Repairing the NHS after HASCA2012
The health and social care Act of 2012 is, according to certain Tory cabinet insiders, the biggest mistake the Tories made in government. It was a direct contradiction of their manifesto pledge not to impose any top-down reorganisations of the NHS, and it wasn’t mentioned in the Coalition agreement. LibDem endorsement of it was a far greater betrayal of principle than Nick Clegg’s about-turn on tuition fees.
HASCA2012 continued Nu-Labour’s reform agenda, which bought into the unsubstantiated neo-liberal claim that cost savings could be made by outsourcing healthcare provision to private-sector suppliers. Another facet of the reform agenda was the use of PFI agreements to build new hospitals. These off-balance-sheet instruments made the public sector finance numbers look prettier in the beginning but were badly written, badly negotiated and have left today’s and tomorrow’s NHS facing payments they can’t avoid for services and hospitals they no longer need. Nu-Labour is as guilty as the Tories on this; I will allow that they were more gullible schmucks than conniving predators, but the result is the same.
Anyway, back to the current (and future) problem. Billions of pounds of NHS expenditure is going through outsourcing, PFI and other contracts to private-sector suppliers, when in many cases the services can be provided more flexibly and often more cheaply by directly-employed NHS professionals working to a patients-before-profits, care-before-costs agenda. The government, and in particular a future government of honour and integrity (we can dream) will be stuck with honouring deals done by the present bunch of thieves. There are international laws and standards about not breaking deals your predecessors in government have done. Surprisingly some of these are human rights laws (Governments can’t deprive citizens of their property without compensation).
So what is to be done? What can a future good-Labour, Green or NHAParty government do to unpick these deals and rebuild a fair NHS? While the deals themselves can’t be undone, the context in which they continue can be changed. It could make the legal, economic and tax environment too uncomfortable for the private sector contractors to continue, and it could provide a mechanism by which they could choose to give up or change the terms of their agreements. However, such a change would have to be done without discrimination. A law directed specifically at NHS contractors would be open to challenge.
Naturally, I would make the case for a law about transparency as part of the mix. Make it so that every government and public sector contract must be published in full. Plus information about the beneficial ownership, tax status and political affiliation of the contractor. Let’s add to that a requirement that NHS trusts also publish their accounts in detail, leaving out only any personally-identifiable data – transparency is a good thing all round: the only thing that should be confidential in the NHS is patient information.
By pursuing the transparency agenda, the new government will make it more and more uncomfortable for the worst private contractors. If the ownership paper trail ends up at a brass plate in Grand Cayman (as well it may), the Government can and should require the UK end to disclose the details or forfeit the contract.
This forced opening of contracts will allow teams of NHS supporters to conduct forensic analysis of the terms. It may be that some private-sector contracts actually turn out to be more efficient than keeping the services in house; if so, there are other things to worry about.