Health Ministers are fed up. They have little power to control NHS decisions, those being devolved to the governments of Wales and Scotland, to NHS England, and to local health organisations that go their own merry ways. But, it’s Ministers who are held accountable by the public and the media for those local, regional and devolved administration decisions over which they have so little influence.
Whoever’s fault it is, covid has made itself a political problem for Health Secretary, Matt Hancock. He has been left the fall-guy by the legacy of the reforms brought in by Andrew Lansley through the process that lead to the Health and Social Care Act of 2012. Throughout the pandemic, Hancock has received hospital pass after hospital pass, and always with one arm tied behind his back.
So, Ministers are revolting. They’re demanding change, and change there will be, as I predicted back in May. Already, Westminster and Whitehall observers are reporting that a task force is at work and legislation is coming, even foundation trust status may be abolished, unwinding decades of NHS travel in broadly the same policy direction – decentralisation and localisation.
A cold dose of covid reality means that politically we’re going to be returning to central control.
Healthcare service, product and infrastructure providers can wait, if they wish, until a White Paper or draft legislation is published, but that’s really to leave it too late in what will be a rapidly developing policy; so, engagement now, more informally and urgently, is absolutely crucial for the sector to minimise threats and maximise opportunities. Why wait to close the stable door until the horse has bolted?
The two main points of political principle under debate are simple:
- Is control of the NHS better for being “centralised” or “devolved”?
- If it is to be centralised, then is it better for being controlled by an accountable politician, or by an unaccountable official (Simon Stevens)?
Healthcare is demonstrably better in England than in Wales or Scotland (despite the latter two receiving more per capita funding), which would suggest that devolution, not only to the nations, but also to local communities, results in a “devolved” or “postcode” lottery, and commands little public support, though much support from those with a vested interest [their jobs] in that local economic control.
That first decision in principle is currently being taken, so, the second point will then jump promptly to be the overwhelming view in the Conservative Party: name that the NHS is clearly better back under political, rather than bureaucratic control.
Once that consensus is established, there will need to be a formal policy development process: announcement, White Paper, draft legislation, formal legislation published, parliamentary debate.
But, crucially, Government will want to move fast, so expect a debate at pace, in which minor issues of purchasing policy and pricing, service commissioning details, and infrastructure investment rules, which can have a huge impact upon individual providers’ businesses, will be mere footnotes lost in the bigger issues.
Get ready, the wind of change is blowing through the NHS and social care more strongly than it has done for a decade! Businesses in the sector should engage, or risk being left behind.
The Whitehouse team are experts in providing public affairs advice and political analysis to a wide range of clients engaging with health and social care providers and policy makers, not only in the United Kingdom, but also across the member states of the European Union and beyond. For more information, please contact our Chair, Chris Whitehouse, at email@example.com.