It took Tony Blair’s Labour government several years and a couple of health secretaries to draw up major health reforms.
Blair fan David Cameron wanted to learn from the previous government’s mistakes, and do more, faster.
A close look at the DoH response to the Health Bill listening exercise suggests his bid to outdo Labour in the reforming zeal stakes is going rather well.
Labour managed three overhauls of the NHS system over a decade.
The coalition is on track to complete two in about a year and a half.
Not for the sake of simplicity, either. RCGP chairwoman Clare Gerada says the reforms have made the NHS look like Spaghetti Junction, and our infographic proves she’s got a point.
It’s often said each NHS reform costs two years of progress. On that basis, Labour just about did better than standing still, but the coalition’s going backwards.
Here’s a potted history of the Labour reforms. The party created around 500 primary care groups (PCGs) that fitted in under 100 health authorities and eight regional NHS offices inherited from the previous government.
In 2002, Labour transformed PCGs into 302 PCTs, scrapping health authorities and the regional offices to create 28 strategic health authorities (SHAs).
It then went pretty much back to scratch in 2006, cutting the number of PCTs to 152 (not far off the number of health authorities it had at the beginning) and effectively re-establishing the NHS regional offices by cutting the number of SHAs to 10.
The coalition, of course, is abolishing PCTs, many of them already amalgamated into clusters. Their commissioning powers are in the process of being transferred to clinical commissioning groups.
Our interactive map shows there are 257 and rising of these groups (think PCTs circa 2002).
But the DoH response to the listening exercise makes clear that it plans to create one health and wellbeing board for every ‘upper tier local authority’.
According to the Local Government Association, there are precisely 152 of these – one for each of the PCTs the government has just abolished.
These boards will play a role in approving commissioning boards to become statutory organisations, and as part of this process will have to bear in mind ‘how shared geographical boundaries between local authorities and clinical commissioning groups can support joint working’.
NHS chief executive Sir David Nicholson has already suggested the number of clinical commissioning groups will fall, and GPs have warned they are likely to be pushed towards mirroring health and wellbeing boards.
Meanwhile, the listening exercise response also said SHAs would be clustered into four for now, ahead of their
abolition.
So, less than two years after the White Paper Liberating the NHS, and before its Health Bill has even gone through parliament, this government looks on track to recreate an NHS structure based around the 152 units it hasn’t even finished scrapping yet. All it needs to match Labour now is to scrap a few health secretaries. Watch this space.
