David Cameron’s oft-quoted assertion that the Health and Social Care Bill has now won the support of NHS professionals is much derided. And last week’s volte face from the BMA to actively oppose the bill only further undermines his optimism. In fact it’s hard to find much support anywhere.
But support there is and most of it was congregating at the NHS Alliance conference in Manchester this week. The NHS Alliance is the perky puppy dog of primary care. Its conferences are always unusually optimistic for a gathering of NHS dwellers – it’s an organisation built largely in the image of its cheerful bow-tied GP chairman Michael Dixon, who set the upbeat tone for the conference by bursting onto the stage through a paper banner screaming “Breakthrough.” Yes, it was as odd as it sounds, but for many delegates at this conference (GPs and primary care management on the whole) the Health and Social Care Bill is what they’ve spent 14 years pushing for. This is their moment.
A straw poll of the crowd saw just a handful rejecting the bill outright and hundreds offering it their support. And they are a persuasive bunch….
A lot of problems with the bill really aren’t being adequately answered. I’ve yet to hear anybody give a convincing reason why PCTs couldn’t be restructured rather than abolished and rebuilt. Clinical senates still strike me as the most spectacularly pointless layer of guff. And the utter balls-up of an afterthought that is education and training smacks of a total failure to think through the consequences of reform. But the narrative around the core idea of clinical commissioning, as presented at the conference, was coherent and compelling. Here was a room of hundreds of doctors and managers who are already effectively working in clinical commissioning groups, who have redesigned services and are doing their work to great effect. They have problems, the bill has problems, but for them the shifting direction has been, by and large, a Good Thing. The rest is noise.
However, one of the smallest but most challenging contributions was from one of the bill’s biggest sticking points: the private sector. Over 48 hours we heard from the very greatest and the goodest in the NHS: the secretary of state, the chief executive, the chair of the Future Forum, the chairman of the parliamentary committee on health, the medical director of NHS England, the head of the King’s Fund, the department of health’s head of finance, and more knights and dames than might feature in a whole season of panto. But the repeated murmur among those listening was that the best, most visionary, and engaging talk was 10 minutes from Ali Parsa.
This is a name that hit the headlines last month as the founder and managing partner of Circle Health, the organisation that has controversially taken over Hinchingbrooke Hospital.
There are many big questions being asked over how private firms work in the NHS and 10 minutes showmanship should absolutely not be mistaken for an NHS panacea: there was little on show to tell how he would fare day to day in his new role. But I imagine I was far from alone in leaving the auditorium thinking that next time I’m in a hospital I would rather he was the chief executive of it than anybody else on that stage.
The thought struck me that if we’re serious about quality in the NHS, we may need to be less hesitant to embrace it, in all its forms.
Edward Davies is editor, BMJ Careers