Steve Richards: NHS reform should be dropped, before it's too late

Sweeping upheaval is a polite way of expressing the chaos that is being imposed

Share

Here is a scene from the recent past that becomes baffling in the light of what followed. During the Conservative leadership contest in 2005, David Cameron had a private meeting with the MP John Redwood in an attempt to secure his support. As any candidate does in these circumstances, Cameron highlighted areas of common ground. Then he paused and said to Redwood: "I must be honest with you. I am sure you want to reform the NHS but I am not going to touch it."

This was the point at which Redwood decided to back Cameron in the contest. To Cameron's surprise, Redwood agreed with the aspiring leader, pointing out that Margaret Thatcher took the same pragmatic view. Redwood, a more interesting political figure than caricature allows, is now one of those who are bewildered that sweeping upheaval within the NHS is one of the Government's defining themes.

Sweeping upheaval is a polite way of expressing the chaos that is being imposed. At the weekend, I met a lawyer who specialises in the sort of contracts the new GP consortia will be navigating. She told me the contracts will be nightmarishly complex and lawyers will charge a fortune to navigate on behalf of the consortia. Accountants will be similarly on hand to make money as GPs, trained in medicine, seek to become businesses on the back of guaranteed incomes from the Treasury, an arrangement that defies reason on several levels.

Last week, a GP wrote that more extreme forms of medical rationing are already taking hold, partly because of the unprecedented real-terms cuts in spending. This is before GPs have to calculate how much of the budget they have left for medical matters once they have spent huge sums on legal and administrative bills and perhaps on themselves. What will happen if they spend their budget before the end of the financial year, or fear they might and so ration accordingly?

In the meantime, waiting times soar after the Coalition dropped the relevant target, a centrally determined objective that was highly effective in measuring outcomes and focusing the minds of NHS managers – minds that are capable of meandering without such structures firmly in place. Now we have the worst of all worlds – prescriptive guidelines from a government that has rubbished the principle of targets from the centre.

The changes would be calamitous at the best of times but to attempt such reform when spending is being cut takes ideological commitment to a level well beyond anything attempted by Thatcher. As the Health Committee reports today, under the chairmanship of the former Conservative Health Secretary, Stephen Dorrell: "The reorganisation process continues to complicate the push for efficiency gains."

Note that the observation is made after the so- called "pause" in the legislative sequence. Most of the original proposals are still in place. Placing councillors on GP consortia, a Lib Dem demand that was met during the "pause", is not going to change anything. Shirley Williams told me recently that Nick Clegg had not read the Bill when he declared his original support for it. I wonder now whether he fully realises what he is signing up to.

How has it happened, given Cameron's public assurances before the election and his more significant private declarations to those like Redwood? The Liberal Democrats need to do much more work on what their support for vaguely defined "localism" means. The acquisition of spending powers by local providers, when the money comes from the centre, raises many questions in relation to accountability, efficiency and who is best placed to make key decisions.

The Liberal Democrats' instinctive support for "localism" is sometimes fruitful but leads them to a dangerous place on the NHS. Combine it with the evangelical "small-state" views of some of Cameron's closest allies, who were in despair about the "pause", and it is possible to see how the supposedly expedient Prime Minister gave the go-ahead. All of them, it seems, are ideologically incapable of calculating that if the PCTs are inefficient, some hospitals poorly managed and GPs take us for a ride then the centrally elected government should reform the PCTs, transfer the best managers of hospitals to the poor performers, and negotiate with less naivety when dealing with the pay demands of GPs. All the while pledging that every penny of taxpayers' money will be forensically audited.

Presumably, Cameron is an instinctive supporter of the reforms, but, as the historian AJP Taylor wrote of himself, Cameron has strong views weakly held. Sometimes weakness can be his strength when a U-turn is called for. Also, rather brilliantly at times, Cameron makes a big move, though nearly always in relation to political choreography rather than the hard grind of policy. For once, he should make a big move in relation to policy and drop the Bill altogether. He will have to scrap the policies at some point in the future amidst a major crisis, so he might as well do so now. I bet there are some in No 10 and in the Treasury who reached the same conclusion long ago.

s.richards@independent.co.uk

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Maths Teacher

£110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for spe...

Business Analyst - Surrey - Permanent - Up to £50k DOE

£40000 - £50000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

***ASP.NET Developer - Cheshire - £35k - Permanent***

£30000 - £35000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

***Solutions Architect*** - Brighton - £40k - Permanent

£35000 - £40000 Per Annum Excellent benefits: Clearwater People Solutions Ltd:...

Day In a Page

Read Next
Women are working in some of the lowest-paid sectors such as cleaning, catering and caring  

Women's wages have gone backwards. Labour would give women the pay they deserve

Gloria de Piero
 

Taking on Ukip requires a delicate balancing act for both main parties

Andrew Grice
Wilko Johnson, now the bad news: musician splits with manager after police investigate assault claims

Wilko Johnson, now the bad news

Former Dr Feelgood splits with manager after police investigate assault claims
Mark Udall: The Democrat Senator with a fight on his hands ahead of the US midterm elections

Mark Udall: The Democrat Senator with a fight on his hands

The Senator for Colorado is for gay rights, for abortion rights – and in the Republicans’ sights as they threaten to take control of the Senate next month
New discoveries show more contact between far-flung prehistoric humans than had been thought

New discoveries show more contact between far-flung prehistoric humans than had been thought

Evidence found of contact between Easter Islanders and South America
Cerys Matthews reveals how her uncle taped 150 interviews for a biography of Dylan Thomas

Cerys Matthews on Dylan Thomas

The singer reveals how her uncle taped 150 interviews for a biography of the famous Welsh poet
DIY is not fun and we've finally realised this as a nation

Homebase closures: 'DIY is not fun'

Homebase has announced the closure of one in four of its stores. Nick Harding, who never did know his awl from his elbow, is glad to see the back of DIY
The Battle of the Five Armies: Air New Zealand releases new Hobbit-inspired in-flight video

Air New Zealand's wizard in-flight video

The airline has released a new Hobbit-inspired clip dubbed "The most epic safety video ever made"
Pumpkin spice is the flavour of the month - but can you stomach the sweetness?

Pumpkin spice is the flavour of the month

The combination of cinnamon, clove, nutmeg (and no actual pumpkin), now flavours everything from lattes to cream cheese in the US
11 best sonic skincare brushes

11 best sonic skincare brushes

Forget the flannel - take skincare to the next level by using your favourite cleanser with a sonic facial brush
Paul Scholes column: I'm not worried about Manchester United's defence - Chelsea test can be the making of Phil Jones and Marcos Rojo

Paul Scholes column

I'm not worried about Manchester United's defence - Chelsea test can be the making of Jones and Rojo
Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

Frank Warren: Boxing has its problems but in all my time I've never seen a crooked fight

While other sports are stalked by corruption, we are an easy target for the critics
Jamie Roberts exclusive interview: 'I'm a man of my word – I'll stay in Paris'

Jamie Roberts: 'I'm a man of my word – I'll stay in Paris'

Wales centre says he’s not coming home but is looking to establish himself at Racing Métro
How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?

A crime that reveals London's dark heart

How could three tourists have been battered within an inch of their lives by a burglar in a plush London hotel?