Michael White: vultures circle the NHS

“Drive for NHS to share pain of saving” thundered the FT’s splash headline on Tuesday. It flagged up a report confirming that rival ministers want to reclassify some of their own commitments − defence, justice, etc − as “health spending” so they can be dumped on Jeremy Hunt.

The vultures’ idea is to breach the ringfence that supposedly protects the NHS budget.

‘Here was a rare debate, full of mature and impassioned expertise on both sides’

With defence activity dwindling and crime falling we could argue demand pressures on stalled NHS spending is already great enough, though we can’t blame the vultures for trying. But it’s the “pain” which interests me this week, specifically the anguish so evident when the House of Lords debated those revised procurement regulations for clinical commissioning groups − heirs to the section 75 row − for two fractious hours last Wednesday evening. Less publicised than the day’s Cameron vs Miliband NHS spat at PMQs, it was also less futile.

I hesitate to recommend Hansard to busy NHS professionals but here was a rare debate, full of mature and impassioned expertise on both sides. Labour peer Phil Hunt, ex-health minister, ex-trust chair, Iraq war rebel, opened the debate, warning the new regulations will force NHS providers to compete in costly and fragmentary ways that allow predatory lawyers and US health corporations to cherry-pick the system.

So far, so familiar. But there was plenty of firepower on the government side (Shirley Williams vs her old mate David Owen), including the magisterial Lord Freddie Howe, a minister as calm under fire as his great military ancestors in the 18th century. Winding up the debate he gave a cogent defence of the official position that those predatory lawyers will have to study hard to thwart.

Choice and competition

The new regulations enshrine in law the choice/competition regime created by Labour within the constraints of EU procurement law. As economic regulator Monitor, whose guidelines (peers complained about this) are still pending, will supervise the CCGs in their functions and provide what Lord Howe calls “a firewall” between them and the courts – a protection not available in the past.

‘Lord Warner mocked the “paranoid fantasy” that Monitor’s 40 staff can play the Stasi to CCGs or that competition is not in patients’ interests’

Three sentences from Lord Howe’s speech leapt out. “One area of the law that we have not changed one iota is the law relating to competitive tendering.” And “There is no government agenda to privatise the NHS − quite the contrary.” And “NHS commissioners and no one else will decide whether, where and how competition in service provision should be introduced.”

It did not/will not placate those who fear the worst. Nor is this mere party point scoring, since plenty of weighty NHS professionals share those concerns. Will the regulations create a culture of “defensive contracting” by CCGs who put services out to tender to be on the safe side? Is the “single capable provider” concept (that allows CCGs not to deploy competition) all but meaningless in most places? Will the welcome drive towards the “bundling” of services be stalled? Will care pathways and networks be fragmented by the market?

Worse. Don’t interventions by competition cops in Bristol, Bournemouth and Torbay already demonstrate insane zeal? Howe had a fluent answer to it all (the Bournemouth spat is a review issue), though it does again beg the question: “If the 2012 Health Act changed nothing, why pass it?” My own hunch was best expressed by Labour rebel, ex-minister Lord Norman Warner (echoed on hsj.co.uk by Sir Stephen Bubb) who mocked the “paranoid fantasy” that Monitor’s 40 staff can play the Stasi to CCGs or that competition is not in patients’ interests.

It was a brave speech, nastily disrupted by some old comrades. But the “Keep Calm” faction might be wrong, I can see that. Uncertainty is huge and vultures circle.

Michael White writes about politics for The Guardian