The latest state-of-play report from the NHS Confederation is intended to be helpful, but succeeds only in demonstrating just how confused health policy now is, especially over accountability. And, to be fair to Health Secretary Andrew Lansley, how confused it has been for ages.
The paper dissipates the clouds of ambiguity surrounding the nebulous notion of ‘localism’. GP consortia are going to be ‘local’ (though they may embrace populations of many hundreds of thousands, and rely on multinational companies to do their work) but they are not going to be locally accountable. Neither patients nor public will have any say in what they do. Nor councils.
Here, if you needed an example, is an instance of the almost complete failure of the Liberal Democrats to influence the Tory agenda. In their manifesto for the 2010 election, the point repeated at their recent spring conference, the LibDems said that councillors should control or at least be appointed to GP consortia.
That was the last thing Lansley intended to do. It would destroy the very principle on which consortia are based – professional autonomy mitigated only by the mystical relationship between GP and patient (the patient’s voice only ever to be heard in the sanctum of the surgery). Lansley, says the Confed, was never going to ‘reduce political interference at national level’ and introduce political interference locally.
The NHS Confed is writing off local health and wellbeing boards for the plausible reason they won’t get much funding and why should GPs pay them any attention. As for councils’ public health responsibilities, the Confed concludes they will probably end up doing little more than publishing public health data.
The Confed itself is guilty of naivety in its recommendation that the government should strengthen the powers of council oversight and scrutiny. ‘This could be done by requiring consortia to account for their decision making to local O&S committees and to health and well-being boards.’
That flies in the face of the long-established antipathy of GPs to councils and councillors. Having got all this new freedom, they are unlikely to start turning up at the town hall to give an account of themselves.
As for McKinsey and the health companies that look likely to make money from working for the consortia, let alone the ‘any willing provider’ clause – the idea that US corporate executives will prostrate themselves before councillors and answer questions... We’ve seen from Kraft – whose chief executive feels no obligation to answer to the UK parliament – how unlikely that is going to be.
The Confed paper is a useful summary but it comes to a surprising recommendation. Far be it from me to criticise communications as a function, but you need a good story before you can persuade. The Confed says ‘effective communications are essential to reducing the risks of any reform programme’. But it goes on ‘the government needs a compelling narrative about why the reforms matter’.
Isn’t it a bit late for that, as the Health and Social Care Bill goes to the House of Lords, for the government to start inventing a story about what it is doing? The government could re-employ all those communications professionals it sacked, reinstate the Central Office of Information, and bring back Matt Tee, the permanent secretary for communications who has just left – it could do all that but still have a problem. To quote the Confed ‘just why do the reforms matter? This narrative continues to be lacking.’
David Walker is the former managing director for communications at the Audit Commission
