Department of Health: NHS Modernisation – Listening Exercise
UNISON response, May 2011

Executive summary

UNISON remains fundamentally opposed to the government’s plans to bring about a massive top-down structural reorganisation of the NHS that favours markets and competition over integration and cooperation. The union’s key concerns are laid out below:

· Government plans represent a move to wholesale competition. This will undermine attempts to provide more integrated care both with the NHS and between health and social care. The application of competition law means the NHS is likely to become increasingly mired in wasteful litigation.
· The NHS will become increasingly subject to European competition law, meaning that instead of devolving responsibility to the local level, government plans will permit the EU a greater say in the way the NHS is organised.
· The full-blooded market system will allow services, wards or even entire hospitals to be lost with insufficient contingency arrangements to protect continuity of care for patients.
· The regulatory system is insufficiently robust to deal with the new provider landscape.
· Changes are needed to the Department of Health’s Operating Framework to rule price competition out completely, and the regulator Monitor must be forced to toe this line.
· The move to Any Willing / Qualified Provider will lead to instability and waste. It could even lead to less choice for patients in the longer term. UNISON supports a return to the previous model in which the NHS was the “preferred provider”.
· Plans to undermine NICE and bring about “medication tourism” will increase health inequalities and threaten value for money.
· The government’s plans are riddled with conflicts of interest and undermine the accountability of the health service to patients, public and Parliament. Most significantly, the Secretary of State should not be able to abrogate responsibility for the NHS. And handing responsibility for charges to commissioning consortia opens up the prospect of more widespread charging for services or top-up fees.
· Health and Wellbeing Boards need to have greater democratic involvement and need stronger powers. The plans for local HealthWatch also need strengthening.
· Government plans for education and training will lead to a loss of strategic planning and will undermine the ability of the system to respond effectively to changing demands.
· Separating out the commissioning of pre- and post- registration courses poses a significant risks to the effective way in which workforce planning currently operates.
· There is a need for substantial extra training for those visiting health and care providers.
· There is a need to retain national workforce structures for terms and conditions, for pay and bargaining, and for training and education.
· The abolition of the private patient income cap mean that some foundation trusts will prioritise those that pay for their care over NHS patients, who will find themselves waiting longer for operations and treatment.
· Reassurances about the need for foundation trusts to reinvest their private patient income in improving NHS services have been inadequate. Plans for foundation trusts to keep separate accounts listing their private patient income and their NHS income are so far only referred to in the Bill’s supporting documents, not in the actual legislation itself.
· For social workers, the right of appeal will in future be much narrower and less responsive to the complexities of social work cases. Pursuing an appeal will become more expensive and risky. The current Care Standards Tribunal system has proved itself to be accessible, efficient and cost effective in ensuring fair outcomes for social workers.