Government responds to Future Forum NHS report 22/06/2011

Summary:

The government's "listening exercise" has ended with recommendations from its Future Forum for changes to the Health & Social Care Bill. The government's response contains some victories for UNISON, but too much of the original plan remains.

In full:

In the past week the government's "listening exercise" ended with the report of the Future Forum making a series of recommendations for changes needed to the Health & Social Care Bill and associated plans. The government then responded by accepting the vast majority of these recommendations along with a number of extra changes of its own.

The Future Forum report and government response can be found here:
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127443

The government's response includes a number of victories for UNISON's campaigning:

Most significantly, clinical commissioning groups (the new name for GP consortia) will now be "unable to delegate their statutory responsibility for commissioning decisions to private companies or contractors".
Monitor's powers to promote competition will be removed and it will be required "to support the delivery of integrated services".
The policy of Any Qualified Provider (previously Any Willing Provider) will now apply to fewer services and will not start until April 2012.
Health and wellbeing boards will be strengthened.
Clinical commissioning groups will be more transparent, with a greater role for the patient voice.

However, a large number of problems remain, with government action either woefully inadequate or missing altogether, for example:

Despite the changes mentioned above, the policy of Any Qualified Provider remains. This confirms that for many services the NHS will no longer be the "preferred provider" and existing providers will be destabilised by the creation of a larger role for profit-motivated companies.
The government says that "the Bill does not change EU competition law". This is not the point; the Bill was never going to change the EU's own laws. What it did, and will still do, is make it more likely that EU laws can be invoked by disgruntled private providers. Activity carried out for social purposes is generally not subject to EU competition law. However, the more private providers are encouraged to deliver healthcare the less clear this exemption becomes. The government has freely admitted that once the policy of Any Qualified Provider brings in a wider diversity of providers to the NHS, then EU competition law is more likely to be applicable.
The government shows no sign of backtracking on the crucial issue of abolishing the private patient income cap. This means that as waiting lists continue to grow - as they already are - NHS patients will find themselves pushed to the back of the queue by those that can afford to pay. After all, hospitals will be under a huge amount of extra pressure to up their income from whatever source possible as they struggle to make savings. The government will require foundation trusts to produce separate accounts for NHS and private-funded services - something that it had already committed to before the "pause" - but there is still no suggestion that this greater transparency will actually be written into the legislation itself (at the moment it exists only in the Bill's accompanying documents).
Lansley's plan to completely free the Secretary of State from responsibility for the NHS has been dropped, but even this issue has been fudged as the Secretary of State will not be responsible for securing NHS services directly, but rather will do so through other bodies such as the NHS Commissioning Board.
The government states that it will "uphold all of the patient rights in the NHS Constitution", but there is pointedly no suggestion that staff rights in the NHS Constitution will be honoured. This is hardly surprising, as there has been no movement whatsoever to reaffirm the importance of national structures for staff pay, bargaining, or terms and conditions.

There is still uncertainty about how exactly the government's changes will be reflected in amendments to the Bill itself, with more problems likely to come to light - particularly around the fact that although Monitor's remit has been changed it remains an economic regulator, and it will now incorporate the existing Cooperation and Competition Panel.

The Department of Health is expected to issue guidance in the week of 20 June on how the changes will be implemented and the government will also publish its latest amendments to the Bill, following a debate in Parliament on Tuesday 21 June that will confirm which parts of the Bill will be "recommitted" - sent back for line-by-line scrutiny by a Committee of MPs in the House of Commons. This Committee process will then run up to Thursday 14 July. It is unclear at this stage exactly when the next major debates on the floor of the House of Commons will take place - Report Stage and Third Reading. Parliament goes into recess on 19 July so it is unlikely that these will take place before September. Further information will follow about TUC / UNISON activities to mark these events once we know dates.

UNISON will be keeping up our opposition to the Bill.