Too much water under the bridge?

Fri 17 Feb 2012

Jon Restell's blog challenges the assumption that the Health and Social Care Bill is needed because it has already been implemented

Plenty of people believe that there is now no choice but to go ahead with the Health and Social Care Bill. They think ‘too much water has flowed under the bridge’. We are told such people include the Prime Minister. It’s not a trivial point. But are they right?

The ‘too much water’ argument relies on two related ideas: the existing system has effectively collapsed in the last two years, and the new system has effectively come into being, needing only the Bill to give it legal force.

Has the new system come into being? Well, see what you think.

Two weeks ago, 55,600 staff in the existing primary care trusts, strategic health authorities and various arms length bodies received letters from their employer with the available information about their futures in the new system. Most recipients got the ‘can’t tell you where your function’s going’ version. No-one received a letter that said anything about their particular job.

Similarly, the design of the functions and structures of new organisations is being conducted at a frantic pace, is far from finished and has barely begun in some cases.  There remain huge gaps in a very long list. Every day I speak to some official or other who cheerfully tells me ‘We’re making it up as we go along’. Earlier this week I listened wearily as someone explained that there weren’t enough finance staff for the much greater number of new organisations the Bill will create.

Does this sound to you like a baked cake just waiting for Parliament to pop a cherry on the top?

I don’t believe the system has collapsed either. It has certainly been paralysed – disgracefully – for nearly two years, as politicians make an unholy hash of reform and law-making. It has lost too many good people. But it has not collapsed.

I am not for a moment saying this paralysis or these lost people have not been hugely damaging.

Yes, important and difficult re-organisations have been delayed. Yes, important commissioning decisions that would have made a real difference to real patients have got lost in the administrative chaos. Yes, the loss of talented people has been negligent and costly. Listen to a manager explaining bitterly why her plans to improve end of life care have been shelved, letting down her local patients, their families and their clinicians, and you wonder how any Government Minister has the nerve to celebrate the fact there are fewer and fewer people like her. Or to advance the claim these changes are primarily about improving the care of patients.

But we can overcome paralysis and patch up and modify the existing system. Like many others, MiP believes that what needs to be done can be done in the existing system.  We need to stop mucking about with structural change and Fancy Dan policy, designed in and for an era when the money never stopped flowing.  Instead, everyone in the NHS – clinicians and managers – needs to concentrate on patient care and the best use of money.

Whatever position you take on the Health and Social Care Bill, please don’t take it because you think too much water has flowed under the bridge.