April 5, 2012, by Fraser

The Health & Social Care bill: The battle for implementation has begun

Professor Ian Shaw, from Nottingham’s School of Sociology and Social Policy, gives his professional view regarding the implementation of the Health & Social Care bill – and the resistance it is already facing.

On 20 March, the day the Health and Social Care Bill was passed, I wrote a blog around the impact of the `Kidderminster effect’.

It seems that this is coming into being already in many parts of the country as Hospital Trusts merge to try and save monies through economies of scale. For example, three major A&E departments are set to close in London alone. These are unlikely to be closed without a significant local political battle.

Efficiency savings

With the passing of the Bill into law, and the striving for `efficiency savings’ within the NHS, these `little Kidderminsters’ will become a more and more common feature of the local political and health landscape and will raise public awareness of the changes taking place in the NHS.

Difficult though the passing of the Bill was for the Government, it could be that this was actually the easy bit. The reforms have now got to be implemented.

Implementation at ground level

`Street Level Bureaucracy’ is a well known term in policy analysis. The argument is that there is discretion afforded at every level of policy implementation and that what turns out to be policy when it `hits the streets’ isn’t actually what is legislated, but is the sum total of all those discretionary decisions. Often policy is skewed during implementation in directions not intended by the policy makers.

Almost everyone working in the Department of Health and in the Health Service was against the Reforms. Every single Royal College and Health Union was against the Reforms.  The most powerful person in the new structure, Sir David Nicholson – who is in charge of the National Commissioning Board (NCB) – gave evidence to the House of Commons Select Committee advising against the Reforms.

Similarly, the Royal Colleges and the BMA are advising their members, particularly GPs (who are to be the new health service commissioners), how best to work with the new structure to avoid what they see as `the privatisation of the NHS’.

Resisting the reforms

The Labour party, which has vowed to repeal the market element of the reforms when next in Government, has issued advice to all the Local Authorities it leads on how best to resist the market reforms in the NHS through their membership upon the new Health and Wellbeing Councils (which sets local health and social care strategy for Commissioning, which the new Clinical Commissioning Groups must follow) – and it is using this issue as a platform in the May local elections.

The more little kidderminsters there are the more this will fuel public reaction locally and nationally and stiffen implementation resistance. Against that background discretion is unlikely to be used in the direction the Government intended.

Ian Shaw

Professor of Health Policy


Posted in Politics