Organisations of health professionals have been lining up to denounce the Health and Social Care Bill. In view of the potential hazards to patients arising from reforms to the National Health Service in England, it is not hard to understand why.
Many problems have been identified in the Bill. At a time when the service is under particular pressure, for instance as a result of an epidemic or pandemic, these might become particularly apparent.
In the past, the NHS and partners such as local authorities have worked together to tackle such situations. However, successive governments have embarked on expensive reorganisations that have increasingly fragmented the NHS. The Health and Social Care Bill seems set to take this further still.
There will be a national public health service, and local authorities will also have a key role in public health. But the health professionals planning and delivering services on the ground may work for a variety of agencies, with varying arrangements.
Let us imagine the scenario in a particular locality in a few years. Suppose there is a surge in illness, and the two local NHS hospitals are rapidly filling up and about to run out of beds. One hospital is managed by a private company under contract, the other led by governors and a separate board of directors who do not always agree.
Their services are commissioned by a clinical commissioning group made up mainly of GPs, some self-employed and others working for one of the private firms that have been increasingly running local health centres. Day-to-day work connected with commissioning is largely carried out by a consultancy firm specialising in finance, whose staff do not fully understand the urgency of the situation. The local health and wellbeing board, and clinical senate for a wider area, also have a say in planning.
District nursing is supplied by a social enterprise made up of ex-NHS employees, which won this contract through a tender process. GP and pharmacist services, who along with district nurses are being called on to manage as many patients as possible in the community to reduce pressure on hospitals, are commissioned separately, by a national Commissioning Board.
Community and primary care services too are struggling to cope. There is some spare capacity in community health services in a neighbouring borough, but they have a contract with a clinical commissioning group for a different area.
How easy would it be for the different agencies to coordinate their activities? How quickly could contractual arrangements be renegotiated so that, for instance, priorities could be altered and providers take on extra staff? Would commissioners’ lawyers delay this, on the grounds that unsuccessful tenderers might take legal action because contract variation had distorted competition?
Such problems might be replicated nationally. The human cost if things go wrong is potentially extremely high – and there would also be a major economic cost. The reforms raise serious questions about the values that guide society.
(c) Savi Hensman works in the equalities and care sector. She is an Ekklesia associate, and a regular media commentator on politics, society and religion.