A revealing document has come to light that gives insight into the Coalition Government’s plans for the NHS. It would seem to be an early draft of the section in the coalition agreement that was dropped in favour of reassurances that there would be an end to top-down reorganisation of the NHS and that the NHS budget would be protected.
- NHS – DRAFT – CONFIDENTIAL
We will contain NHS spending by removing any duty on the Secretary of State to provide healthcare and by giving new powers to devolved commissioners to decide what care they can afford to provide for their locality.
We will open the market in healthcare to any body willing to provide it, so that the NHS will cease to be the dominant provider of healthcare.
The new competition will offer the impression of greater choice to the consumer and will force our older and less efficient hospitals to close. For this to happen we need to accelerate Labour’s Foundation Trust programme so that all NHS hospitals can be regarded as stand alone units which can be allowed to fail.
We will give responsibility for commissioning healthcare to the GPs. They may have better ideas for how to spend the money. If they cannot find cheaper services to enable the money to go further, they can take the rationing decisions.
GP commissioners will be encouraged to employ firms of consultants to achieve the most efficient use of commissioning moneys.
As GP commissioners will only have responsibility for their own patients we need to avoid conflict with Public Health doctors who have traditionally taken a view of the health of the whole population. Public Health will therefore be divided up. The largest share will transfer to Local Authorities. Some Public Health functions will become answerable centrally, and some will cease.
The costs of introducing these changes will be met by staff reductions, preferably from the PCTs which will be abolished, but if necessary by temporary reductions in nursing staff.
By 2015 NHS expenditure will be fully cash-limited. Any under-spends will be returned to the treasury, so it is likely that in most years there will be a reduced spend on the NHS in both in real terms and in cash terms.
- IMPLEMENTATION NOTES – VERY CONFIDENTIAL
Dave, George, Andrew and Nick are on board with this. We may have a bit of trouble from Ken who has occasional rushes of blood to the head and seems to have become a bit of a lefty, but if we remind him of his days at Number 11 and point out that what we are doing is only the logical extension of what he and Maggie started back in the 80’s he should be OK. Nick says that there may be an awkward squad in the Lib Dems, but he is confident that he can deliver them. It is suggested that no-one show this document to Vince.
We don’t expect any trouble from the Medical Royal Colleges, they stand to gain too much from private practice. “Stuff their mouths with Gold” Ha, Ha.
If some of them do get restive we could threaten their gongs. If necessary we go for the nuclear option: tell them that if they behave in a political manner we shall deprive them of their charitable status.
The public are a bit twitchy about the word “privatisation”. So it is important that we stress throughout that there is no intention to privatise any single part of the NHS. We could do with someone looking up a few obscure meanings of the word “privatise”, but if necessary can fall back on the defence that we didn’t intend it, it just happened by accident. After all, when all the NHS providers go bust we shall need the help of Virgin, Serco, United Health et al.
The independence of Foundation Trust Hospitals will make it easy for us to allow them to go bust, but we may need to sacrifice a few viable hospitals to ensure that hospitals with large PFI contracts continue to pay their annual fees: we have too many colleagues heavily invested in the PFI business to allow them to go under.
It is likely that someone will notice that the USA gets worse value for its spend on healthcare than any other country in the world, so it is important that we stress that we are not introducing a US style health system (at least not all in one go.) We had better play down the presence of US providers already in the UK and keep quiet about all the help we have had from McKinsey in drawing up these plans. Perhaps we should get them to draw up the wording of the legislation through an intermediary. (I don’t know why the public are so queasy about the USA, they are perfectly content to buy their coffee and burgers from US companies, so why not health?)
It is important to keep the management consultancies in the loop, many colleagues in both houses have useful connections there and we can encourage them to convey the message back that although it may look as if we are giving all the power to GPs, we fully expect GPs to need logistical help, and within a few years most of them will have thrown in the towel and we can let the commissioning companies take over the whole shooting match.