'Devil will be in the detail'

Health secretary Matt Hancock today (February 11) announced government plans to overhaul the NHS in England by reversing reforms of the health service first introduced by then-prime minister David Cameron in 2012.

Hancock said the new reforms, set out in a white paper published today, will aim to create a “more integrated, more innovative and responsive” NHS, which will try to eliminate “burdensome bureaucracy”.

But Labour, Unite and other health unions have questioned the timing of the announcement – in the middle of the pandemic – and have argued that any reforms must be coupled with robust funding for social care.

Unite has also said that the changes must address other problems in the health service such as staff shortages and rampant privatisation. The union which has 100,000 members in the health service, said that there was too much rhetoric from Matt Hancock on tackling bureaucracy and not enough about how the integration of health and social care would function on a daily basis.

Commenting on the proposals, Labour’s shadow health secretary Jonathan Ashworth said, “Boris Johnson must explain why a reorganisation in the midst of the biggest crisis the NHS has ever faced is his pressing priority.

“With 192,000 patients now waiting over a year for treatment, our cancer survival rates shamefully low by European standards and mental health services stretched to the limits, Ministers need to outline how an NHS reorganisation at this point in time will deliver the standards of care patients deserve.”

It is understood that the proposals will include ditching the tendering rule first introduced by the Health and Social Care Act 2012, where NHS bodies are forced to tender contracts for clinical services worth more than £615,000 and compete with private companies to win the contracts.

Although an ostensible win against NHS privatisation, critics have pointed out that the proposals don’t go far enough and that there will be no change to rules on procurement of non-clinical services, including  ‘professional services’, such as digital systems.

“There is no proposal to roll back the contracts of services already outsourced, or even terminate the contracts when they expire,” Dr John Lister, secretary of campaign group Keep Our NHS Public, told the Guardian.

The white paper has revealed plans to give far greater power to the health secretary over arms-length bodies such as NHS England, which oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the health service in England, as well as the Care Quality Comission and Health Education England.

In practice, this would mean NHS in England would be subject to much more political control.

Unite has called for more detail on the reorganisation plans.

 “The devil will be in the detail as to how the promised improvements will roll-out,” said Unite national officer Jackie Williams.

“The early indications that it won’t remove the private sector – a key component of the 2012 Act – and no change in the rules of procurement of non-clinical services,” she added. “Unite supports the removal of section 75 that brought NHS commissioning under EU procurement legislation.

“But we have little faith that ministers have lost their obsession with outsourcing health services, despite the private sector’s abject failure over the ‘test and trace’ programme roll-out and the fiasco of how the PPE contracts were awarded,” Williams noted.

“The successful implementation of the vaccination programme by the NHS ‘family’, with more than 13 million people receiving their first dose, is a tribute not only to the doctors, nurses and army of volunteers, but what a health service unencumbered by unnecessary private sector involvement can achieve – truly, a heroic effort,” she went on to say.

“There  seems to be no plan to grapple with the ‘recruitment and retention’ staff crisis which sees NHS staff vacancies ranging from an estimated 80,000 to 100,000, many of them nursing posts desperately needed in the battle against Covid-19. NHS staff are exhausted after a year of caring for Covid-19 patients.”

Unite national officer for health Colenzo Jarrett-Thorpe added, “We need to hear more from Matt Hancock about how his reforms will lead to tangible benefits for patients and staff

 “The integration of health and social care, long delayed, but desperately necessary, will need a serious amount of funding. Matt Hancock has repeatedly said that the government is ‘committed’ to providing the extra funding – the figure of at least £4bn is often quoted.

 “That commitment must be translated into action because the success of the NHS depends on rapidly improving social care provision in this country,” Jarrett-Thorpe noted.

 “The lessons of the pandemic have provided a big opportunity for a reset as to how the government has viewed an under-resourced NHS and an underpaid workforce over the last decade.

 “It is time for the rhetoric to give way to a practical blueprint for revitalising the NHS and restoring the morale of its dedicated workforce.”

By Hajera Blagg