This document,
which was handed to Social Investigations, reveals the lobbying process that
took place from the NHS Partner Network – in its attempts to ensure competition
remained a big part of the Health and Social Bill following the listening exercise.
No words have
changed as the details speak for themselves. To receive full original document contact me - andrewfiskar(at)gmail.com and if you write an article on the issues with this document, I ask you to please quote Social Investigations as your source.
NHS
Partners' Network: Director's update on the NHS Reforms - 20 May 2011
The task
At our AGM on
19 April we agreed on how best to handle the considerable threats posed for the
sector by the "pause" in the legislative process because of the
opposition to the NHS reforms and the return to levels of hostility towards the
independent sector not seen or heard for some years. The essence of the
strategy was to recognise that if the report by the NHS Future Forum to the
Prime Minister went the wrong way for us, retrieving the position would be
almost impossible. Therefore the tactical imperative had to be to influence the
forum members directly and to concentrate other activity on those who themselves
would have most influence on the forum.
Where has
the process got to?
To all intents
and purposes, the "pause for listening" is now over and the decision
taking phase is starting. The Prime Minister meets the Forum today for a final
"round-up" and the report will be drafted and agreed very early next
week. the Forum has talked to over 5000 people, with an overwhelming emphasis
on the mainstream NHS and especially clinicians.
From the
various sessions I have attended I would say that the quality of the discussion
has been higher and more balanced than I had feared would be the case. I also
have the impression that the arguments in favour of choice, competition,
plurality and economic regulation put forward by the small handful of
like-minded members ably led by Sir Stephen Bubb have often carried the day and
won more support than we might have expected. Support, that is, for the intent
and the substance, rather than for the presentation and mode of delivery, where
criticism has been sharp.
What have we
managed to do?
Our main thrust
was originally to try to use individual relationships with forum members to get
messages across, using "common hymn sheets" on our key issues.
However, on investigation it became clear that the number of personal contacts
were too few for this to be enough. We therefore sent more polished versions of
our key briefs to all forum members. I received about a dozen acknowledgements,
including several that specifically commended the clarity and helpfulness of
the briefs. That I hadn't expected but suggests the materials
"worked" in communications terms.
In terms of direct discussions:
•
I had one lengthy, very early discussion with Sir Stephen Bubb at which we
agreed on the approach he would take, what the key issues are, and how to
handle the politics. He has not deviated from this for a moment throughout the
period.
•
A number of members secured individual meetings with him, thus reinforcing and
validating the messages.
•
I had a second lengthy meeting with Stephen to discuss the position with him
last week, under the auspices of "Reform", with only a handful of
other (all like-minded) people present, including David Bennett, the chair of
Monitor. He has also consistently taken the same line as us throughout.
•
I have heard from most of the members who said they could make direct contact
with Forum members confirming they have done so. Thank you.
•
Personally I have been able to speak to Steve Field himself , Jimmy Steele ,
Niti Pall, Julie Moore, and Paul Farmer.
• I also
participated actively in two of the Forum's major "listening" events:
one run by the Confederation and one by/for the Secretary of State's National
Stakeholder Forum. Both were well attended by forum members. At the latter,
every Minister was present and I was able to make key points in a workshop
session attended by the Secretary of State and Earl Howe and chaired by Steve
Field.
Sir Stephen had
hoped to find a couple of hours for a meeting with the NHSPN Board, but the
schedule of country-wide meetings arranged for the Forum by the DH in the end
made that impossible. He is now hoping to be able to confirm a meeting on1 June
when he will discuss with us what his report says and what he thinks it mean
for all independent providers. I will confirm this to members as soon as I can.
In terms of
"supporting" discussions:
• I have
coordinated our position carefully with Monitor, the CBI and the FTN and have
devoted considerable time to securing a reasonably helpful response from the
NHS Confederation. That has, however, only gone off today, illustrating the
problems of trying to react speedily when representing disparate interests.
• Several
members have used their own "routes" to gain access to key players
within No.10 and have been able to report back that the stance there is
supportive, though there is low awareness of exactly what the independent
sector does or could do . I did brief the new No.10 health policy adviser very
fully, and indeed "cleared" our materials with him. I have has several
other "stock-take" phone conversations with him. We are certainly on
No.10's radar - I received an invitation to the PM's big speech last Monday and
went. (Incidentally, for those who had the pre-event text, he specifically
added a sentence about the importance of patients being able to attend private
hospitals if they wanted to, provided NHS standards and prices were being met.)
• There have
been a number of contacts with the Lib Dems. I had an early meeting with Norman
Lamb who continues to advise Nick Clegg very closely, and a further very long
phone call with him on Tuesday this week. I will come to the politics shortly.
• We organised
a letter from our Clinical Forum, on behalf of the 45,000 clinicians who do NHS
work from the independent sector, to Steve Field. This was powerful. Steve
himself told me how useful and well-argued it was and No.10 also thanked me for
it.
