The most radical and misguided set of NHS reforms in a generation

By Tom Keeley

Andrew Lansley and Conservatives have backed themselves into a corner over the National Health Service reforms. The 2010 White Paper laid out the most radical and misguided set of NHS reforms in a generation.

The response from the medical profession has been as expected.

Over the Christmas break the Royal College of Nursing issued a stark warning over the effect these reforms will have on the ability to provide high quality care. This weekend the NHS Confederation described the reforms as “extraordinarily risky”. Furthermore, the British Medical Association council is set to hold a vote at the end of this month on whether to convene an emergency meeting to discuss these plans.

This has led to growing unease within the Conservative Party. There is a feeling that Lansley has gone too far, too fast. It appears to many within the Tory party that Lansley has cobbled these reforms together on the back of a napkin. By forwarding an agenda that was not present in the Conservative manifesto or the coalition agreement, there is a concern that they are implementing policy without a mandate.

If the government could take back the last seven months of the health agenda they probably would. However, they can’t. The political capital that they have tied up in this White Paper means that a full U-turn in the face of opposition is very unlikely. A partisan and aggressive Labour resistance will likely make little difference; the government looks to have the votes in the commons. Once this occurs the cost of reversing these reforms would be prohibitive. A more nuanced Labour response is vital.

Ed Miliband has two options. He can wait for the reforms to pass narrowly through parliament and then Labour can score huge political points from the likely disaster it will cause up and down the country in hospitals and GP surgeries. Or, he can provide constructive opposition. By working with the government, he can bring Lansley back from the brink and start to find a workable way forward that does not threaten the future NHS.

It is currently unclear which option Miliband will take. He and the remarkably low profile John Healy have been surprisingly quiet on health. They have hedged their bets. By allowing professional bodies to provide much of the opposition to the reforms, Labour has avoided coming down too quickly on the side of the unions. The opposition line is still to be written. However, it needs to be written quickly, because when the White Paper is discussed this week we will be witnessing the dying days of a National Health Service in this country.

Constructive opposition

The Labour line should be one of compromise. As the party of the NHS we should use this opportunity, not to score political points, but to continue our stewardship of the NHS. An offer should be made to work with the government. This offer should be along the following lines: The maintenance of the National Institute of Health and Clinical Excellence (NICE), a stay of execution for the Primary Care Trusts and the rolling out a regional 5 year test on GP consortia.

NICE, the cost control mechanism in the NHS, while not perfect, is a model that is being used worldwide because it works. It will be needed over the next 10 years to ensure that spending matches the level of funding available to the NHS. NICE is vital to ensure that NHS gets the most from the limited amount of money that this government is will allow it.

The PCTs should be left in place. They are the most likely way that the NHS will be guided through the future period of belt tightening. The expertise within them means they are also the body that should oversee any future reform.

A single region five year test of these reforms would allow for evidence-based policy making. In the case of GP consortia using any willing provider there is little precedent. A full five year test would let us see the effects of such reform. It would allow assessment of whether under this model, private companies “cherry pick” the most profitable patients, leaving NHS hospitals with the costly, complicated treatments. Through the assessment of vital health indicators the question of whether these reforms improve outcomes such as cancer survival and heart disease could be answered with confidence. The impact of these reforms on the efficiency and the equity of the NHS could be measured through differential outcomes. Most importantly a regional test would be reversible if required.

Ed Miliband needs to decide whether he wants Labour to use this chance to work in a bi-partisan manner, to keep the health service in this country national. The 60th birthday of the NHS was recently celebrated. Whether we will celebrate the 70th is now largely dependent on the Labour response this week.