Smoke and mirrors have attended the latest differences in opinion over the NHS. Andrew Lansley, Health Secretary, has taken some flak for being too radical in public sector reform. Wasn't that the distinct flavour of the coalition? Yet, after a torrid spring conference for the Liberal Democrats with howls of "save the NHS" from the remnants of producer interest still within their ranks, Cameron and Clegg have bowed to concerns and the bill is stayed at committee stage.
The raft of reforms appear quite radical on the surface: a regulated market in healthcare, an independent commissioning board and concentrating procurement power in the hands of the GPs. Yet, the right of centre think-tank, Policy Exchange, have cast doubt on the efficacy of the reforms:
The statement by Lansley follows the Policy Exchange warning that the health and social care bill's proposals to abolish every primary care trust (PCT) by 2013 "could lead to the new structure simply replicating the existing system in all but name".
Without support from GP consortia and ensuring the necessary skills to exploit the new structure, an NHS 'big bang' could result in much heat and eventual status quo. So, the 'Lansley problem' is one of two left feet: annoying the GPs without Bevan's pot of gold, whilst the set of reforms suffers from a skills gap. Surely the answer is to seek out those who have the skills and allow them to partner with GP consortia to allow the reforms to move forward (perhaps they could, whisper it, make a profit too!).
Lansley's reforms, a rehash of earlier organisations, are failing because they do not allow enough diversity in provider or provision. Typical top-down revolution without considering that local structures must mutate to meet local needs. Wasn't devolution a principle once upon a time?
