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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”.

Readers' comments (12)

  • Plan B seems a sensible option given where we've got to in (pre-legislation!) commissioning organisational change. Retain the SoS duties as currently- too contentious otherwise. Then we need a calm, open, non-political debate about the appropriate role of the private and public sectors in a) commissioning and b) provision of services (which?) - not a hidden rationale with uncertain intent.
    Unfortunately I know it's not going to happen - but it would be a far healthier and more mature approach than the current spun selective arguments and consequent disruption to the people who are trying to deliver high quality patient care in so uncertain and insecure environment.

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  • Roy Lilley

    First, given the turmoil of the Bill it is inconceivable that the Big-Beast hasn’t thought about it. I hear he has commissioned a consultancy to look at the scenarios and there is a set of PowerPoint doing the rounds that looks genuine to me. It is true they cannot be verified – yet.
    50 PCTs, Docs in the driving seat and a management cost-cap is doable without legislation. Introducing private sector providers can be at local pace under AWP/AQP; already in place. Trusts can earn what they like in the private sector; already in the 1989/90 enabling legislation and FT freedoms. Monitor is better than the Office of Fair Trading and should stay only as a regulator; already doable and in place. CQC is a basket case and needs new management; otherwise it is in place. HealthWatch and all the rest can be parked for now.
    The NHS needs to catch its breath, figure out how to save £20bn without more slash and burn. Let the service settle down and find its feet again. And, if the politicians are brave, a Royal Commission on the future.
    Job done.

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  • Why do so many people think that the Bill's approval is so inevitable? Is it the amount of political capital invested in it? Cameron's changed his position on a few things (Forestry for a start) - or is that just small beer by comparison? I do think Plan B is better than the shambles we have now, so part of me hopes that there are Mandarins in Whitehall (not just Richmond House) who're trying to find a way to deliver it.

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  • Cameron came across as a desperate, cornered man in Parliamentary Question Time yesterday. Milliband is now scoring points and Cameron's reposts are not the confident ones you would expect of someone who was expecting to win.

    Despite what the DOH say, I am certain that there is a "Plan B". I think what needs to happen now is to get the Coalition to see that it could be a way out without losing too much face.

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  • Roy gets my vote again. A more sensible, well thought out assessment is hard to find (excepting Alistair's excellent editorial's). Regrettably though I am of the opinion that this bill is unstoppable and will pass into law. The only Plan B Mr Cameron will listen to is the one who makes million selling music albums and the last time I looked he didn't have a view on the Health Bill!!!!!

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  • Anon 2.03 scuse us oldies not familiar with the latest popular beat combos...
    Mind you, people like Steven Fry have signed up to the stop the Bill e-petitions, so you never know...

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  • well if all the health professions can't stop it perhaps a united front from celebreties will do it. Someone text Beckham and Posh quick.

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  • Of course the supposed Plan B may have been the DH Plan A to start with.

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  • What about the plan B for public health?

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    Same HSJ journalism that suggested, from informed sources, the demise of PbR was nigh - a few months back?

    Or the same that headlined that Interim Managers pay had increased significantly last week (based on a second hand, obviously flawed survey)

    Has 24 hour 'no news' effect got to HSJ?

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  • Yep, Mr Pritchard

    As it says at the end of the article

    "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."

    Slow news day? Make it up...

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  • No Plan B discernible in our PCT. The SHA has said no contingency, just get on with implementing.

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