Health and Social Care Bill

We are a nation that no longer knows when to put its rubbish bins out.

So I reflected, as I dragged our two overflowing wheelie bins back to their usual place. To be fair to Bromley Council, it’s not that they fail to pick-up our rubbish; just that no one can quite predict what sort of rubbish they are going to collect in any given week.

I won’t bore you with the details. Suffice to say that some months ago they changed the system of waste collection here – successfully ‘piloted’ with local residents I should add – so that various items would be picked-up on alternate weeks. Well, for the life of me, I and my neighbours have got it wrong at least 40% of the time. I wouldn’t mind that much but after hours toiling over separating tetra packs from the New Scientist it does get a bit irritating to see the bin men and women dump it all together in the back of a dustcart. As my mother would say – and she is usually right about most things: ‘it all goes down one way.’ But I do wonder if I am part of some sort of rather wicked observational study.

Such episodes in life do however serve as useful metaphors for larger trends at work. In this case, perhaps, it is the passing of what was once certain, fixed, reliable. Now I just sound like John Major don’t I?

Anyhow, enter stage centre-right, the NHS. September is upon us after another crummy August and our politicos have quickly rejoined battle over the health service reforms. The Sunday Times front page from yesterday suggesting that overseas companies are being primed to run hospitals (or should that be the other way round) left me unsettled to say the least.  Notwithstanding the so-called ‘Listening Exercise’ prior to the summer, it really does feel as if the tectonic plates are shifting beneath the NHS and fast.

The BBC Online has a good overview of where the battle lines have been draw if you wish to look deeper and I wish that I had been able to attend this evening’s Stempra briefing and discussion on the Bill – perhaps someone will post a comment giving us a sense of what happened. 

But I was struck by the passage in the BBC piece about the anticipated forensic scrutiny of the legislation when it gets to the House of Lords.  Heavens knows it needs it.  When I was a little closer to these things than I am now it was well-known that Peers were getting together regularly to examine and prise apart the Bill in preparation for its stages there.

This is the thing.  If you are into your pure politics then I suspect you will be attracted by the likely rough and tumble during the party conference season and in the House of Commons come October.  If, however, you are looking to throw your weight behind the forces that might ensure the reforms are changed for the better then I encourage you to assist our Peers in every way you can with good evidence and good briefing.

Otherwise, it will not be that the NHS fails to treat people in the future, rather that none of us will be able to predict which patients it will treat in any given week in any given part of the country.

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PS: Apologies that the links are to ‘home pages’ but I can’t seem to use anything other than the WordPress recommended links on this computer.

From the NIHR website today following the Government’s response to yesterday’s publication of the NHS Future Forum conclusions.

A real result as far as I can see with regard to excess treatment costs as well as the strengthening of the duties and responsibilities to promote research in different parts of the NHS structure. Very good news indeed and congratulations to all the good work by AMRC and others on this.

For the usual thorough and sharp analysis of all the announcements in full, go to Becky’s Policy Pages.

The prospect of the legislation going back to committee gives us a real opportunity to press on the very vexed issue of how we ensure research is driven as an activity at a local level.

A reminder that David Cameron will be making five pledges on the NHS in a ‘keynote’ expected this week (possibly tomorrow (Tuesday)). Things like..there will be no privatisation, and an end to waiting lists etc.

The Economist’s ‘Leviathan’ blog – which is always worth a look – takes a rather derogatory view of the Prime Minister’s five-a-day prescription, calling it mood music.

I read it as a sortof high-five to the NHS to rebuild confidence. But it will be the stuff between the lines that we’ll need to look out for, since this will hint at the conclusions drawn after the recent ‘listening exercise.’

As a self-confessed member of the worried well, I ask that people think carefully before they throw strange words at me.  Particularly on the day of a regular visit to my ‘prescription-happy’ doctor.

A colleague asked me this morning how my interregnum was going.  It  sent me into a momentary panic.  Is it treatable I wondered anxiously?  Then I asked myself if I’d been asleep longer than I thought during which time there had been an overnight interregnum akin to other moments in history such as the Spanish Inquisition.

Finally I realised she was referring to my being between two jobs – I start at Ovarian Cancer Action on Monday.  Phew.

The final days of the Department of Health’s listening exercise have seen a last minute flurry of submissions.  I read on BBC News Online that over 15,000 comments have been made and 750 letters received by some poor official who only three months ago had an empty in-tray. The Association of Medical Research Charities’ (AMRC) submission on behalf of the charity sector can be found here – and very good it is too.  Elsewhere the King’s Fund has kept up its usual pace of incisive criticism with a report on accountability in the proposed new NHS set-up.

Indeed, accountability is a theme that has resonated strongly in these final days.  Mark Walport, Director of the Wellcome Trust, referred to it in his Times article yesterday.  The Daily Telegraph reports this morning that the inclusion of patients and the public in the management boards overseeing GP consortia, is likely to be one of the key recommendations that the NHS Future Forum chaired by Steve Field will make when it reports to the Cabinet shortly.

That has to be right.  There seems to be an inherent contradiction between Big Society politics and the NHS reforms if the public are not to be given greater access and opportunity to influence and shape how health care is delivered in their neighbourhood.  Of course, that’s always assuming you believe in the Big Society mantra.

But I do understand the difficulties for the Government in getting the composition of these bodies right given the equally understandable clamour from all and sundry to be represented.  I see the nurses are the latest to make their pitch today.  However, patient and public representation should be one of those ‘red lines’ for charities and the voluntary sector on which we should not give way in the months ahead.

If you are planning a holiday around developments with the NHS reforms then you may wish to take a look at the Financial Times article today which speculates about the timetable from here onwards.

Not long now before we’ll find out how much of its original plans the Government decides to alter or whether it is intent on flying in the face of its own self-imposed interregnum. 

Footnote:  By the way, I heard an interesting bit of ‘Whitehall’ news last week which is that the Office for the Strategic Co-ordination for Health Research (OSCHR) has moved offices from its HM Treasury base (its home for the last few years) and is now located in the Department of Health.  Happy to be corrected if I am wrong.

The word on the street is that the Coalition Government is going back to first principles in its review of the proposals in the Health and Social Care Bill. 

As each day passes, the ‘natural break’ begins to feel more like gardening leave for a piece of legislation that was supposed to be one of the Government’s flagship Bills.  At the moment it looks possible that the Bill will be re-committed in the autumn.  I assume that this will push back the timing on the ‘second session’ of parliament legislation as well – this second Bill is significant to health research because it will deal with changes to the way in which research is regulated. 

So, from a flying start earlier in the year, it feels that the whole thing is becoming akin to a set of roadworks – the bollards are omnipresent as is the hole in the road and the queue of traffic but not much else is visible in terms of progress. 

Still we should be pleased that the Government is at least prepared to radically re-think its plans.  This week, you may have seen, 40 charities issued a statement urging there to be a stronger patient voice in the plans (quick plea to press officers – if you are going to issue something to the media, please make it available on your website the same day, I could not find it on any of the charity websites I checked).

And Cancer Research UK also held a very well attended briefing for MPs and others on the research aspects of the Bill. 

This is going to run and run and run…