Bill has been going through recommittal proceedings this week, I felt I should tune in to BBC Parliament, and the weekly political panel show, Question Time, to make sure that I stay on track with the progress (and I use the term loosely) of the Bill.

Recommittal sadly puts me in mind of funerals and the ‘committal stage’ and I must confess that following the political melee of this Bill has a similarly depressing effect on me. Alas, politics is hampering, not facilitating NHS Reform.

The debate in Parliament on Tuesday was to pass a motion for the Bill to be ‘recommitted to a public bill committee for reconsideration’. Approximately 160 amendments are being made to the Bill, incorporating changes to 63 clauses and 6 schedules, a significant rethink on the content of the original Bill.

The debate was meaningless, as this recommittal was fully supported by the coalition so this was a rubber stamping exercise to allow the Bill to progress to Public Committee. Even though there were very few MPs in the House for the discussion, which was limited to one hour, I found the spectacle unusually entertaining.

Andrew Lansley, UK Secretary of State for Health, allowed another Health Minister, Simon Burns to do the talking. Burns rambled on at the outset with the usual political schpeel and was admonished by the Speaker (for overseas readers – the speaker ‘controls’ MPs during parliamentary sessions) for wasting time and not specifying the point of the motion. He may have been trying to use as much of the allocated hour to splurging soundbites to avoid discussion and his performance was petulant, grumpy and defensive. He talked of a ‘bottom up culture of clinical leadership’. I have no idea what that actually means and could only think of proctology!

Burns continued ‘while the pause has finished, we will never stop listening’ … mmm – why don’t I find that reassuring?

John Healey, Labour Health Minister, was much more eloquent and persuasive. Admittedly – it is so much easier to be in opposition when it comes to a gritty issue like the state funded health service, but even so, he spoke with confidence and conviction. The Labour line was that the entire Bill should be reconsidered as changes reviewed out of context do not give a clear picture of how the reforms will ultimately work. He talked about ‘A wasted year of chaos and incompetence’ and the ‘sclerosis of the health service’ and sadly I agree.

John Pugh of the Lib Dems got up to support the amendments but wasn’t convincing and it struck me in a moment of madness how wonderful it would be to have a free vote on NHS Reforms, with no party Whip to bully MPs into agreement. Now that would be an interesting debate

BBC Question Time was equally depressing. What was once a lively panel show with political and topical debate – it is usually now a deadly regurgitation of party political speak and ‘on the fence’ opinions. One consensus view was that the Coalition, rather than impressing the general and political population with their listening skills and flexibility, are constantly weakening their position with a succession of U-turns. These U-turns include privatisation of forests, sentencing policy, defence cuts and university tuition fees. So moving the goal posts on NHS Reform seems like just one more change of heart. Indeed the coalition seemed to have made more U-turns than a motorist with a malfunctioning Sat Nav!

But The NHS is different. Why? For two main reasons Firstly, the vast sums of money involved, year in, year out and secondly because this Bill effects each and every one of us. Even the fabulously rich get taken to an NHS hospital in an emergency. This is just too important to get wrong.

The politics have confused the issue. The Public Bill Committee will now be reviewing only part of the Bill. For instance only the amended clauses involving Monitor, the regulatory body, will be reviewed, out of context of the total responsibilities. Cut and pasted reports rarely work and a ‘cut and paste’ parliamentary Bill should not be the way forward

We are no nearer a real solution to NHS woes. Some units are ‘business as usual’, some GP practices are staffing up for consortia whose remit may now change, some agencies are continuing, with fewer staff, to undertake functions they expected no longer to deliver. The politics go on. The Lb Dems try to take credit for a U-turn, the Tories try to show they are still listening and Labour enjoy something to get their teeth into in opposition.

Meanwhile the NHS lumbers on – a rudderless ship whose crew are doing their level best to keep afloat while the admirals play chess.


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