Does the government really have a Plan B for NHS reform?
As the Health Bill staggers through the House of Lords and opposition grows to it in a daily basis, the question is reasonably asked whether the government has a Plan B.
The answer is that, of course it does. But before anyone gets too excited about the idea of an alternative master plan waiting in the wings, it is important to put that “plan” in context.
What has not happened – as reported elsewhere - is that NHS chief executive Sir David Nicholson has employed consultants to develop this plan. Sadly the enticing powerpoint presentation that is doing the rounds detailing this work appears to have little credibility.
But that does not mean people like Sir David, his deputy David Flory and other senior figures have not discussed – over past months - what would happen if the Health Bill was pulled or significantly reduced in scope. These are responsible, highly experienced civil servants who understand the importance of contingencies. Who knows, they might also enjoy a bit of speculation like the rest of us.
Various scenarios have been under discussion. The most common being the withdrawal of the bill in its entirety, or the passing of a “short bill” without Part 3 which deals with competition regulation and the NHS provider licensing regime.
The results of these informal discussions should surprise no-one. Indeed, HSJ reported in September how primary care trusts clusters were working on their own Plan B should the reforms falter.
Of course, the details of what Plan B consists of vary depending on who you talk to – and when. But broadly, the solution is as follows.
The NHS Commissioning Board would remain as a specialist health authority rather than giving it a statutory role as proposed within legislation.
The board would, as planned, have responsibility for commissioning development and oversight, service reconfiguration, specialist commissioning, tariff development and resource allocation.
Strategic heath authorities and PCT clusters would be maintained with their governance structure retained. Clinical engagement would be increased by appointing a greater number of clinicians to the PCT cluster boards.
Clinical commissioning groups would continue to go through the current authorisation process. Once passed, they would operate as sub committees of PCT clusters, taking over the majority of local commissioning.
Emerging commissioning support organisations would be operated by PCT clusters, with responsibility for some functions transferred to the CCG committees as appropriate.
The roles of regulators Monitor and the Care Quality Commission would continue broadly as now.
However, this is purely the sensible contingency thinking of officials. Civil servants who, for the great part, are working hard to deliver Plan A and who, again largely, now expect that plan to happen. Many also think that, with so much water under the bridge, just getting on with the reforms as they are would be the best outcome.
There was a bit of wobble last week, when it looked as if the Royal Colleges might form a united front against the bill. But the moment passed.
Of course, Andrew Lansley and his team are not contemplating a Plan B. They are as fixed in their mind about delivering Plan A in the face of ferocious opposition as Tony Blair was to support the USA-led invasion of Iraq.
As a result, Plan B is very unlikely to see the light of day. Which is a pity, as it has a lot to recommend it.
ADDENDUM: The Department of Health email to say: “There is no Plan B”.