The Health and Social Care Bill is a complex piece of legislation with the potential to have a profound impact on health services in the UK. Often an understanding of such pieces of complex legislation can be facilitated by hearing from those involved in the conceptualisation or codification of such legislation as well as discussions about key points. With that in mind, I undertook a search on YouTube for material on the Health and Social Care Bill using the search term ‘Health and Social Care Bill’ and also by identifying any relevant related videos from the search results. There were a number of confounders within the returned results and these related mainly to the Health and Social Bill in the USA. Of those that were relevant the video material could be broadly divided into a discussion of the benefits of the legislation or opposition to the Bill. In the latter group there were numerous videos of protests including marches which illustrated the feelings that the Bill has evoked but which did not offer further insights into the Bill itself. The material below therefore represents the most useful material both for and against the Bill which I identified from the relatively simple search.
Firstly the King’s fund has a series of videos on the Health and Social Care Bill
1. In this video Health Secretary
of State Andrew Lansley discusses some aspects of the Health and Social Care Bill including patient choice. One interesting analogy he uses is the Blackberry which is a ubiquitous device representing the integration of multiple organisations operating in a competitive framework. There is also a Q&A session where Lansley answers questions about education and training of the medical workforce and the effects on quality of the Health and Social Care Bill. and
2. Legal aspects. Solicitor Gill Thomas looks at a number of the legal aspects of the Health and Social Care Bill. GP’s spending public money, review of decision, scaling of consortia. 250,000 in consortia will bring a focus on to the scalability of the infrastructure.
3. Partnership working. Chief Executive of United Health looks at some of the possibilities for partnership. These would include recruiting organisations with expertise in commissioning including commercial skills and engagement with the public. This will be contingent on what can be achieved ‘in-house’ which will become clearer with time.
In this video, MP Simon Burns gives a succint presentation on the Health and Social Care Bill. He comments on differences in health outcomes between the UK and other EU countries and also on how commissioning should go to the GP’s who are the first point of contact for patients. Nicky Morgan MP talks to the house about the Bill and suggests that GP’s would be very capable of commissioning services but she also talks about Mental Health services. Morgan quotes research commissioned by Rethink suggesting that GP’s are less confident about commissioning Mental Health services compared to other services. Morgan also suggests that the need to commission appropriate Mental Health services will lead to an improvement in understanding of Mental Health issues.
The Royal College of Midwives secretary Cathy Warwick talks about the Health and Social Care Bill in this video from May 2011. Warwick explains some of the needs of the College including Commissioning Bodies with ‘associated advisory networks’, that commissioning for midwifery should be at a supralocal level, requesting that Monitor promotes not just competition but collaboration as well as trying to remove promotion of competition from their role for midwifery services. There is a series of 4 videos (1, 2, 3, 4) of a presentation by Professor Graham Scambler and Professor Wendy Savage. Bigger than the original 1946 bill. He describes the internal NHS market as a ‘pseudomarket’. His argument against adopting an American model of healthcare is that 25% of the American healthcare budget is sent on administration compared to 5% in the UK. He also comments on the evidence base for Private Finance Initiatives which were introduced by former Prime Minister John Major and discusses the formation of H5 in the private sector. European competition law could be used to ensure that contracts go to the lowest bidder. He suggests that wealth and power coalesce in classess and that this trend is increasingly evident globally. He also looks at resistance to the Bill and he comments that the Bill is based on
‘policy based evidence’
‘What I think we’re seeing is a remodification of health care‘
Professor Wendy Savage gives a presentation which includes a discussion of the ‘Keep Our NHS Public campaign.’ Professor Savage comments on some of the details about the commissioning boards being vague. Who is taking over the other roles of the PCT’s? There is also a question of the complex interactions between patient choice and GP commissioning. Fragmentation of the health service and the effects on training of healthcare professionals are just a few of the important subjects tackled in the presentation. Professor Savage is sceptical in her interpretation of the Liberating the NHS paper asking whether it is about 100 billion being liberated for the private sector and also that healthcare doesn’t do well with market mechanisms. Professor Savage also comments on the practicality of MP’s reading 367 pages of complex legal material contained in the Health and Social Care Bill. Market Driven Politics by Colin Leys was also considered to be an important book to read – this is a work that suggests that politics is being increasingly driven by global financial markets.
The BMA has a nearly 10 minute podcast on the Health and Social Care Bill which explains the process by which the Bill passes through the House of Commons and then the House of Lords including the roles of the reports, committees and MP’s. At the BMA AGM a poll was taken on whether the BMA should oppose the Health and Social Care Bill and this was defeated narrowly. This video features interviews with many of the delegates and one of the arguments used against opposing the Bill was that there had been a move towards working for changes to the Bill instead.
Dr Louise Irvine talks about the Bill. She refers back to multiple top-down reorganisations which have been expensive and disruptive. Dr Irvine suggests that the GP’s will need to be saving money on referrals and that they in turn will be monitored with regards to their savings. Dr Irvine then discusses her concerns that these changes will mean that there is a risk that the doctor-patient relationship will be perceived to be influenced by financial factors and that there will be an undermining of the role. She also raises the possibility that GP’s will lose their contracts and jobs. Dr Irvine makes a number of other points:-
‘If towards the end of the financial year we’re reaching out budget limit, we may not end up referring patients for a couple of months till we get into the new financial year’
‘The whole thing of competition which I think is difficult for people to really understand because we don’t think of the NHS as a marketplace with lots of competing organisations’
‘The government reforms explicitly rule out collaborative relationships between hospitals and other healthcare providers’
Dr Irvine then discusses the role of Monitor
‘It’s role is to promote competition and it’s there as a kind of court of appeal for private companies that are not happy with local NHS hospitals continuing to get the contracts to provide care’
She suggests that large organisations can afford to use loss leading approaches to the bidding process and also notes that reducing the costs of services can be associated with staff cuts. Dr Irvine makes a number of other points suggesting for instance that contracts are difficult to pull out of once entered into, that it’s difficult for commissioners to find out about performance due to commercial confidentiality and that there will be an expected increase in transaction costs which is estimated at about 20 billion pounds a year. With regards to non-profit versus profit based organisations, Dr Irvine notes that certain health research studies have identified a reduction in quality of care in the former (although in the question and answer video above, Andrew Lansley makes the point that tariffs would ensure a focus on quality).
Dr John Lister gives a presentation on the implications of the Health and Social Care Bill. He suggests that relocation of staff between organisations will involve the cost of redundancy fees for the transfers resulting from the reorganisation. He goes into some detail about the role of referral managers in parts of the NHS already. Dr Lister also comments on the structure and operation of consortium. He also asks questions about treatment of certain populations for instance managing emergencies in commuters or tourists. Dr Lister also asks ‘who is any willing provider’. In discussing the tendering process he refers to the previous tendering of cleaning contracts. Dr Lister also comments on the proposed efficiency savings of 4% per year which he suggests are without precedent. He also points out some of the risks including service closures and the possibility of reduced procedures due to budget constraints.
I wasn’t able to identify any material discussing the Bill in detail. The videos above are about the implications of the bill without directly referencing the text of the Bill. These videos also represent a relatively small proportion of the wider debate about the bill and this broader discussion is to be found in other media.
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