Health Policy InsightEditorial Tuesday 2 October 2012: What does Labour's plan to repeal the Health And Social Care Bill mean?
The text of Ed Miliband's 'look, no notes' speech to the Labour Party conference this afternoon doesn't yet seem to be online anywhere I can see, but these paraphrase-quotes from The Guardian liveblog seem useful (UPDATE - BBC News clip of the speech is now up):
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The NHS depends on a set of values. You leave your credit card at the door.
It is something the Tories just do not understand.
Remember those posters that Cameron put up before the election. Cameron said he would defend the NHS. It was a solemn contract with the nation. But then he came out with a top-down reorganisation.
Cameron had a pause. He said he would listen.
Miliband lists all the health groups opposed, and asks what they said - getting the audience to say no.
He says he hates the waste the reorganisation involves. There are 5,500 fewer nurses than when Cameron came to power. Think what could have happened if he had used the money to employ nurses, not sack them.
And Cameron based his NHS reforms on the competition model in the gas and electricity market. What does that tell you about the Tories?
The old adage is true, he says: you just can't trust the Tories with the National Health Service.
That is all good red meat to the party faithful. There is just one slight problem.
Which is that genuinely repealing the Bill would mean another enormous top-down system-wide structural redisorganisation of the NHS.
Oh, and there is the small matter of winning a general election before Labour's NHS policy position can matter a lick of spit.
The old world of SHAs and PCTs is very definitely dead, but the new world is very definitely not yet born. The NHS is in the middle of a revolution half-completed, which is a very dangerous place to be.
To paraphrase the old medical cliche, it would be a shame if the repeal of the Bill were a great success, but the patient died.
Laporascopic surgery required
If Labour are not to be stupid (and it is early in the day to make a call on that), then they will not waste time and energy in addressing the complete repeal of the Bill.
They will instead focus their efforts here, on the Monitor section and here on the competition remit.
Even if we were to move to evolving CCGs into local clinical partnerships with capitated budgets and the NHSCB to a pan-England risk pool manager, there will remain a need to have internal mechanisms to hold providers to account for their safety, quality, outcomes and activity.
Of course, we have no evidence that the Nicholson Commissioning Board will be hands-off, nationally, regionally or locally. (The DH, SHAs and PCTs certainly weren't.)
Equally, banning any kind of competition and use of the private sector smacks of the dogmatic. Both are, let's face it, tiny.
Private provision is not going to get rich on a deflating NHS tariff, and has significant problems of its own.
Private medical insurance is quite likely to be torn a new one by the Competition Commission investigation, about which you can read more by private providers and associated groups here and here. (WARNING - The 126 consultants' responses through the first of those links might make you weep with laughter.)
If Labour win in 2015, there will not be any more money - and there may not be a great popular demand to increase income tax. There are only so many mansions to tax.
That means that any changes to the operation of the NHS need to be cost-neutral - if not cost-saving.
The changes will also need to work with the grain of those areas where clinical commissioning has succeeded. There will be not a few such places.
If Labour were going to be really grown-up, they would offer cross-party talks on reconfiguration of acute services. But memories of Dr John Reid and Hazel Blears manning the hospital closure protest marches are fresh.
It was true of Andrew Lansley and it's true of Andy Burnham: the person who thinks the NHS's problems are about its organisational structure has simply not understood the questions that face them.