The DH
•
Jill Watts and I went to the DH yesterday to see Earl Howe. Unplanned, Simon
Burns also asked to join the meeting, which certainly indicates that they
recognise that we are less than happy about things. the two Ministers
(supported by Bob Ricketts) were necessarily constrained by the fact that
everyone is supposed to be "listening", but gave every signal
possible that they understood and sympathised with our concerns and shared our
view of the key issues and priorities. Earl Howe's depiction of the Government
position was, to paraphrase, that "choice" was a non-negotiable; real
choice requires a range of provider types; that means competition; and
competition has to be expertly regulated. He could have been delivering a
précis of our briefing notes (which of course he had already seen). Simon Burns
seemed more engaged than before, defended the reforms firmly and took notice of
our arguments on the issue of health sector training arrangements. In short, I
do not think, under the circumstances, we could have hoped for more from the
two ministers at this delicate moment in the process.
• Later in the
day, at the National Stakeholder Forum, Earl Howe endorsed my arguments twice
during the session on competition and regulation .
The Politics
What both
Ministers were at pains to point out is the need to try to distinguish between
three things: the policy debate; the health politics (BMA etc); and the high
level "noise" around the coalition politics. We said we completely
grasped this, but had to be hugely vigilant over the risk of the
"noise" turning into "real risk". They did not deny this.
However,
without wasting members' time on extensive political speculation, my analysis
is that the aim is to use the authority of the Forum's report and the listening
exercise to improve and make more acceptable the policy; circumvent the
traditional "health politics" of the BMA etc; and provide the
coalition with a robust basis for getting a revised Bill through the Lords and
past the remaining dissenting Lib Dems. Meanwhile Nick Clegg is, frankly making
noise in order to persuade parts of his party that he is really driving the
changes needed to "save the NHS". There will be more of that as we
enter the next phase, but we need to see it in context and not over-react.
The Forum's
Report
Again, beware
speculation, and we should know for sure in about a week, either officially or
otherwise, but I currently expect:
• Major changes
on "commissioning", which will become "clinically led
commissioning" rather than "GP commissioning. There will be more
flexibility on timetable and there will be a number ( 50 or so) of ongoing
commissioning bodies at the level of the current "clusters". These
will do the heavy lifting until "consortia" are up to the job; will
provide the location for commissioning which requires scale; will also provide
the place where clinical input from people other than GPs can be increased; and
where other vital skills can be accessed.
If that or
something like it emerges it should be better for us - terms of stability and
"expert planning and buying", than the original proposals.
• Major changes
on accountability, to reflect Lib Dem concerns to advance local democracy and
everyone's concerns about accountability for £60m+ of public funds. On to watch
for is Sir Stephen's idea of picking the concept of local "right to
challenge" which feature in the Localism Bill.
Of less direct
relevance to us, so impact relative to the original reform proposals is
probably neutral .
• The Education
and Training proposals will be endorsed in principle but slowed down: there is
no need for a crash programme of change so why try to do it at the same time as
everything else.
Impact is
helpful as it slowing down avoids the distraction and gives time for fuller
discussion of exactly how the independent sector participates.
• Economic
Regulation and competition - the big one for us. I currently think the need for
an economic regulator in the form of Monitor will be endorsed by the Forum and
retained in the Bill. The language may change: "sector regulator"
perhaps.
• What will
undoubtedly change are the top-level duties of the regulator. The hugely
contentious duty to promote competition will be dropped and instead we will see
duties to promote any or all of: "choice"; "integration of
care""; "provider sustainability"; "continuity of
services". That will be claimed by others as a huge victory.
• However, in
reality, those objectives are more akin to the ones required of other
regulators. Competition is indeed a means to an end, not an end in itself, and
can be used effectively to help achieve all of those objectives. And despite
Mr. Clegg's unusual "take" on European law, national government's
cannot change or undo EU law on "undertakings" or procurement!
Of course, this
is the area in which the forces of coalition politics are most in play and
there are other options which have been or are being talked about, including
retaining the CCP, and/or dropping Part 3 of the Bill. At this moment I do not
think these will emerge as the way forward but the next few days will determine
all.
If this view is
right, Monitor will be free to do its job, and while progress will not be fast,
the framework and principles will be alright for us.
The Media
Finally, the
media. We agreed we would "up" the profile on key issues, without
inflaming the debate. Members will have seen some very good reporting in the
specialist press of my public defence of the role of competition at a
conference earlier this week. We have also had good coverage on the BBC
website. Our Clinician's letter was mentioned in the Telegraph. And the whole
sequence of Telegraph articles and editorials on the importance of the
Government not going soft on public
service reform, including some strong pieces on health,
is something I have been orchestrating and working with Reform to bring about.
Next
We need to keep
as close as possible to No.10 over the next few weeks. So much depends, first,
on what the Forum Report actually says. But as we move into the next phase we
will need to shift our efforts onto the politicians - those the Government
listen to, and those who will play key roles in the House of Lords when the
Bill gets there. The report, which I am sure will be almost entirely accepted
by the Government, will then guide the redrafting of parts of the Bill so that
(Ministers hope) the legislative process can get under way again in early July.
David
