The future of the NHS at stake in 2015 election, says Ed Miliband: Labour is launching its pivotal election pledge on the NHS, promising 36,000 more staff and the repeal of privatisation laws [xpost /r/LabourUK].

Disclaimer: vested interest as I'm employed by the NHS!

While I personally find the direction of travel in the Labour policy promising, the detail - and my experience of how things actually work is surprisingly worrying to me.

There's little mention of policy detail in today's new items and I know I'll be following closely - but previous Labour policy was to merge Clinical Commissioning Groups (CCGs) with Local Authorities (LAs). In theory this enables social care and other LA responsibilities plus CCG NHS services to be run under one roof and could encourage full integration of services.

In practice, the NHS and Social Care already works incredibly closely together, especially since the recent push on integrated care and the 'Better Care Fund'. In my experience, LAs have far more bureaucracy and process than the local NHS and any transfer of NHS services to the LAs is likely to slow down NHS changes and responsiveness to local needs. The way LAs conduct themselves is heavily regulated, with entire teams of governance staff dealing with their committee's and groups. Yes - LAs possibly conduct their business more transparently in some ways, but there's also much more potential for things to be hidden in swathes of documentation or corrupted with local politics at play.

Which leads me on to the potentially even bigger issue - that with the NHS transferred to local Councillor control, the NHS is even more open to local politics than it ever has been before. We now don't just have to worry about the impact of national politics on our work, but also local politicians. And while yes - that's always been a part of the job, it's one thing to have a local Councillor campaigning against a service change or building closure, it's another for them to sit on the Committee deciding on it.

I'm all for the further integration of health and social care - although there is virtually no reliable evidence that it will reduce costs from similar initiatives around the world. What I personally want though is for this integration to happen under an independent, open and evidence based organisation, not the Local Authority.

I want the politics to be reduced in the NHS - not increased. If that could happen, we could be honest about, for instance, the integration of health and social care - there are studies that indicates it impacts on the quality of services, safety and patient experience heavily. Which is a great thing - we should be emphasising that, not pinning hopes on that it reduces costs when it's unlikely to.

There's a similar situation with the 'privatisation laws'. The 2012 Health and Social Care Act did not strongly affect existing legislation with regards to NHS procurement. Yes, it reinforced guidance that had been in place for years, but there was not anything significantly new in there in practice. Locally, we've not handed over a single contract to a private provider - indeed 3 have actually come back to NHS run social enterprises or NHS providers instead since the legislation.

For me personally, I'd like to see NHS providers as the 'first option' provider, but the bigger picture is ensuring that whatever provider is the highest quality and provides the best, most appropriate patient experience. This isn't impossible to achieve under current legislation, but does require more work and external legal advice to ensure that our service specification and tender processes are in line with law. The standard procurement process tends to lean heavily towards value for money and experience in producing bids on the provider side. This is why private providers tend to be successful and NHS organisation often fail, a private provider may have an entire team dedicated to bidding for contracts with in house legal advice, while NHS organisations often have to bring in interim expertise every 4 years to deal with it - or make do with staff who only do it every 4 years.

Lastly, I'm not sure many of us can stand another re-organisation. I'm now doing more or less the same job but employed by the 4th organisation in 5 years. If there's another re-organisation this year, that's 5 for 5...

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