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Rival factions fight for influence in Future Forum’s second coming

Why continue with the NHS reform listening exercise? The NHS is already changing with a momentum no report is likely to affect.

That, broadly, appears to be the reaction to the Future Forum’s second coming.

The response is understandable – and to some degree – accurate. However, HSJ would encourage you to read between the lines.

Health policy development in 2011 has as many factions as the Libyan uprising. It is a situation a world removed from the New Labour NHS project when the leadership of the government, the Department of Health and the professions were broadly aligned (at least around the NHS Plan of 2000).

Now – and these descriptions are generalisations of more nuanced positions – the players take the following stands:

Health secretary Andrew Lansley wants his vision for a GP led system put in place. He has now accepted the inevitability of retro-fitting the reforms to make them palatable to the other players.

Numbers 10 and 11 Downing Street, mindful that health expenditure will account for one third of public spending by 2015, are concerned with ensuring value for money for that investment, that waiting times do not slip and avoiding allegations of a “postcode lottery”.

The coalition partners contain within them a bewildering range of opinion – from right wing Tories urging greater private sector involvement to left wing Liberal Democrats wanting to roll things back to 1975. Both parties, of course, want to be seen as defenders of the NHS.

Various interest groups, most significantly the British Medical Association and Royal College of GPs, are intent on riding the wave of suspicion about the reforms. In contrast, the cheerleaders – the NHS Alliance and National Association of Primary Care – are desperate to keep the dream alive.

NHS chief executive Sir David Nicholson looks down on the resulting policy turmoil and concludes – with much encouragement from the top of government – that maintaining financial stability is key.

The Future Forum is no longer about amending the Health Bill. It is focusing on what happens next. It is a vehicle that allows these myriad tensions and competing priorities within the reform process to be played out in the seemingly neutral guise of a “listening exercise”.

Forum chair Professor Steve Field makes the point that many of the questions raised by members were also suggested by Cabinet ministers when he visited Number 10. The information workstream co-chair David Haslam – an addition to the forum – is both a reformer and the newly elected president of the BMA and, therefore, well placed to square the circle between privacy concerns and the need for transparency.

Indeed, information and integration are the most significant forum workstreams. Here the allegation that the forum is gazing after a bolting horse is patently untrue. The government’s “information revolution” has seen only the initial stirrings of a new dawn, while integration is still the new kid on the block.

Of course, nothing the forum will say and do will help the NHS cope with the severe challenges of the next 18 months and it might, therefore, be seen as a distraction. It will also not be the only place these two reform strands are teased out. Department of Health policy makers will not want to live in the forum’s shadow, while the King’s Fund and Nuffield Trust’s work on integrated care is bound to carry significant weight.

All that said, the forum’s new focus at least offers the opportunity to avoid last year’s benighted policy development process. Also, because it is now working on relatively virgin ground – as opposed to trying to re-engineer pre-designed reforms – it can deliver really influential work. For those reasons the forum’s work deserves our attention.

Readers' comments (4)

  • It does not stay quiet for long with the NHS. There much unresolved unhappiness with the changes and especially with the privatisation (AKA choice and competition agenda) stealth programme.
    Forget the Libya revolution analogy and think Balkans
    P.S Has anyone got a spare 20bn?

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  • Clive Peedell

    You state that:
    "Various interest groups, most significantly the British Medical Association and Royal College of GPs, are intent on riding the wave of suspicion about the reforms".

    I don't how much more evidence you need that increasing NHS privatisation is on the cards, but the public interest lawyer, Peter Roderick, adds significantly to the "debate". Surfs up!
    Please see:

    He states the following:
    A direct line of logic can now be traced in the Bill:
    (a) from removing the duty on the Secretary of State to provide or secure provision, through the “hands-off clause” and the wide range of powers and duties given on the face of the Bill to the clinical commissioning groups which they must be “free” to exercise without “unnecessary burdens”;
    (b) backed up by procurement and competition law requirements that are enhanced by the Bill, and reinforced by removal of the private income cap on NHS Foundation Trusts; and
    (c) continuing through to a member of a commissioning group, such as a private health company, being entitled to exercise the group’s powers and duties, including awarding contracts and charging for commercial activities, if the group
    decides amongst itself to say so in its constitution,

    which leads to the unavoidable conclusion that if the Bill was to be enacted, the legal stage would be set for private companies to be entitled to run much of the NHS and for market forces to determine the way many health services are provided.

    "Thus, the main concern remains that the fundamental legal basis for the NHS, which was put in place in 1946, will be removed by the Government’s Health and Social Care Bill."

    Meanwhile, the editorial staff of the HSJ continue to think that it is the vested interests of the medical profession that are making this all up!

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  • Clive Peedell

    The full legal opinion on the HSCB is available here.

    It has already been reported in the Guardian.
    Alan Maynard has also done an opinion piece in the Guardian.

    It is remarkable that the HSJ hasn't even mentioned this. It should be a leader article

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  • I am compelled to agree with Clive Peedell - As an NHS Manager I subscribe to the HSJ in order to be in touch with the latest key developments in my area of work, but currently I am better off scanning the Independent and The Guardian.

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