Tories: The party of NHS bureaucracy

In the Tory vocabulary, bureaucracy is a very dirty word, one step removed from Stalinism and a slippery slope to that end. However, in a bid to save the much opposed health reforms the coalition is turning to bureaucracy in spades.

In its response to the NHS Future Forum listening exercise (pdf) the government aims to create clinical senates, commissioning consortiums, health and wellbeing boards, a national commissioning board. That’s four types of bureaucracies for the price of the current two: Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs)

Mr Lansley is aiming to abolish PCTs and SHAs by April 2013. Both served a purpose in massively reducing waiting times under Labour however by removing them the health secretary aims to make £1 billion a year in savings from cutting “central bureaucracy” – otherwise known as the jobs of managers and administrators.

How much extra bureaucracy will this mean on the ground? See if you can untangle it for yourself: The clinical commissioning groups will need “authorisation” from the national commissioning board with “input from health and wellbeing boards and local clinicians”. If they don’t get authorisation they might exist in “shadow form”.

The clinical senates will give advice “which we expect clinical commissioning groups to follow on how to make patient care fit together seamlessly in each area of the country”.

The document reads:

“Clinical senates will have a formal role in the authorisation of clinical commissioning groups. In addition they will have a key role in advising the NHS Commissioning Board on whether commissioning plans are clinically robust and on major service changes.”

On the subject of health and wellbeing boards, it states they:

“Should be involved throughout the process as clinical commissioning groups develop their commissioning plans, and there will be a stronger expectation, set out is statutory guidance, for the plans to be in line with the health and wellbeing strategy. Though they will not have a veto, HWBs will have a clear right to refer plans back to the group or to the NHS Commissioning Board for further consideration.”

In addition:

“There will be a new requirement for the Care Quality Commission to respond to advice from its HealthWatch England subcommittee. The Secretary of State will be required to consult HealthWatch England on the mandate to the NHS Commissioning Board.”

As the Guardian NHS liveblog writes:

“Isn’t it the case that doctors will spend all their time consulting -with clinical senates, clinical networks, health and well-being boards and citizens’ panels – to get on with commissioning? Let alone seeing their patients?”

And let’s not forget that all the commissioning groups will have to publish minutes from all their meetings. In short the Tories could be the new NHS Stalinists.