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A few thoughts on the Coalition's NHS programme

By Tim Montgomerie

Andrew Lansley's reorganisation of the NHS was one of the most unexpected components of this Government's radicalism. Yesterday, in evidence to MPs, the Health Secretary confirmed that his reforms would go ahead although he would address concerns at their speed, as revealed during his consultation process.

A few thoughts and observations off the back of recent press commentary:

  • The Times (£) notes that Cameron is ready to request more funds for the NHS from George Osborne. Rising inflation and the costs of the reorganisation threaten Cameron's promise to deliver real terms increases but a Downing Street spokesman confirmed that the spending guarantee would be honoured. Perhaps at future elections we need a hierarchy of pledges so we know which ones are most likely to be honoured in hung parliamemts (eg NHS funding, protecting Winter Fuel Allowance and immigration cap) and those which are negotiable (eg jail for knife criminals and VAT rise).
  • In a leader The Times (£) worries that the Lansley reorganisation makes the NHS a political issue, cancelling out the benefit of the funding pledge: "As Mr Lansley, of all people, must comprehend that the big task for the NHS in this Parliament will be to bridge the gap between the real increase in its funding and the even bigger increase in its costs. The reforms are doubtless regarded by ministers as making a contribution to this task. But it is just as likely that they will prove a distraction and that both the efficiency drive and the reforms will be the poorer for it. There is also a broader point about timing. This Government has plenty of political battles to fight. Is it really sensible to add another one, fought on territory where the Conservatives are weak? It is not too late for Mr Cameron to ask Mr Lansley to draw up a new timetable."
  • Thirdly from The Times (£) (a good read today!) Professor David Kerr of Oxford University defends Andrew Lansley's plan to put doctors in charge of health purchasing: "Clinicians will make better decisions on designing integrated ways of caring for people that produce improved health for the nation. This will shift the balance of care into the community and make the health service more locally accountable." Kerr is right to emphasise this idea of "clinical leadership" but it should be introduced at the same time as increasing patient power. Earlier this week, on Comment, Dr Rachel Joyce pointed out that "the current proposals seem to be heading in the direction of large GP consortia, based on geographical area." She continues: "This means that although a patient will technically have a choice of GP – and therefore their consortia – in reality all the practices in their area will part of the same consortium, so offering no real choice for patients." This needs to be reformed so that patients have a real choice between consortia in their own geographical areas.
  • Over at The Telegraph there is a broad welcome for empowering GPs but also disappointment at the fact there won't be greater use of co-payments. Without co-payments we won't get responsible use of health services but, as the newspaper concedes, "hell would be unleashed" if the prescription charges model of a patient contribution was extended.

Barrie_free2bme The area of NHS reform most unpopular with ConHome readers is Andrew Lansley's emphasis on improving public health by nudging-not-nannying on the expensive lifestyle diseases. I support this action wholeheartedly and don't see how we can control the NHS budget if we don't bring obesity etc under control. I think there is a real clash between the libertarians' 'leave-me-alone' instinct and the taxpayer's interest in keeping health costs low. I'll return to this issue shortly and in detail.

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