Andrew Lansley proposes an independent NHS for England

Keeping up the momentum that has characterised the post-Blackpool Tories [we have also had announcements on English votes for English laws, a new emphasis on immigration and withdrawal from talks on party political funding] Andrew Lansley publishes a draft bill to make the NHS in England independent.  [Message to CCHQ: Nothing on conservatives.com about this as I write.  Time and time again the party website is behind the news].

You can read about the proposals at the BBC, Sky, Telegraph, FT and Guardian.  Andrew Lansley, who has been rising steadily in ConservativeHome's shadow cabinet league table, was also on the Today programme just after 7.30am.

Here are some of the Tories' key proposals:

• Two-thirds of the NHS' budget would be put in GPs' hands according to The Guardian.  GPs would decide which services would by provided at their own surgeries and which would be purchased from NHS hospitals and from private providers.
• An NHS Constitution would define the level of treatment that patients could expect and would include the idea that healthcare would be free at the point of use.
• A new independent health board that would take over the existing Whitehall Department's responsibilities and so free the system from "political tinkering".  Its responsibilities would include the allocation of resources, the setting of national standards of care and the issuing of commissioning guidelines.
• The Health Secretary would then become the Public Health Secretary - focused on issues like smoking and obesity.
• There would be a new body - HealthWatch - which would handle patients' complaints about treatment.

Labour Health minister Ben Bradshaw MP immediately rejected Tory overtures to help them implement the draft bill that could be introduced by the Opposition or an individual MP:

"It is simply wrong to suggest that taxpayers should invest £90bn in the NHS but there should be no political accountability for how that money is spent.  Under Tory plans, ministers would be powerless to intervene where a hospital is failing."

Birmingham University's Professor Chris Ham, the former head of the Department of Health's strategy unit, told the FT that while the "details differed considerably, the thrust of the Conservatives' bill would have produced similar results as Blairite reforms".

Comments

[John Moss]

This is good.

We should never have made Fundholding voluntary in the 1990s. If it had been universal, Labour would never have been able to dismantle it, go backwards for four years, then have to bring it back again.

Anything which moves money closer to the patient has got to be better than the bureaucratised mess the NHS is today.

[601]

The current system is far from perfect, but how will parliament be accountable to voters if the Tories plan goes ahead? (a select comittee is not enough).

[Moral minority]

Ben Bradshaw has a point. Taxpayers and patients hold the Government, through Ministers, accountable for the performance of public services. Creating a new quango to evade responsibility is just a cop out.

A new Public Health Secretary to focus on smoking and obesity? Lansley's real agenda he wants to become the public health nanny! What next - fat food taxes or bans on smoking in your own home? He has just gone down in my ratings.

[John Leonard]

Unfortunately, this seems to be what was in the Public Service Reform report. I didn't like it then and I don't like it now. The PSR report was probably the most bueaucratic and inaccessible report of them all. Where QOL failed because of poor proposals, the PSR report failed because it was fundamentally wrong. It was just centralist, socialist nonsense.

The most annoying thing about this proposal is that Lansley seems to want to disavow responsibility for the country's medical services handing them to an unelected quango. This maybe politically expedient, absolving political responsibility, but it hardly displays confidence in the Conservatives being able to address the issues the NHS face.

Before he even considers any of this the NHS structure should be stabilised, reformed and the bureaucracy significantly cut.

Then it should not be handed to a Quango. Front Line services such as A&E, GP's and maternity should be devolved (to the counties?) with a health supremo in each area elected democratically (as we propose for Mayors and Police Chiefs).

This would leave the strategic services (such as Papworth for example) under the control of the UK Government, which ideally would be devolved to a national assembly if one were created once it they had been reformed and restructured.

Public Health should be downgraded and handed off to a department dealing with Quality of Life issues and the health fascists should be put back in their box. We need people treating us NOT people telling us how to live our lives. Particularly, when there is less and less time in peoples lives to spend on making sure we are healthy.

Unfortunately, (as with the English Grand Committee) Labour are right. In this case we should not fund an NHS where there is no democratic accountability. 'Nanny' Lansley is wrong and these proposals fly in the face of the ethos of localism and accountability that the Conservatives are supposed to stand for.

Anyway if it goes ahead he will get his just deserts. Public Health is a poison chalice and 'Nanny' Lansley will become the most ridiculed minister in Government (when we win the next election that is)!.

Back to the drawing board I think!

