The NHS (Procurement, Patient Choice and Competition) Regulations 2013. An Idiot’s view.

Statutory Instrument 2013 No. 257 was “Made” on 11th February, 2013; “Laid before Parliament” 13th February, 2013; and is “Coming into force” on April 1st, 2013.

I do not intend a legal analysis, because there’s an excellent one here; neither do I intend a comprehensive translation into plain English. because that’s available here.  I would just like to take a seat on the Clapham Omnibus and make a few observations, and in no particular order.

I don’t read very newspaper or listen to every news broadcast. That notwithstanding, my sense is that without that original blog on the SHA website, written by Dr Shibley Rahman and promoted through the social media by NHS supporters, these Statutory Instruments would have come into force without mention in the mainstream media; which would have remained –  as George Monbiot described the BBC on another matter – “disgracefully incurious”.

The UK system of government – the arcane, unwritten rituals and processes of our Parliament – is a set of Mithraic mysteries (or Masonic) kept so, and quite impenetrable, to Her Majesty’s subjects. It constantly surprises and appals. One day we learn that Lords and Ladies may speak in debates where they have a vested financial interest.  On this occasion we learn that highly significant changes to the lives and wellbeing of everyone in England can “come into force” without debate in either House, let alone a vote. Unless someone says a prayer.

Dr Sarah Wollaston MP tweeted today that she was shocked by the negativity faced by MPs, and how wearing it is . Surely here is an egregious example of why our democratic process is in such a deficit;  MPs almost cannot remain principled when such huge changes are slid into place without public consent (the more cynical amongst us might suggest, deliberately so).

Because as Nicola Cutcher and Lucy Reynolds point out in their blog for Open Democracy, these Regulations implement exactly what former Health Secretary Andrew Lansley said in 2005 that he would do in government. What we have had between that date and now, most especially since the Coalition Agreement and now, and most particularly during the passage of the Health and Social Care Act 2012 (which enables these regulations, and not the other way around) was near silence on this matter; a silence only broken by denials and obfuscation.

The genesis of these Regulations as much as their contents screams at us that our political system is unfit and undemocratic; and that too many of its denizens are (and have been) as dishonest to the public as they are craven to their real masters: the lobbyists, private corporations, the so-called Big 4 accountants, and the mendacious mesh of rightwing thinktanks.

Barely more than a week before  these regulations were laid before Parliament (and don’t fail to consider that untimely haste), the National Health Service had been presented with the third of three man-made (or politician-made) challenges. To the challenge of a reorganisation so large it could be “visible from space”; and the “Nicholson Challenge” to cut an unprecedented £20B in five years; was added the Francis Report: the only one of these three of actual, real relevance to patients and the public, and the only one to base improvement on evidence not ideology or whim.

The Francis report laid bare how the reorganisations and management targets, the bullying and distractions and failures in patient care actually impacted patients and their families. Francis set out nearly 300 proposed improvements, the implementation of  any number of which might conflict  with either the Nicholson Challenge or the Health and Social Care Act. Utterly unbelievably to anyone who has been involved in service or project delivery, that Act was written and put into legislation while the Francis report – commissioned by the very same Health Secretary – was being compiled. It was almost as if Lansley had raced to get the Act into law before Sir Robert could recommend anything. Just in case.

So now, on top of the £20B of so-called “efficiency savings”, on top of the cost and effort, and issues of implementing the Health and Social Care Act, on top of the to date unbudgeted costs and effort of implementing Francis; the Department of Health sees fit to bring into effect major changes through Statutory Instrument.

And how are these changes to be implemented anyway? What well-run business would throw out a major reorganisation (on top of three other major reorganisations) without an implementation plan, a risk register, programme managers to manage the whole thing, and – not least, a budget to pay for it? The whole thing is insanely incompetent.

Let’s not forget that the impact of all this will be – as Francis recorded in his report – suffering, anguish, and unnecessarily and untimely deaths. While the real problems facing care of the sick and elderly in England accumulate, the management of the NHS will be reading through these regulations and buying advice on EU competition law.

As it has for so many years, the actual effort of caring and treating the citizens of England will crash with increasing pressure upon the staff of the NHS. And yes, England. Because England has been singled out by English MPs for this awful experiment and experience.

Coming into force on April 1st. April Fools’ Day. How our political system makes sorry fools of us all (at least, in England).


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