blank to publish it.
Lansley, then shadow health secretary, made great play of this in the run-up to the election, challenging and ridiculing Labour’s secrecy. Indeed one of Lansley’s first actions, once installed as Health Secretary in 2010, was to publish the McKinsey report, as he had promised.
However Lansley was also determined to enforce the £20bn savings target at the centre of the McKinsey plan. So denouncing and publishing the document turned out to be simply a prelude to Lansley effectively compelling almostall commissioners and many NHS trusts to adopt some of McKinsey’s key proposals, and implement them in the quest for cost savings.
Since this one grand gesture of transparency (at the expense of the former government), the doors have swung completely shut once more. The drive towards greater secrecy has been resumed, taken to new levels by the fragmentation and attempts to foster competition set out in the HSC Act.
Retreating to arm’s length
Clause 1 of the HSC Act ended the duty of the Secretary of State to secure or provide a universal and comprehensive health service in England. This responsibility was transferred to the body now known as NHS England. Lansley’s successor as Health Secretary, Jeremy Hunt, has taken full advantage of the new scope this has given him.
Released from any formal responsibility Hunt has repeatedly used his position to criticise the NHS whenever things go wrong, while doing nothing to address the resource constraints or inefficiencies imposed upon it by his own government. In this way the HSC Act can be seen as a way of ‘liberating’ not the NHS but ministers – to attack it whenever they feel it politic to do so.
Hunt clearly feels free to point the finger of blame for any problems either at the local commissioners and providers of services, or at NHS England, the new national commissioning board which is now theoretically responsible for commissioning – while the responsibility for frontline services remains firmly on the local NHS trust or Foundation Trust.
Lib Dem minister Norman Lamb has taken similar advantage of the separation of the NHS from parliamentary control, washing his hands of any responsibility for NHS England’sdecision to impose bigger cuts on mental health budgets than on acute hospitals.
Speaking to the NHS Confederation’s Mental Health Network, 13 Lamb criticised NHSE’s decision to impose a tariff reduction of 1.8 per cent in mental health contracts, compared with 1.5 per cent in acute care. He told delegates the decision was ‘flawed, not based on evidence and cannot be defended’. But then he dumped the problem straight back onto the mental health trusts, saying they should ‘fight’ with their commissioners over their contracts: ‘Do not accept a proposed settlement which results in mental health losing out.’
Since his Tory bosses have (with LibDem support) forced through legislation that puts all of the financial control in the hands of commissioners, and all of the problems in the court of the provider trusts, this is a cynical, hypocritical evasion.
However, Lamb’s outburst did at least confirm that the bold proposals of the Department of Health’s ‘Closing the Gap’ report, 14 launched by Lamb and Nick Clegg in January 2014 with the declared aim of working towards ‘parity of esteem’ between mental and physical health care, were not worth the paper they are written on. Having set up a dysfunctional system, Lib Dem ministers and Tories alike intend to stand back and blame the NHS as things go horribly wrong.
Now the Secretary of State is no longer responsible, in theory accountability for our health services runs through a variety of bureaucratic bodies. The Act established a new NHS Commissioning Board, now known as NHS England, which is responsible overall for the commissioning of primary care and specialist services, and for vetting the constitutions, setting the budgets and monitoring the decisions of all
Lansley, then shadow health secretary, made great play of this in the run-up to the election, challenging and ridiculing Labour’s secrecy. Indeed one of Lansley’s first actions, once installed as Health Secretary in 2010, was to publish the McKinsey report, as he had promised.
However Lansley was also determined to enforce the £20bn savings target at the centre of the McKinsey plan. So denouncing and publishing the document turned out to be simply a prelude to Lansley effectively compelling almostall commissioners and many NHS trusts to adopt some of McKinsey’s key proposals, and implement them in the quest for cost savings.
Since this one grand gesture of transparency (at the expense of the former government), the doors have swung completely shut once more. The drive towards greater secrecy has been resumed, taken to new levels by the fragmentation and attempts to foster competition set out in the HSC Act.
Retreating to arm’s length
Clause 1 of the HSC Act ended the duty of the Secretary of State to secure or provide a universal and comprehensive health service in England. This responsibility was transferred to the body now known as NHS England. Lansley’s successor as Health Secretary, Jeremy Hunt, has taken full advantage of the new scope this has given him.
Released from any formal responsibility Hunt has repeatedly used his position to criticise the NHS whenever things go wrong, while doing nothing to address the resource constraints or inefficiencies imposed upon it by his own government. In this way the HSC Act can be seen as a way of ‘liberating’ not the NHS but ministers – to attack it whenever they feel it politic to do so.
Hunt clearly feels free to point the finger of blame for any problems either at the local commissioners and providers of services, or at NHS England, the new national commissioning board which is now theoretically responsible for commissioning – while the responsibility for frontline services remains firmly on the local NHS trust or Foundation Trust.
Lib Dem minister Norman Lamb has taken similar advantage of the separation of the NHS from parliamentary control, washing his hands of any responsibility for NHS England’sdecision to impose bigger cuts on mental health budgets than on acute hospitals.
Speaking to the NHS Confederation’s Mental Health Network, 13 Lamb criticised NHSE’s decision to impose a tariff reduction of 1.8 per cent in mental health contracts, compared with 1.5 per cent in acute care. He told delegates the decision was ‘flawed, not based on evidence and cannot be defended’. But then he dumped the problem straight back onto the mental health trusts, saying they should ‘fight’ with their commissioners over their contracts: ‘Do not accept a proposed settlement which results in mental health losing out.’
Since his Tory bosses have (with LibDem support) forced through legislation that puts all of the financial control in the hands of commissioners, and all of the problems in the court of the provider trusts, this is a cynical, hypocritical evasion.
However, Lamb’s outburst did at least confirm that the bold proposals of the Department of Health’s ‘Closing the Gap’ report, 14 launched by Lamb and Nick Clegg in January 2014 with the declared aim of working towards ‘parity of esteem’ between mental and physical health care, were not worth the paper they are written on. Having set up a dysfunctional system, Lib Dem ministers and Tories alike intend to stand back and blame the NHS as things go horribly wrong.
Now the Secretary of State is no longer responsible, in theory accountability for our health services runs through a variety of bureaucratic bodies. The Act established a new NHS Commissioning Board, now known as NHS England, which is responsible overall for the commissioning of primary care and specialist services, and for vetting the constitutions, setting the budgets and monitoring the decisions of all
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