Mr Hancock’s reforms are irrelevant to the longer term and bigger issues… Drs failed or were disbarred from involvement in management many years ago. Part of the reason was that they realised the system was broken – and their efforts would be futile. Wales and Scotland are free to differ – of course, as there is no NHS.

NHSreality does not necessarily agree with Mike Padgham, of the Independent Care Group, that “Reforming NHS care without reforming social care is like rebuilding a house without mending the roof.” If Social CAre becomes “free” in the same way as Health care is meant to be, then there is a case, but the risk is of a two tier system where the bankers of london get superior priate care and choices compared to those in the left behind regions. Admittedly, the perverse incentive to deny dementia as a disease will be removed. If health care is means tested, same as social care, then we do at least have a machanism of levelling out. It is much more realistic, but the perverse incentives will remain. No other country has copied us for a reason… lets talk about that. The consultants failed to commit to management because they realised the system was broken, and their efforts would be futile. Wales and Scotland are free to differ – of course, as there is no NHS.

Chris Smyth reports in the Times 12th Feb 2021: It’s the right time for NHS reform, says Matt Hancock
Reform of social care funding will happen this year to make an NHS overhaul set out yesterday work better, Matt Hancock has said.

The health secretary told MPs there was “no better time than now” to reorganise the NHS in England. “The pandemic has made the changes in this white paper more, not less, urgent,” he said as he published an 80-page plan for the biggest shake-up for a decade.

It is a partial reversal of 2012 reforms and Hancock said that the changes would make it easier for health bodies to work together in the interests of patients by getting rid of bureaucratic rules requiring competition.

The NHS internal market has been retained however, with last-minute additions to the white paper specifying that the divide between buyers and sellers of care would not be scrapped.

“Our proposals preserve the division between funding decisions and provision of care, which has been the cornerstone of efforts to ensure the best value for taxpayers for more than 30 years,” he said. “However, we are setting out a more joined-up approach built on collaborative relationships, so that more strategic decisions can be taken.”

Hancock is using the new laws to impose greater ministerial control over the health service, which was handed day-to-day independence under the 2012 law. He will gain powers to issue direct orders to NHS England, adjust his strategic instructions more often and intervene directly to block changes to local hospitals.

He said that while clinical decisions should be independent, “when the NHS is the public’s top domestic priority — over £140 billion of taxpayers’ money is spent on it each year — and when the quality of our healthcare matters to every single citizen and every one of our constituents, the NHS must be accountable to ministers.”

Jeremy Hunt, Hancock’s predecessor who now chairs the health select committee, backed the “brave” decision to change structures but said: “It is a very big deal to do a structural reorganisation of the NHS, and I know from my time as health secretary how distracting it can be.”

Danny Kruger, the MP for Devizes, asked for reassurance that Hancock “doesn’t want to hear the sound of dropped bedpans from his office in Whitehall as Nye Bevan did”, one of several largely supportive interventions from Tory backbenchers.

Jonathan Ashworth, the shadow health secretary, welcomed the goal of integrated care but said: “The test of the reorganisation will be whether it brings down waiting lists and times.”

He contrasted the success of the vaccination programme, run by the NHS, with that of Test and Trace, run by ministers, to warn against centralising power. To make plans work “we need a sustainable social care plan; we were promised one on the steps of Downing Street and we still do not have one”.

Munira Wilson, the Liberal Democrat health spokeswoman, said that after 25,000 care home deaths, the prime minister had to “make good on his promise to fix social care”.

Mike Padgham, of the Independent Care Group, an industry body, said: “Reforming NHS care without reforming social care is like rebuilding a house without mending the roof.”

Ruth Driscoll, of Marie Curie, the charity, accused Hancock of “silence on the underfunding of social care” urging him to “finally grasp the nettle and deliver a sustainable solution”.

WHAT’S IN THE WHITE PAPER?

Structural reforms
The clinical commissioning groups set up to buy care under 2012 reforms will be replaced by integrated care systems, to bring together different parts of the health system to work together to plan care. Hospitals, GPs and councils will sit on their boards, and social care and housing agencies will be consulted.

Collaboration not competition
NHS bodies will have a duty to collaborate, rather than be expected to compete with each other. Rules requiring competitive tendering of contracts will be ditched, but the NHS internal market will remain, with a clear division between commissioning and providing bodies such as hospitals. Patients will get more rights to choose private providers for NHS care.

Public health
A ban on advertising unhealthy foods will be made law, and ministers will get powers to impose mandatory health warnings on the front of food packets. Government will also be able to order fluoridation of water.

Safety
The Healthcare Safety Investigation Branch gets a legal basis and ministers will be able to overhaul professional regulation. Medical examiners to scrutinise deaths will be set up.

Social care
Funding reform promised; ministers get powers to demand data from social care providers and give emergency bailouts.

Denial and reluctance – a cultural black hole is revealed, and is probably in every DGH. Feb 2020

Consultants failed to get involved in management many years ago, and GPs are seen as mavericks who only look after their own businesses: because they are self employed. Gps should be on health boards, but almost everywhere they have been excluded. Other countries have better consultant involvement, as many elect to serve their colleagues by getting involved. This is relatively rare in the UK, where managing doctors are seen as “going to the dark side”. This is the iceberg of denial and reluctance – a cultural black hole is revealed, and it is probably in every DGH…

Consultants and management

Private sector to have a “valuable ongoing role”. Inevitable now that 1 year waits are routine. An honest conversation….!!? “…there was no plan for capital, there wasn’t a plan for public health, there wasn’t a plan for workforce, there was no plan for social care”. What sort of government was so unprepared?