Edward Davies: The health bill: no trust and no U-turns

Edward Davies Last week marked a “humiliating climbdown” for the Health Secretary. Apparently. “Andrew Lansley is now in open retreat and is being forced to cave in on issues he previously fought to the hilt,” said his Labour nemesis Andy Burnham.

And so why does his acquiescence to an amendment demanding he take ultimate responsibility for the NHS feel less like a U-turn and more like a cup of tea at Charnock Richard services on a steady journey up the M6? Time and time again the amendment of this bill has been met with at worst a shrug, and at times a warm embrace.

In this case, when presenting the bill at the second reading to the Lords, Earl Howe pointed out that changes to the role of the Secretary of State were to reflect how the NHS already operated, but that of course Lansley and his successors would retain ultimate responsibility. But assurances were demanded and now they’ve come. Of course they have:

Rotund MP for Somecityshire: “I would like to ask my Right Honourable Friend what he intends to do about the 10 year surgical waiting lists and the closure of all hospitals in Somecity.”

Reclining Secretary of State for Health: “Absolutely nothing my equally honourable friend. I’m merely a figurehead these days. The chap you want is a GP in Oldham. Nothing to do with me.”

Rotund MP for Somecityshire: “Apologies. My bad, your honourableness. Do you have a number for him?”

The idea that the government would not be held to account for health is just possibly possible under the bill, but utterly unimaginable in the real world. In a world of infinite possibility there needs to be a degree of common sense. There’s nothing about the use of ground unicorn horns as a treatment for smallpox in the bill either. Do we need some clarity on that?

And the list for this kind of benign amendment is long and salubrious.

One of the initial major outcries was around Monitor, whose duty to promote competition caused outrage. A quick “where appropriate” later and many Honourables were mollified. But of course “where appropriate.” Who would argue otherwise? The line seemed to suggest that previously there was a subclause demanding that Monitor also promote competition where “wildly inappropriate and potentially dangerous too.” Of course it’s possible they might, but there’s nothing in the bill about paying the NHS tarrif in Fisher Price pirates’ doubloons either. Should the people be told?

And by far the greatest number of amendments was around the renaming of GP commissioning groups to clinical commissioning groups – around 700 amendments no less. This change in name was to reflect the concern that GPs may commission services without ever asking a local nurse, consultant, or indeed anybody about what they were doing. Surely a mighty blow to the GP-centric future envisaged by Mr Lansley? And yet the 700 changes sailed through. Because there isn’t a commissioning group in the country that does not speak to other experts about their area of expertise already. It’s just common sense. Of course they do. There’s no clause ensuring all groups don’t slaughter a goat at the start of every minuted meeting either – should we say something?

So what is going on? Perhaps it is that a vast amount of criticism of this bill seems to focus on what is not there rather than what is. The bill draws up a vision for the NHS but does not explicitly exclude 2000 alternative visions. And the bottom line is that we have lost trust in everyone else, not to pursue these 2000 alternatives. And that means everyone, not just politicians.

Of course we don’t trust politicians to take responsibility. But we also don’t trust regulators to work in our interests. And we don’t trust our GPs to weigh up all the evidence. Heck, we don’t even trust GPs to treat patients at all without one eye on their wallet. There is nobody in any position of power that seems to merit our trust at all. Anywhere.

Who knows how this bill will pan out in the next year, let alone the next decade, but I’m as depressed by this spectacular universal loss of trust, deserved or not, as I am by any Lords-amended subclause of a barely comprehensible health bill.

But why should you trust what I think anyway.

Edward Davies is editor, BMJ Careers