Latest news with #Lansley
The Guardian
14-03-2025
- Health
- The Guardian
What were the Lansley reforms and how did they create NHS England?
Keir Starmer announced on Thursday that the government was abolishing NHS England. Here we look at how and why the arms-length body was set up as part of reforms initiated by former Conservative health minister Andrew Lansley in an effort to improve decision-making in the health service. The changes introduced by Andrew Lansley, health secretary in the coalition government, represented the biggest reorganisation in the history of the NHS. One NHS leader quipped at the time that the overhaul was so big it was visible from space. Lansley promised that his Health and Social Care Act 2012 would take the politics out of the day-to-day running of the NHS. The act scrapped regional health authorities and shifted NHS commissioning power to GPs, through organisations later known as clinical commissioning groups. It also set up autonomous NHS organisations such as the NHS commissioning board, which later became known as NHS England, to run the service at arm's length from ministerial micromanagement. In addition, the act transferred responsibility for public health to local government. No, but they introduced what critics called a 'creeping privatisation' with a market-based system for more private involvement in healthcare. Under the banner of extending choice, Lansley's act allowed providers from the private and voluntary sectors to bid to supply NHS care. Critics claimed that handing budgets to GPs as independent contractors amounted to privatising the commissioning function of the NHS. They were almost universally criticised at the time, and there is now a general consensus they have been a disaster. Much of the criticism focused on the role of the private sector in the reforms. But experts also questioned the scale of changes at a time when budgets were being slashed under the austerity programme. The British Medical Association condemned the act as the 'end of the NHS as we know it'. In his critical review of the NHS for the Labour government, Lord Darzi pointed out that since the act public satisfaction with NHS has nosedived. Darzi described the Lansley reforms as a 'scorched earth' policy. The reforms caused widespread upheaval but also greater bureaucracy and duplication. In his last report, Lord Darzi complained that the NHS has been in 'constant flux' since the reforms. Darzi said: 'The instability of NHS structures and the multitude of workarounds and sticking plasters that became necessary as a result of the dysfunction of the Health and Social Care Act meant that NHS processes became fiendishly complicated. The Act divided up functions among a multiplicity of new institutions. In a single decade, NHS Improvement, the NHS Trust Development Authority, Health Education England, NHS X and NHS Digital were all created and abolished, with their functions and staff rolled into NHS England.' Critics also complain of less accountability due to the complexity of the system and the increased role of private providers. Yes, according to the health secretary, Wes Streeting. He claimed that 'the number of people working in the centre has more than doubled since 2010' referring to roles in both NHS England and the Department of Health and Social Care. The reforms also started a pattern of creating and then abolishing a number of NHS bodies, leading to more duplication and complexity. Many of the reforms have been chipped away or significantly modified. The Health and Care Act 2022 shifted the focus of the NHS from competition to collaboration with a scrapping of a markets-style economic regulator. It also scrapped GP-led clinical commissioning groups with integrated care boards to fund and plan NHS services. These included various NHS organisations and local councils. Under the 2022 act, NHS England was also given more commissioning power for primary care, dentistry and optometry. Despite these changes, private and voluntary sector organisations continued to be involved in providing NHS care. Only time will tell, but Streeting insists the move is 'the final nail in the coffin of the disastrous 2012 reorganisation'. He says that integrating NHS England into his department 'will put an end to the duplication resulting from two organisations doing the same job in a system currently holding staff back from delivering for patients.' However critics point out that, like the Lansley reforms, this latest upheaval comes against a backdrop of public spending cuts that threaten to undermine the good intentions behind the plans.
Telegraph
24-02-2025
- Business
- Telegraph
One in 10 peers paid for political advice by companies
The investigation found 91 members of the Upper House were being paid for their political advice by organisations such as Santander bank, the French arms manufacturer Thales and the British digger-maker JCB. There is no suggestion of wrongdoing by any of the peers highlighted. Under House of Lords rules, peers – who receive no salary for their work but can claim an tax-free allowance of £361 a day can take paid – consultancies to give general advice on political issues, current affairs and how parliament works. They are not allowed to use their position to lobby directly for an individual company or business that is paying them. They cannot contact ministers or officials to promote that company. Campaigners say there is a conflict between their public duty in the Lords and the commercial pressures of the companies for which many are working. Sue Hawley, the director of the transparency group Spotlight on Corruption, said: 'There is clearly a risk that peers, who can gain considerable access to ministers and other decision-makers, could be perceived to be using their privileged position to obtain political consultancies of this kind.' The Guardian's analysis has taken information from the House of Lords register of financial interests, which lists peers' declared paid positions, up to the end of October 2024. From this register the newspaper identified 91 peers hired to give advice about political matters, defined in the register as advising, for instance, on 'public affairs', 'public policy', 'strategic advice', 'government and policy development' or 'political risk'. Lord Blunkett advises legal and lobbying company DLA Piper on public policy and his internal understanding of government and policy development. He told The Guardian: 'I advise DLA Piper on their broader work here and across the world … My contract with them explicitly rules out 'lobbying'.' Lord Lansley is a director of the public policy consultancy Low Associates, which is run by his wife, Sally Low. According to the business, Mr Lansley is a 'member of the UK House of Lords and acts as Low's strategic counsel. With his extensive experience in policy and public affairs, Lord Lansley is uniquely positioned to advise Low's clients on how to achieve their strategic objectives.' Low Associates told The Guardian it is not a lobbying company and Lord Lansley is not involved in lobbying. Natalie Evans, Baroness Evans of Bowes Park, leader of the Lords under Theresa May and Boris Johnson, has been hired by Rud Pedersen, a large lobbying company. She is described as a 'senior adviser' who 'supports the firm's consultants in providing general advice on the broad development of UK policy and regulation'. The full list of the company's clients is not made public. Ms Evans and Rud Pedersen have previously said she would not lobby for its clients, and The Guardian said Lady Evans did not respond to a request to comment. John Woodcock – now Lord Walney – advises the Purpose Coalition, an organisation run by a lobbying company, and the lobbyists Rud Pedersen. He did not respond to a request for a comment. A House of Lords spokesman said: 'The code of conduct obliges members to adhere to high standards of transparency and propriety. It requires members to register and declare relevant interests and to maintain a clear distinction between their outside interests and their parliamentary activities.'
