LETTER from Ray McHale
While I agree with the thrust and conclusions of this [website] article, some of the specifics (perhaps flowing from Alison Pollocks article in the BMJ) do worry me in terms of arguing a case. While no-one can believe the Tories, and we need to dig deep for information – some of the things we now seem to reject are what we have previously argued for.
When the Tories effectively made the NHS independent from Government – we said the Secretary of State should be responsible and accountable. Now we appear to argue against the re-establishment of that responsibility. Competitive tendering has been the bane of the public sector and more lately the NHS – with Trusts bidding for the work of other Trusts. and most commonly them all losing out to the private sector – who are much more geared up to the procurement process, and to fully exploiting contracts once they have been won for the lowest bid.
Now we seem to hold this process up as a safeguard against Tory cronyism, when it has been a driving force in privatisation. In Local Government it has increasingly been side-stepped as a process that can’t deliver for the long term because it is inflexible, and essentially adversarial rather than co-operative. (My private bin collection company handed the contract back 7 years early because they were losing money. they had previously taken the council to court.)
Clearly there are worries that the new legislation is based on an American model and may be a foot in the door to more privatisation (perhaps with companies having seats on the Boards of ICSs – Integrated Care Systems, previously called STPs). And we need to decide if the existing CCGs should be defended or allowed to be subsumed into the ICS – becoming sub-regional big CCGs. We don’t want the sub-regional ICSs to effectively become mini-NHSs strictly expected to operate within a budget. On the other hand, if ICSs are formalised and accountable, they may represent an increased level of accountability.
Either way we should not forget to denigrate the Tories / LibDems for their failed 2012 reforms and another re-organisation after just 9 years.
