John Pugh: Stop tinkering, and start again with NHS reform

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The Prime Minister is promising substantial and significant changes in the Health and Social Care Bill. But if yesterday's press reports are to be believed Professor Steve Field, the man appointed to pull together the Government's listening exercise, is likely find himself on the same page as many of the Bill's critics – particularly over unbridled competition within the NHS.

This could be embarrassing for Andrew Lansley, the Health Secretary, but it could also be an opportunity for him to show that the Government does listen. His oft quoted slogan "No decision about us without us" could be just the right principle for NHS reform and the way to win over the people who need to believe in and implement real reform.

Certainly, my parliamentary colleagues want radical surgery on the Bill, and like my Lib Dem colleague Norman Lamb, many Conservatives are exercised about a rapid roll-out of an untried scheme in a time of unprecedented financial restraint.

Accepting the growing evidence might be a helpful turning point for the relationship between Tories and Lib Dems, but wouldn't such change in the Bill mean having to start the parliamentary process all over again? And would there be a major loss of face attached to such a switch?

These are major concerns, but the concerns on the ground in the NHS are even greater, each with possible political consequences. With £20bn to be found in NHS savings as a result of Alistair Darling's last Budget; major hospitals heading for financial collapse under PFI deals; waiting lists rising; and the full lessons of Mid Staffs yet to emerge, there is justifiable concern that a chronic succession of bad health bulletins will dog the coalition. Neither coalition partner wants the next election based on why it wanted to completely restructure the NHS.

In recent weeks, my job has been to collate and condense Lib Dem and professional opinion on these controversial reforms. Issues such as the promotion of competition but not collaboration; the thin veneer of democratic accountability; and the competencies and composition of commissioning consortia feature universally in everyone's list of concerns.

However, we can now add to that: new anxieties about how medical training will be managed; how public health can function; and how regional clinical networks for illnesses such as strokes and cancer can survive with no regional or sub-regional bodies. The issue must be about about getting the future of the NHS right, getting professional opinion onside and winning over patient groups and health charities.

It is a genuinely open question if a radically amended Bill can actually do that and not end up as unworkable and bedecked with bolt-ons. Resubmission without recrimination could be an option.

Fundamentally, no one objects to the outline original aims of the Bill – more clinical engagement, accountability and less bureaucracy, even if we struggle and fall out over the mechanics of achieving it. Mr Lansley has reacted with some dignity to pressures that would destroy a lesser man. He needs, though, to show that he regards the NHS as being as precious as the nation does. He needs to stop tinkering with the existing Bill and start again. Some would say it would be a humiliation. I wouldn't. I'd say it was the act of a wise man.

John Pugh MP chairs the Liberal Democrat Parliamentary Policy Committee for Health and Social Care

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