News / News review: Health bill uncertainty

Uncertainty surrounding the health and social care bill continued in May as divisions within the government, together with the constant stream of criticism and suggestions invited by the listening exercise, contributed to a growing sense of malaise around the reforms.

With the Liberal Democrats taking a battering in the local government elections at the beginning of the month – and the electorate’s overwhelming rejection of the Lib Dem-championed AV voting reform – party leader Nick Clegg needed to show the electorate and disillusioned party members that he would stand up to his Conservative partners in government.

While open warfare might be too strong a description, there are certainly differences of opinion between the Lib Dems and the Conservatives in the government, particularly over the extent of competition in the reformed health service. Mr Clegg (right) told Lib Dem MPs he would veto the reforms without substantial changes, including making Monitor responsible for promoting collaboration rather than competition. In late May, he accepted there could be further delays when MPs scrutinised the amended bill again.

The deputy prime minister was agreeing with Steve Field, chair of the NHS Future Forum, who had earlier called for Monitor’s role to focus on the promotion of co-operation and integration of care.

Professor Field’s former organisation, the Royal College of General Practitioners, agreed with his analysis. In a letter to the prime minister, it insisted the Department of Health make clear, as soon as possible, which formula will be used to allocate funds to GP commissioning consortia. The approach to consortia’s management of financial risk should be ‘made explicit, negotiated and agreed’ with consortia before they take up full responsibilities in 2013, it added. Financial decisions and board minutes should be made public to ensure consortia are accountable to the public.

Former Healthcare Commission chief Anna Walker said the NHS should ‘not be a slave to competition’, arguing that competition was essential in modernising the NHS, but a more sophisticated understanding of where and when it should be implemented was needed. She added the reforms had to deliver greater productivity or the NHS could be undermined.

In the face of the criticism, prime minister David Cameron (below) gave another impassioned speech insisting he had no plans to privatise the NHS and the private sector would not be allowed to cherry pick profitable services. However, he insisted the proposed reforms were needed to help the service cope with ‘enormous financial pressures’. The NHS Future Forum was due to report at the beginning of this month and the government will respond later in the month.

An OECD report gave an insight into one of the financial challenges. It said the costs of caring for the elderly – currently about 1.5% of GDP in member countries – could treble by 2050. Countries must face the issues of long-term care with clear strategies.

Another great polarising issue – the use of the private finance initiative in the NHS – has raised its head again (Healthcare Finance, May 2011, page 8). The Commons treasury committee is holding an inquiry into PFI and in its submission to the inquiry, the NHS Confederation called for a ‘more measured’ debate on its use. The confederation said in future the NHS should consider whether more risk could be passed on to investors without significantly raising costs or deterring investment.

The Department of Health highlighted the importance of reducing delayed transfers of care. It said the extra £162m earmarked to support local authority activity helped address a range of winter pressures, including delayed transfer of care. In 2011/12, the figure has risen to £648m and the Department said that while the funding should have an impact on a range of problems, it expected the additional funding to lead to continued improvements by reducing delayed transfers of care.

Last month there were elections to the Scottish Parliament and Northern Irish and Welsh assemblies. New health ministers have been appointed in Wales and Northern Ireland, with Nicola Sturgeon (right) remaining in post as Scotland’s deputy first minister and cabinet secretary for health, wellbeing and cities strategy.

Lesley Griffiths (left), who has spent 20 years working as a medical secretary at the Wrexham Maelor Hospital, has been appointed minister for health and social services in the incoming minority Labour administration in Wales. Former health minister Edwina Hart has become business, enterprise and technology minister.

DUP Assembly member Edwin Poots has been appointed health minister in the new Northern Ireland executive. Speaking on his first day in the job, Mr Poots acknowledged the health service faced ‘major budget issues’, but emphasised his priorities to protect frontline services and promote illness prevention.

Little change in health policy is expected in Scotland and Wales – the SNP held power as a minority administration before the election, but now has an overall majority. Meanwhile, Labour, formerly part of a coalition in Wales, have formed a minority government. One pledge to keep an eye on is Welsh Labour’s promise to try to reclaim the £70m-£85m a year spent in A&E departments on alcohol misuse.

In Northern Ireland some change is likely. In the new Assembly, Mr Poots’ party continues to hold the finance ministry, which often had public battles with former health minister Michael McGimpsey over funding. In its manifesto the DUP said several hundred million pounds could be saved without affecting patient care. Finance and personnel minister Sammy Wilson has asked his department’s performance, efficiency and delivery unit to look into the health budget. A focus on efficiency is likely, though he has promised to increase health spending if necessary.