A house without foundations will subside. The decennial reorganisation of the NHS has neither sure foundations nor structure. It will struggle to withstand the complex health challenges raining down on it. The one chance to meet the next decade’s health and care needs still awaits the foundational pillars of public health, mental wellbeing and social care White Papers. The Secretary of State’s proposal for yet another mass reorganisation is structurally unsound without those vital foundations.
With 5 million people queuing for operations and appointments, old and disabled people stripped of their money and dignity in a broken care market, mental health challenges enduring and deepening, embedded inequality and complex comorbidities, it is only the love and care of the staff that is holding the whole NHS together, while they are robbed of pay and respect and battling their own mental exhaustion.
I have four points to make. First, for years, Professor Michael Marmot has called for a focus on tackling health inequalities to improve health and wellbeing. This reorganisation will not see such a shift in health outcomes. Secondly, absent of a funding framework and with the national prescription of NHS provision ripped out of the NHS in 2012 by the coalition, the postcode lottery will entrench. In places such as York, rationing denies people vital healthcare.
Thirdly, I know that this Government hate scrutiny, but without it, wrong decisions are made and people suffer. Better accountability, not less, nationally and locally is needed. There is too much blame shift under this teflon Tory Administration. Strong governance and accountability leads to transparency and better outcomes. Fourthly, tragically, this past year has seen the most vulnerable exposed to the greatest risks. Of the 128,000 who have died, a third were in care homes, many alone.
Since 2010, this Government’s annual pronouncements of imminent social care White Papers have been worn like the emperor’s new clothes, laying the Government bare with no resolve. Unless there is a fully integrated public health and care service free at the point of need, we will never build the caring and compassionate society that we need.
The Government’s proposals drive the market through the centre of our NHS. While stripping out section 75 regulations is a must, their purchaser-provider approach conflicts with the planned collaboration necessary to fix the scale of challenge. These reforms provide neither remedy nor cure. There are no foundations, no strong structure. The Minister needs to go back to his architect—in my book, it should be the Labour architect of our NHS—and redraw his plans.