Independent MP Sarah Wollaston is optimistic that proposals for helping to deliver the long-term plan will survive the often stormy waters of parliamentary passage
The NHS is the institution we are most proud of as a country. The scale of public affection can, however, lead political parties to exploit divisive arguments rather than take a constructive and longer-term view. Ken Clarke, reflecting on his time as health secretary, said you can “declare war more peacefully than you can reform a healthcare system”.
Lessons to learn
The problem is that many of the reforms of the past have tended to be so clumsy. The history of the NHS is littered with big bang top-down upheavals. Grand plans, concocted in Whitehall and passed by Westminster, have often caused disruption and led to far fewer gains on the frontline than expected.
The Lansley Act, for example, tried to cement choice and competition as the organising principles of the NHS. But, as was widely warned at the time, competition, in the way it was envisioned, was deeply flawed as a driver for improvement. Fast forward to 2019 and competition barely gets a mention, but the time consuming and wasteful contracting rounds too often get in the way of integration in the best interests of patients. It feels as if that joint working is happening in spite of the legislation rather than being assisted by it.
My hope is that in future the drivers for legislative change will come from the NHS itself as well as from those who use it and work alongside it. Such an approach is also a pragmatic necessity when there is a hung Parliament, as there is little realistic prospect otherwise of government top-down NHS legislation passing the Commons.
Eliminate barriers to reform
For the first time ever, a set of legislative proposals have been developed by the NHS itself, designed to facilitate its long-term plan. For some the legislative tweaks will not go far enough, but there is little appetite across the majority who work in the service for another major upheaval. Others have flagged concerns about potential unintended consequences that need to be carefully considered.
The passage of health reform through Parliament is never easy. Health legislation is deeply politicised. But I remain optimistic, because the NHS itself, rather than government, is asking for and driving these reforms.
I also hope that the involvement from the outset of the cross-party health and social care select committee, with our focus on building consensus and listening to a wide cross-section of views from outside Parliament, will give these reforms a better chance of success. After listening to evidence, the committee concluded the proposals were a pragmatic set of reforms that could help remove some of the barriers to integration, as well as some of the costs and complexities that competition rules have created.
Hope amidst uncertainty
There are still important questions that need to be debated before a bill is ready to be presented to the House of Commons, and we have highlighted some of the issues that were raised with us. My colleagues and I on the HSC Committee are ready to play our part by conducting a further round of pre-legislative scrutiny.
With the uncertainty and toxic divisions of Brexit still hanging over Westminster, there has been an appalling failure to progress a number of major areas of health policy, including finding a lasting settlement for social care.
It is a great shame that the prime minister did not take the opportunity to act on the practical recommendations of two select committees working alongside a citizens’ assembly. There is still time for the incoming prime minister to try to depoliticise this crucial issue and hand it to a cross-party Parliamentary Commission to prevent a repeating cycle of failure.
At the very least, I hope the incoming administration will commit to taking forward the government’s promise to support a pragmatic suite of reforms to NHS legislation in order to support the delivery of the long-term plan. This commitment should be included in the next Queen’s Speech.