Here’s the speech I made in the NHS debate in Gateshead on Sunday morning with some notes at the bottom outlining the source of each of the points:
Fellow Liberal Democrats
It’s very strange standing on a stage disagreeing with Shirley Williams. She was the first Parliamentary Candidate I ever worked for back in 1987. And she came and supported me when I was a candidate in 2010. I was and remain a huge fan.
And I completely agree that she, Judith and all their colleagues have majorly improved the bill. To me, that is not in question.
What is in question is something this motion & the proposers don’t address: the structure and complexity of the new system. The impact of changing to it. And that these changes will be happening in the face of the extremely difficult Nicholson challenge which requires the NHS to save a total of £20 billion by 2015.
The bill is talked about as a simple system with your GP in charge.
And it’s not. Firstly more than 40% of the NHS’s budget will be controlled by the new national commissioning board. 25% of local budgets is being transferred from your local area to the biggest national quango in UK history. Centralisation, not decentralisation.
Your GP won’t automatically run anything, but will be working in Clinical Commissioning Group alongside an average of 150 other GPs, and since there are no plans to run them as anarchist collectives, and because commissioning is difficult and technical and not something you do one afternoon a week, there will be managers and bureaucracy and governance of the kind that is supposedly being eliminated.
They’re also not alone – alongside the Department of Health and National Commissioning board, there’ll be Monitor, Clustered Strategic Health Authorities, Commissioning Support Organisations, Clinical Senates, Healthwatch. This system for cutting bureaucracy is taking us from 3 levels of organisation to 7 and from 163 bodies currently to 521.
It’s the enormous complexity and bureaucracy of this new system –
combined with the huge and unavoidable cost of transitioning from one system to another –
combined with an unprecedented savings challenge –
combined with the fact that much of the big savings have already been achieved and from here on in there’s just extra cost –
that creates an extremely serious risk of an unavoidably lethal political cocktail of crisis and chaos in front-line services – in the NHS – in the run-up to a General Election.
This is worse than tuition fees.
It’s a service that more people use, more people are affected by, and the policy we are proposing is weaker.
We’ve been told that stopping the bill now will be an incredibly hard thing to do.
But last year Nick talked about ‘not doing the easy thing, but doing the right thing’ – and withdrawing the bill is definitely not easy, but is also the right thing to do.
This debate isn’t about what you think about the coalition. Or what you think of Labour & Andy Burnham. Or what you think of the Tories & Andrew Lansley.
Or anything other than doing the right thing for the NHS.
And the right thing to do for the NHS is to withdraw the bill. And that is why I would ask you to oppose lines 32 and 33 of the motion.
- The 40% figure comes from Paul Corrigan’s excellent blog.
- The 25% shift of PCT spending to the NCB reflects the drop from PCTs having 80% of NHS commissioning to CCGs having only 60% of NHS commissioning. I think I originally spotted this via the NHS Vault blog. The False Economy blog goes into more detail. But it turns out the original source is Andrew Lansley’s evidence to the Health Select Committee on March 22, 2011 (see Q514).
- The number of bodies – 163 and 521 – is available from a range of sources. I first spotted it on Lib Dem Voice, but the figure appears to have originally come from the RCGP.
- I first saw the reference to 7 levels of organisation in an email from Roy Lilley of nhsmanagers.net. (I think I may also have said ‘types’ instead of ‘levels’ when I delivered the speech but can’t quite remember).
- The economic argument is a based on an article by Professor Kieran Walshe in the British Medical Journal. The original article is behind a paywall, but there’s a helpful report on it here. Professor Walshe also wrote a useful article proposing a practical ’Plan B’ if the bill was scrapped in the Guardian at about the same time.
- I can’t find where I got the figure of 150 GPs per CCG, but there are 34,101 GPs and about 227 CCGs currently planned giving an average figure of 150.22!
- The day after I uploaded this blog-post, an article appeared in the Health Service Journal titled ‘Exclusive: over 60 per cent of CCGs choose PCT manager as their leader’.