'Trust us' is not a good enough defence for this botched rewrite of the health and social care laws
In the ongoing saga of the health and social care bill, one real oddity is the government's assumption that it can brazen things out on the basis of trust. No matter that the bill aroused so much suspicion that it collapsed and underwent emergency surgery in the Commons, the approach has been to lavish rhetorical love on the health service while insisting all the fine detail can be safely left to ministers to finesse.
Take the question of competition. The Bubb report, which the government commissioned to calm fears of privatisation, proposed that the delicate balance between choice and planning should be settled by bureaucrats working up a "model" under a undefined "mandate" to be set out by the health secretary of the day. In other words: we've had the debate, so let's get the bill through and leave it to nice Mr Lansley to make sure the objections are dealt with.
An even more foundational question for the English NHS is the responsibilities of the secretary of state ? the very duties which put the "national" into the health service. It is no secret that Andrew Lansley wants to do away with the idea of the state as medical provider, and move towards a regulated market that the state finances. This was reflected in the original bill: Whitehall's old obligations to "provide" hospitals were largely replaced with requirements to "promote" services. After Lib Dem activists kicked up a fuss, Nick Clegg brokered a new formulation about using "the powers conferred by this act ? so as to secure" services.
It is now tricky to spot the difference between the bill's new clause one and the Labour legislation it replaces. The real threat to the NHS's comprehensive reach, however, is that "the powers conferred by this act" are anaemic. Later passages of the bill strike down the secretary of state's existing ability to direct and delegate to other health service bodies, while a so-called "hands off" clause enshrines the autonomy of the new commissioning consortiums. The objection does not arise out of some misguided wish to see Whitehall micromanage, but a desire for clarity about where the buck stops.
A pithy report from the Lords constitution committee last week warned that breaking the chain of responsibility that connects Whitehall with NHS wards could threaten the right to a judicial review where a service is not available. With acuity, the committee asks why a government that claims no desire to curtail the health secretary's powers does not simply leave the existing statutes as they are. Its members, who include eminent figures of all stripes, including Conservatives, plainly don't think "trust us" is a good enough defence for this botched rewrite of crucial laws. The house as a whole should pay attention before second reading next week.
Mikel Arteta Poland Women Comedy Economic growth (GDP) US foreign policy
No comments:
Post a Comment