Forest of Dean & Wye Valley

THE NHS: A guide through the wreckage

In Guest Feature on June 29, 2012 at 10:10 am

JOHN LISTER looks at the bureaucratic jungle thrown up by the Health & Social Care Act.

Andrew Lansley’s Act eventually passed through Parliament in March – despite massive and growing opposition, not only from health unions and campaigners but also from GPs and hospital doctors. It’s set to change the landscape of the NHS. The changes won’t be instant , but will be imposed as a forced march, with most implemented within a year.

It will sweep away the 150 or so Primary Care Trusts (PCTs) that currently hold the budgets to commission services for defined population areas, and also carry out duties such as protecting patients’ rights.

Also disappearing are Strategic Health Authorities, whose role included co-ordinating PCTs, overseeing NHS Trusts and organising the education of medical and professional staff.

Neither of these were especially popular with the public, nor were they a model of democracy. But they currently plan and control budgets of around £80 billion, and are set to be wound up by April 1st next year. Their replacement will be far worse Рa new and even more complex, many layered bureaucracy, including:-

* A new National Commissioning Board. This will have 3,500 staff, nine national directorates and a “national network of local offices”. It will work initially to oversee the establishment of Clinical Commissioning Groups (CCGs). The NCB will be the body that commissions primary care services, specialist health services and oversees CCGs, with extensive powers to select their leaders, to intervene and to decide whether or not to agree CCG proposals.

* Clinical Commissioning Groups will be the local level commissioners, composed largely of GPs with the token involvement of a hospital consultant and a nurse from outside the area – and in many cases management roles taken by non-GPs. CCGs need to seek authorisation from the NCB.

* Clinical Support Organisations will advise and in many cases shape the commissioning work done by the CCGs. Initially these will be hosted by the NCB – but no later than 2016 these will be hived off as commercial concerns selling their services to CCGs. GPs’ clinical decisions on where to refer patients for treatment will also be second guessed by a growing network of “referral management” organisations, some operated by the private sector.

Those NHS trusts that have not made the transition to Foundation Trusts are now on a forced march towards Foundation status – or face the threat of dismemberment and mergers by 2014.

* “Any Qualified Provider”: a register of organisations deemed to be “qualified” to deliver health care will be drawn up. GPs will be required to offer patients the option of any “qualified provider” in an increasing range of services from September this year.


There will also be up to 152 Health & Wellbeing Boards run by local councils. In theory board members will collaborate to understand their local community’s needs, agree priorities and encourage commissioners to work in a more joined up way. In practice, they can be composed of as few as six people, only one of whom may be an elected councillor, and their actual powers will be limited.

* MONITOR: This body regulates Foundation Trusts, but it is to have new powers. It is required to “exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services”. So its task is to ensure a maximum private sector challenge to existing NHS providers.

However the Act also says that it is free to “exercise its functions with a view to enabling health care services to be provided in an integrated way”. Nobody expects this token, toothless amendment from the LibDems to happen.

The “Co-operation & Competition Panel” is a grim relic of New Labour’s eagerness to turn the NHS increasingly into a competitive market. It lingers on under the chairmanship of fanatical privatiser, Lord Carter of Coles. It will continue to act as a complaints panel for aggrieved private sector companies demanding the right to a slice of NHS budgets in profitable services, and will serve as an advisory panel to Monitor.

The Care Quality Commission was formed in 2009, and is supposed to regulate the quality and effectiveness of care providers. But according to the Commons’ Public Accounts Committee it has “failed to fulfil this role effectively”.

Meanwhile, Healthwatch England is the latest, even more toothless, incarnation of a “patients’ voice”, and follows a growing list of inadequate and marginalised bodies set up after Labour scrapped Community Health Councils and stripped away their extensive statutory powers.

Abridged, and printed with permission from John Lister and the Socialist Health Association 


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