Saturday 10 March 2012

Has the amendment from the Sheffield Conference in March 2011 been delivered?

Here is something for my fellow Lib Dem Conference Reps to consider before voting on the Emergency Motion debate tomorrow.

Dr Charles West and Dr Evan Harris, who proposed the amendment, report back.

Conference therefore calls on Liberal Democrats in Parliament to amend the Health Bill to provide for:

I) More democratically accountable commissioning.

The Government says:
“Commissioning will now be more democratically accountable. Clinical Commissioning Groups will have to involve Councils’ Health and Wellbeing Boards in commissioning decisions.”
[Source: Government leaflet at Gateshead Conference]

The true position:

  • The Bill has had no significant amendments in this area [see Schedule 1, clauses 189-193]
  • The Coalition Agreement called for elected members on commissioning bodies. The Bill never permitted this [see Coalition Programme page 24-25]
  • The Bill provided that the Health and wellbeing Boards need not have naymore than one or a minority of councillors on them. That has not changed. [Clause 193]
  • The only duty on commissioning groups is to consult the HWB on a commissioning plan. If the HWB disagrees it has no power to stop the CCG and there is no statutory right of appeal. [Clause 25, section 14Z12]
  • Overview Scrutiny Committees have lost the automatic right to call in a health decision to the Secretary of State so the new NHS would be less democratic than before. [Clause 189]
II) A much greater degree of co-terminosity between local authorities and commissioning areas

The  Government says:
"There is now a clear presumption in favour of co-terminosity . We expect the vast majority of commissioning groups to sit within social care authority boundaries. But where this is not the case, Health and Wellbeing Boards will be able to object to any boundaries that cross social care boundaries."

[Source: Government leaflet at Gateshead Conference, dropping the word “much” from the motion”]

The true position

  • There has been no amendment to the Bill and there is no mention in the Bill of co-terminosity [Clause 24]
  • There is no statutory right of Health and Wellbing Boards (who could have only one councillor on them) to object to CCG boundaries let alone to veto them. The decision on boundaries is made by the Commissioning Board 9a quango) with no statutory duty to even have regard to HWB's views [Clause 24, ssection 14A & B]
  • There is no role for Council's Overview and Scrutiny Committee [Clause 24, section 14A & B]

III) No decision about the spending of NHS funds to be made in private and without proper consultation, as can take place by the proposed GP consortia.

- Delivered

IV) The complete ruling out of any competition based on price to prevent loss-leading corporate providers under-cutting NHS tariffs, and to ensure that healthcare providers 'compete' on quality of care.

- Impossible to deliver. Tariffs cannot reflect the full complexity of services, and EU and UK
competition law will not permit the NHS to ignore price.

V) New private providers to be allowed only where there is no risk of 'cherry-picking' which would destabilise or undermine the existing NHS service relied upon for emergencies and complex cases, and where the needs of equity, research and training are met.

The Government says:

"The tariff will accurately reflect the clinical complexity of the service to stop any new providers from undercutting NHS services. New requirements on transparency for providers will ensure that they are only allowed to refuse patients on clinical grounds*, so they won’t be able to cherry-pick the profitable easy cases"
[Source: Government leaflet at Gateshead Conference]

The true position

  • The Sheffield Conference called for a duty on commissioners and Monitor to avoid destabilising existing essential services from the outsourcing of profitable services, such as elective orthopaedics, making a trauma service unviable. Amendments doing this tabled by Andrew George MP were not accepted by the Government
  • Refusing patients on "clinical grounds" and getting the same price for the easier clinical cases that are taken is actually the definition of how to "cherry-pick the profitable easy cases" that the motion rejected.

VI) NHS commissioning being retained as a public function in full compliance with the Human Rights Act and Freedom of Information laws, using the skills and experience of existing NHS staff rather than the sub-contracting of commissioning to private companies.

The Government says:
"Commissioning groups will be public bodies, not private organisations, and will be subject to these pieces of legislation. Commissioning decisions will have to be taken in-house by commissioning groups, not outsourced to private companies so it cannot be privatized."
[Source: Government leaflet at Gateshead Conference]

The true position

  • There have been no amendments preventing the wholesale privatisation of commissioning work referred to in the Sheffield motion. The original Bill already provided that the final decision be made by the CCG, but the Government's plan is to allow and encourage the outsourcing of commissioning work to private companies, called "commissioning support" companies.
  • Designing care pathways and evaluation the quality of rival bids, should not be done by private companies with vester interests which are not subject to FoI or the HRA.
  • The spending of £60 Billion of NHS money should remain a public function
VII) The continued separation of the commissioning and provision of services to prevent conflicts of

The Government says:
"Commissioning Groups will now be required to establish robust procedures to tackle conflicts of interest"
[Source: Government leaflet at Gateshead Conference]

The true position:

  • All the Bill now does is to require CCGs to have a register of interests. But there is no sanction against such conflicts unlike in Council. The register doesn't apply to the companies doing "commissioning support".

VIII) An NHS, responsive to patients’ needs, based on co-operation rather than competition, and
which promotes quality and equity not the market.

The Government says:
"Monitor will have a primary duty to promote patient interests rather than to promote competition and can promote co-operation between providers when it is in the interests of patients."
[Source: Government leaflet at Gateshead Conference]

The true position – it's been made worse.

  • After the Sheffield motion the Government increase the promotion of the market by commissioners by increasing the duty on commissioning groups and the NHS Commissioning Board to promote patient choice more than to tackle access and health inequalities [Clause 25, section 14S versus amended 14U]
  • Monitor's duties are only to prevent anti-competitive behaviour [Clause 61(3)] where it deems this works against the patient interest. An amendment to ensure Monitor had a duty to prevent anti-collaborative behaviour in these circumstances was rejected by the Government. [Amendment 165 Baroness Finlay]
  • The part of the Bill [Clause 73] which gives Monitor its enforcement powers omits to do so in respect of integration and co-operation.

Diagnosis: In summary, of the 8 broad (or in some cases narrow) requirements that this conference
passed, at most 3 have been delivered and 5 have clearly not. That is why even the non-political
Royal Colleges, who have read the Bill, are calling for the Bill to be dropped.

Back to me

We are being told that everything that Conference asked for last year has been settled. As you can see above it clearly has not. We do believe in devolving power out to the Trusts but with that we still expect accountability which is clearly missing from what has been done. The Bill still is full of holes and no matter what the Bill with Shirley Williams' name attached says will not save the NHS. Only a rejection of that motion tomorrow stands a chance of doing so.

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