The claim
“The Department of Health publishes mythbuster on NHS modernisation”
Department of Health, 11 October 2011
Cathy Newman checks it out:
Revolting peers have landed their first blows on Andrew Lansley. Today they’re starting a marathon two-day debate on the health and social care bill, and the government is worried.
Labour peers want the legislation dropped altogether, but it’s an amendment from two crossbenchers, Lords Owen and Hennessy, which is really worrying ministers. They want part of the bill sent to a special select committee.
One minister told me if the two peers get their way the whole bill would fall, as scrutiny by a special committee would drag on for months. So no wonder Mr Lansley has been spotted pressing the flesh in the Lords, and the Department of Health has hit back with a “mythbusting” dossier. Will it succeed? Over to the team.
The analysis
The DoH picked off ten “myths” at speed, but with the Lords debate due to trudge on until the vote tomorrow, FactCheck has the time to stop, listen and learn. Here we tackle the issues causing the most alarm:
Claim 1: The role of the Health Secretary
“The Bill does not change the Secretary of State’s duty to promote a comprehensive health service”
The Department is right to point out that the “duty to promote a comprehensive health service” remains unchanged since 1946, but they’ve dodged the argument, which is all about the next line in the Bill.
Mr Lansley currently has to “provide or secure the provision of services”, which means he is directly legally responsible for delivering healthcare. He wants to replace the “duty to provide” with a subtly different duty – to “exercise the functions conferred by this Act so as to secure that services are provided”.
Critics say that, along with a “hands-off clause” later on in the Bill, it makes the government less accountable. And some argue it’s all about bringing in privatisation by the back door.
Lawyer Peter Roderick says the Health Secretary wants to shirk his traditional legal responsibility to provide care so more power and responsibility is shifted on to Clinical Commissioning Groups.
They will then have the freedom to run things as they see fit – awarding contracts and charging for commercial activities – without interference from Whitehall.
Mr Lansley says the change in wording is all about reflecting the reality of how the NHS works: ministers no longer provide care directly, they just commission other people to do it.
He freely admits it’s a more hands-off approach. A Health Secretary will not intervene in the running of clinical commission unless there is a “significant failure” or a public health emergency, he said.
Claim 2: Bureaucracy
“We are abolishing needless bureaucracy, and our plans will save one third of all administration costs during this Parliament”
Abolishing Primary Care Trusts and Strategic Health Authorities will save admin costs – though Professor John Appleby, chief economist at The King’s Fund points out that “the sheer number of changes being made to the health system as a result of the government’s reforms risk creating additional bureaucracy”.
The Royal College of GPs says the number of NHS statutory bodies is going to climb from 163 to 521. New clinical commissioning groups will be set up, and there will be clinical networks, senates and new arrangements for health and wellbeing boards – all of which could pile on administrative work.
A spokesman for the Nuffield Trust also pointed out to FactCheck: “We would question if the original assumptions for administrative spending for Clinical Commissioning Groups are still valid and whether CCGs will be adequately resourced to discharge these activities.”
Claim 3: Competition
“We are not introducing competition. In fact, we are putting in new safeguards to ensure competition will be used to drive up quality, and not be based on price. Nor will we allow competition to be a barrier to collaboration and integration”
Firstly, as Prof Appleby points out, competition already exists in the NHS and will increase under the government’s reforms.
He told FactCheck: “Evidence suggests that this will be beneficial to patients in some areas of care but not in others, so the key will be to get the balance right between competition and collaboration.”
Health Secretary Andrew Lansley told Channel 4 News that competition should be “in a place where it is part of the tool kit”.
The government has clarified the original wording of the Bill – which would have seen the sector regulator Monitor promote competition where appropriate. Monitor will now have a duty to prevent anti-competitive behaviour, rather than promote competition.
But it’s still not quite clear how far the Bill will open up the NHS to the full force of EU competition law. According to the Nuffield Trust, the lack of relevant case law will mean that in reality the pace of change in relation to competition will be heavily dependent on the policies and behaviour of Monitor.
Claim 4: Privatisation
“Claims that we aim to privatise the NHS amount to nothing more than ludicrous scaremongering. We have made it crystal clear, time and again, that we will never, ever, privatise the NHS”
The King’s Fund and the Nuffield Trust both agree there’s some scaremongering afoot. The NHS is not going to be privatised. However, there’s no denying that the Bill does create more opportunity for the private sector to get involved.
Prof Appleby told FactCheck: “The outcome of this remains to be seen but it is likely to result in an increased role for the private sector in the health system. However the private sector has been involved in the NHS since 1948 and the NHS has bought services from private providers since that time.”
The Nuffield Trust told us the original Bill had some coherent, but radical logic in it – that a fully bottom-up, clinically-owned network of GP commissioning groups would be free to make calls on care. The revised Bill however, puts stronger emphasis on accountability for public funds.
Meanwhile, former banker Lord Howe told an audience of private sector providers last month that though the NHS “will not give up their patients easily”, there were “genuine opportunities” for those wishing to “enter the fray”.
Cathy Newman’s verdict:
Many of the myths have more of a basis in fact than the Department of Health would care to admit. The Health Secretary will still “promote” the NHS – as he and his predecessors have done since 1946. But he no longer has a duty to “provide” a comprehensive health service – ie he’s no longer directly and legally responsible for it. That, say his opponents, leaves the door open to privatisation, if not now then in the future.
It’s such a toxic issue that the Tory health minister Lord Howe has just hinted at a U-turn, saying: “I am aware of the concerns around this area and we are ready to listen to such concerns and make any amendments necessary to put this issue beyond all doubt.”
And what of the other so-called “myths”? Bureaucracy is alive and well in the reformed NHS: the number of statutory bodies will more than triple, if you believe the Royal College of GPs. And as for competition, the Health Secretary has himself admitted that it should be “part of the tool kit”.
Finally, although it is true that the NHS will not be privatised, one of Mr Lansley’s colleagues has admitted there will be big opportunities for the private sector. FactCheck finds it can’t give the government’s mythbusters a clean bill of health.
The analysis by Emma Thelwell and Patrick Worrall
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