Edward Davies: The NHS white paper (entirely predictable and not very radical)

Edward Davies Two of the major charges being thrown at this week’s health white paper have been that it is completely unexpected and brain-meltingly radical.

On the first point I’ve already had dozens of conversations with people who just “didn’t see this coming.” David Aaronovitch wrote in yesterday’s Times that there was little point in manifestos if they didn’t contain plans for office. Just how has the coalition government conjured up such a “complete overhaul” in just a few weeks?

The answer is simple – they haven’t, and you didn’t read the Conservative manifesto.

If you’d got as far as page 46 you’d be very unsurprised by almost all of this. On GP commissioning: “We will strengthen the power of GPs as patients’ expert guides through the health system by…putting them in charge of commissioning local health services”. On hospital status: “We will set NHS providers free to innovate by ensuring that they become autonomous Foundation Trusts.” On competition and privatisiation: “We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.” And so on and so forth.

However, I do understand that party manifestos can be dry, tedious affairs and page 46 was a long way in and so here at the BMJ we like to distil the important bits of health policy for you to get to grips with the key facts. And so it is that BMJ Careers published an interview with the then shadow health secretary Andrew Lansley last October in which he talked at length about a number of these ideas.

Again GPs and commissioning budgets were a big theme: “He would like to see GPs have the opportunity ‘to be more innovative, more efficient and to use resources for the benefit of patients.’ For that to happen he wants GP commissioners to be able to “exercise control over their budgets.’ ”

Private competition featured: “Having more competition in health care is likely under a Conservative government… He says that it would ‘like to maximise opportunities for the health service to benefit from new investment. That means giving the independent sector real opportunities to provide services to be innovative and efficient.’

The independent board, transferring management to clinicians, out-of-hours changes – it’s all right there. Read the BMJ, it’s brilliant.

So what of the second charge that this is the “biggest change in the NHS since 1948” as the King’s Fund’s Chris Ham calls it. Has the Conservative party welched on it’s promise for no more massive reorganisation?

Well actually this all feels rather familiar. GP commissioning? Successive governments have been pushing it in some form or other for the last 20 years. The last government has been publishing surveys and uptake target figures aimed at the universal coverage of practice based commissioning since 2006. The NHS has had it’s own Chief Executive with an NHS management board for years, albeit with less power. Foundation trusts are hardly new and as for introducing private providers, not only did the last government introduce this in spades but half their advisors are now working for said private companies trying to win NHS contracts. How quickly have we forgotten Simon Stevens, Mark Hunt or Matthew Swindells? The “creeping privatisation” of the NHS is as new as cholera.

This white paper is both entirely expected and little more than a logical continuation of 13 years work from the previous government. Albeit with a fresh pair of eyes tweaking the fringes and trying to inject a little more impetus, which of course will be completely lost in consultation and law making anyway.
Forget whether this was expected and radical, it was and it isn’t, and start asking if after 13 years the continuation of this direction is any good.

Edward Davies is editor, BMJ Careers.