The government's proposals, leaked over the weekend, to re-reform the NHS raise some interesting questions.
First, credit where credit is due. The proposals recognise that "in practice, the NHS has not operated as the market intended by the 2012 Act. "
So, whereas the 2012 Act (aka the Lansley Reforms) built on earlier ones which tried to introduce market practices by talking about "purchasers" (roughly the the GPs) and "providers" (the hospitals and specialist services) by forcing different branches of the NHS to compete with each other, along with the private sector.
The new proposals intend to reduce the role of the private sector and enable the NHS to work more closely with local authorities.
The intriguing question is that such a proposal has come from the present government, with its hitherto attachment to the neo-liberal ideology of the superiority of markets in allocating resources effectively, the greater efficiency of the private over the public sector (hence the eye-wateringly expensive contracts with Serco et al in running the Test, Trace and Isolate system) and has, until the vaccination programme began, virtually sidelined local government public health authorities in trying to combat the spread of coronavirus.
If this is conversion, then it is welcome. Is it partly the resulte of the departure of Dominic Cummings?
Less welcome is the proposal to give the Health Secretary greater control of the NHS. The tendency to concentrate power in Westminster and Whitehall is sadly typical of both Labour and the Conservatives. They seem incapable of trusting the locals bodies.
This is a long term problem. Maybe the success of local public bodies in the distribution the vaccine will put it to rest. Let's hope so.Also worrying is whether yet another formal re-organization is the best way of going about things. In other contexts we are told that NHS staff are exhausted by the demands of the pandemic, and that when it passes its peak many will go on sick leave for both mental and physical rehabilitation, and quite a lot will actually leave. Do they need yet another formal reorganisation on top of this?
Experience shows that the moment an organisation is to be re-organised , the principal pre-occupation of the employees, and particularly the managers, becomes securing their place, and preferably promotion, in the new regime, and doing what they are paid to do, in this case heal people, becomes of secondary importance.
Cannot we just allow the unacceptable parts of the Lansley reforms to lapse (eg stop putting all contracts out to tender) and gradually introduce the new priorities?
PS (added 9th February)
This article from 2018 puts supportive flesh and blood on my penultimate paragraph: