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All May Have Won, but None Shall Have Prizes

Posted by Dr No on 13 June 2011

all_have_won.jpgAmazingly, roboNick this morning wiped the Vaseline from his glasses, and saw the light. The BBC’s Innuendo-in-Chief, master of the C word, E word and R word, realised it was all about the D word.

‘Duty, that is, Huw. The duty [lugubrious sideways glance] of the Secretary of State, that is, to provide [meaningless pause] a comprehensive health service.’

‘Thanks Nick. That was Nick, ending his report for us from, err, Downing Street.’ That’s the nice thing about Huw: he always takes the trouble to make sure you know who’s who, what’s what, and where’s where, even when, err, he’s not quite sure himself.

Well – long may the light stay on. But although the preservation of that duty is quite literally vital to the continuing provision of a national health service, it is by no means the only vertebra in the backbone of our health service. The Tories’ 400+ page Health and Social Care Bill still contains such a list of measures that virtually no bone would be left unturned, were the Bill, or substantial parts of it, to be enacted.

Meanwhile, the politicking goes on. The Yellow Party, smarting from its drubbing in the polls, has lately been rattling plastic sabres with increasing vigour. In a reckless dice with that number that lies between twelve and fourteen, their leader cocoNick has been waving his NHS scorecard high and low. In reply, the hounds of the Blue Party are baying for the blood of the Yellow Bastards; and all the while, in a stadium far away, the Red Party remains stuck in a dead Ed, in a Balls up of its own making.

The trouble for cocoNick is that his boss, the Prime Minister, also claims to be victor ludorum. Having personally taken responsibility for the reforms, the PM intends personally to take responsibility for the revised and improved HSCB Mark II. This is the kind of pressure up with which a coalition cannot put. We shall find ourselves drawn inexorably towards the black hole side of Alice in Wonderland, where all may have won, but none shall have prizes. It may even – who knows - split the coalition asunder.

But the real danger for now - be it intentional or unintentional – is of a Clouseau/Kato moment. Caught off balance as the Bill revision door opens unexpectedly, opponents of the Bill risk a graceful but doomed flight through the door of history, across the floor of politics, before crashing – and disappearing - through the paper wall of fate. Behind them, the Tories once again shut and lock down the revision door, and get back to their privatisation plans.

For make no mistake: it is the intention of this government, as it is of all governments, to get the NHS, with its fearful risks, off the government books, and into private hands. Dumping the Secretary of State’s duty to provide would have made life easier, but its retention shall not dilute the government’s intention, nor hinder it in the execution of its plans. We must be wary of winning the duty to provide battle, and loosing the NHS war. There is plenty more to be tackled in this Bill if we are not to see the NHS set sail on the Southern Cross course.


"The Tories’ 400+ page Health and Social Care Bill still contains such a list of measures that virtually no bone would be left unturned, were the Bill, or substantial parts of it, to be enacted. "

... and one reason why Andrew Lansley 'must' remain in post if bill stays, which I think will be the case but with major modifications. One of which, as Andrew himself said, would be about this very clause that keeps SoS responsible for provision, why he himself referred this part to the forum ... and, because the bill is very large, no one but him can manouver it ... and now, he'll be ok :-)

Well written piece and right to the point governments for the last twenty years have been preparing towards denationalising our NHS and creating a US style private healthcare market. Our politicians now represent the wishes of the corporate instead of the electorate

Have the Tories agreed to change the wording 'act with a view' then, Dr No?

Julie - short answer here and now is: not sure. Dr No's understanding is that it was a FF recommendation, and the Tories are due to announce their response to the FF report today. We shall have to wait and see.

Whatever concession(s) they do or do not make, Dr No remains alert to the possibility that this may be a Clouseau/Kato manoeuvre (opposition disappears forever through the paper wall of fate); or alternatively the Tories may say: Hey Guys! we gave way on the SoS's duty and all these other things - how about you cut us some slack in return, and let us privatise the health service? Naturally they wont word it like that, but between the lines, that may well be what we come to see.

Julie - and anybody else who is interested: Dr No has now looked at the FF reports available here and Lansley's response statement to the house available here.

The relevant passages on the SoS's duty to provide appear to be:

(a) in the FF report (Patient Involvement and Public Accountability Report, page 21):

"We have heard concern from various quarters that the Secretary of State for Health will no longer have a responsibility or duty in respect of promoting a comprehensive health care service, which could in some way lead to the erosion of the NHS. We understand that this is not in fact the case as far as the proposed Bill is concerned. However, we recommend that:

[13] the Secretary of State’s responsibility for promoting a comprehensive health service should be made clearer to the public in order to allay any concerns and remove any confusion. As part of this responsibility, he/she should report to the nation annually.

The Secretary of State will remain ultimately responsible for improving the health of the nation, and the modernisation plans see her/him setting out the outcomes that the NHS must achieve, and for which she/he will be held to account by Parliament."

...etc etc blah blah can I have my MBE now please sir blah blah...

(b) Lansley's response (para 7 of his speech):

"The Bill will make it clear that the Secretary of State has a duty to promote a comprehensive health service, as in the National Health Service Act 1946, and is accountable for securing its provision and for the oversight of the national bodies charged with doing so. We will also place duties on the Secretary of State to maintain a system for professional education and training within the health service, and to promote research. [emphasis added]"

...nice one Stevie, keep up the good work...

Despite some ambiguities and possible contradictions, it appears the duty to provide remains fudged as a duty to promote...

...that'll learn Dr No to believe everything he sees hears and reads in the news!

We need to watch this one. "Duty to promote" is wholly unsatisfactory.

Dear Dr No,

We've been had. Sharpening my pen as I speak.

We must write, but where to?

I'm writing to our broadsheet, the Herald. I suggest that others do the same. People need to be alerted.

Julie - your contributions - including your last post - are particularly valuable, because you are not vulnerable as we medics are to the old 'they would say that anyway' argument.

Meanwhile, Dr No continues to worry that understanding the NHS reforms is proving just too much for politicians and public alike. He dined last night with Guardian reading friends, and they confessed themselves quite at a loss to know what was going on, or what it all meant, while their copy of the Guardian contained coverage of the reforms that didn't hit all the right notes, let alone in all the right order.

Meanwhile, Cammers appears to have been telling porkies in the House:

The Prime Minister: On the health service—yes—we now have the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Physicians, the former Labour Health Minister and Tony Blair all on the side of reform and, on his own, the right hon. Gentleman: a weak leader of a divided party. That is what we have learned this week.

RCGP on board? That's news to Dr No. Last time he heard their Chair Dr Clare Gerada speaking, on the SuperMarr show, she seemed rather un-in favour of the reforms, even if in the Guardian she was reported saying "the prime minister is heading in the right direction". Observing the PM is going in the right direction isn't quite the same thing as being 'on the side of the reforms'...