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national health executive Editorial


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T


he uncertainty over the future shape of the NHS is becom- ing damaging for the organisations and the staff that make it up – not least because their attention needs to be focused on the billions of pounds of cost savings that need to be made over the next four years.


Some of the opposition to the reforms would have been more muted, we suspect, if it had not been for the impact of the cuts on frontline NHS organisations. The money saved is being reinvested in the NHS nationally, so the health service is not suffering cuts in the same sense as the rest of the public sector, but at each specifi c organi- sation and trust the job losses, ad- ditional workloads and cancelled services certainly feel like cuts.


While the political battle of wills that has emerged over the wider reforms has delighted some medi- cal professionals, as it has stopped Health Secretary Andrew Lansley being able to implement his initial proposals, the nature of the Coali- tion Government means that some sort of compromise appears the most likely conclusion.


Average circulation for the period 1/1/2010 – 31/12/2010 is 8,008 per issue


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This, however, could result in an unwelcome fudge, as well-meaning (or not so well-meaning) attempts to water down the reforms create a confusing and unwieldy mix of the new and the old. Several of the most senior people involved in this debate have called for the Health & Social Care Bill to be scrapped and for ministers to start over, often telling them to “think more carefully”.


Stay informed, stay in front


But the fact is that Lansley and his confi dants have been thinking about this – very carefully – for years now. The failure of the re- forms so far has not been because of a lack of thought, but rather because of the intense and profes- sional lobbying effort at Westmin- ster and through the media of the Bill’s opponents, the need for the


Liberal Democrats to assert their independence following a series of electoral drubbings, and because of the well-informed arguments of some of the most senior fi gures in UK healthcare.


This is what makes Lansley’s po- sition so tenuous: these reforms are in a very real sense his own. Unlike those ministers who seem to spend most of their time doing the bidding of the Prime Minister, the Chancellor, or trying to imple- ment their own party’s policies, the health reforms have always been linked specifi cally to one man. Those of us who met Lansley in his time in opposition heard a lot about the proposals then, but the scope of his intentions did not re- ally become clear until the ‘Liber- ating the NHS’ White Paper, which reportedly caught some of his col- leagues by surprise.


He well knows that even if he pre- vails in this battle of wills, and manages to pass a Health & Social Care Bill containing more or less the provisions he wants, the hard political work will have only just begun. That is because of the likely consequences of a radical shift in commissioning policy and what it means for many smaller NHS hos- pitals, the safeguarding of which has featured in countless election campaigns for MPs and would-be MPs of all parties, such is their totemic status. To others, letting the rigours of more market-like logic create a more effi cient sys- tem makes perfect sense, even if it might end a few MPs’ careers as their local hospital disappears.


David Cameron has said he wants to change the NHS precisely because he loves it – because doing nothing will cripple the health service.


That’s a good argument for reform, but not necessarily for these re- forms, which have looked in more danger with every passing month.


national health executive May/Jun 11 | 3


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