[Dave Bartlett]

I'm not keen on another big quango. Why can't they just give decision making power to county councils? Then local taxpayers can fund the health service they want to have.

[Opinicus]

I must declare a vested interest as an NHS GP

This is not a sensible policy. It is structural change again as though that ever changes anything. A QUANGO allows the government to hide behind the incompetence of others. IF the government is going to retain control of health supply as well as health policy - though God knows why given its persistent record of continuous failure - then it should at least be directly accountable. Otherwise healthcare provision should be genuinely separate and professionally run and patients should have genuine and meaningful choice. This means vouchers or at least devolution to GPs through the reinstatement of total fundholding ie PBC without the current stifling PCT control. If it gets no bolder than this now, then government, if it ever comes, is going to be one prolonged explanation and excuse - exactly the same as for the present shower.

[Lindsay Jenkins]

While no doubt Mr Lansley is well intentioned the words deckchair and Titanic spring to mind.

I agree with those above who say this proposal is just another quango.

Governments and their quangos can't run healthcare period.

Let us have privatised health care with the government acting as safety net for those who cannot pay either directly or via insurance.

[Moral minority]

Excellent post, Jonathan.

Dave Barlett should note that not everyone has a county council. The last thing I want is Red Ken running London's health service.

[Matt Wright]

The first thing we have to understand is that the NHS is a truly massive organisation and it just is not even remotely possible to direct this from the top on a "push" basis. Such thinking is utterly backward and doomed to failure (think of Russian bureaucrats trying to make tractors). The process has to be a "pull" methodology from the patients (consumers acting with the advice of the local GP working with specialists) in manufacturing terms and it has to see real empowerment of ordinary NHS staff pushing decisions downwards centred on quality and whole tiers of wasteful managers above sacked.

[Jake]

This is an EXCELLENT IDEA .

The above posts reveal that there are still far too many people who remain bewitched by Britishness and are easy meat for Labour propaganda which endlessly refers to "the NHS " when it means the English NHS .

In fact , the 1946 Act which set up the single British NHS has long ago been superceded.It was ended deliberately by Blair and his cabal who successfully and with the aquiescence and cooperation of the other parties ( shamefully including the Conservative party ) and the press ,continues to this day to kid the people of England and her pathetic MP's that somehow the British NHS continues .

The 1998 Scotland Act specifically handed over the running of that part of the British NHS which was in Scotland to the Scottish executive .
Since then there have been numerous pices of legislation which have reinforced and expanded the separation . There are now four NHS's , one each for Scotland , Northern Ireland and Wales all administered by their own governments
- and the " NHS in England " as the Labour sometimes reluctantly calls it
ie the English NHS , still administered , governed and ruthlessly sqeezed by an uncaring British government , heavily staffed by Scots who are committed by oath to considering Scottish interests always to be "paramount ". The Barnett Rules apply - of course - to health care and that means that there is massive relative underfunding of England - by the British government .

A Quango ? - so what . The idea of an NHS Board - even an English NHS Board - has already been floated and not met with derision so far as I know . Most English people will probably react by saying that such a board will at least be a lot less political than the present lot and might well be better and more responsive by far .

Re the remarks pertaining to vouchers etc , new departures are worth entertaining . One of the benefits of that limited and disguised separation of NHS's which has taken place so far is that we in the English NHS
( I also have to declare an interest here as an NHS GP )
really do not have to bother any more with what goes on in the other three since administration of the NHS in England at local level is already spcific to England . We are bombarded every day with government literature from one quango or another
( and there many which could be culled to make room for an English NHS Board )
which pertain only to England .
The GP trade mags have long ago accepted the separation of the NHS's and write articles and comment accordingly .
Typically , some GP's haven't yet cottoned on .
The subtle and not so subtle inter national rivalry for money from the British government , which used to be such a marked feature of the old UK-as-Yugoslavia when dealing with the grab for health funds and much else , is no longer there .

Proposals for vouchers , insurance etc ,
if applied to England only , will meet with a far more considered response on their merits and avoid that reflex socialist rejection of all change which is such a marked feature of Scottish health politics .
They simply won't be involved .

By the way , the much hated NICE - the National Institute for Clinical Excellence- this begs the question as to which nation , in fact it applies only to England , used to be , confusingly , to England and Wales
-should be renamed .

I don't think the English have much time for overweaning titles such as this , it should be
English Clinical Review Committee .

Much more understandable and sums up its remit in one go .