Leading article: Andrew Lansley should listen to those sounding the alarm

Structural health reforms always end up exceeding cost estimates, at least in the short term
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The Independent Online

Andrew Lansley's plans to reform the health service have been met with a chorus of disapproval. As we report today, doctors' groups, NHS managers and health economists have all voiced profound concern about the Health Secretary's proposals. Indeed, it is nigh on impossible to find anyone involved with the NHS who believes that what Mr Lansley wants to do is sensible.

Mr Lansley would argue that this is the age-old resistance of vested interests. And he might be right that some of the objections spring from narrow self-interest, rather than concern for patients. Yet the vehemence and breadth of the opposition should surely give the Health Secretary and the Coalition pause. When the NHS chief executive, the British Medical Association and the Royal College of GPs are all raising the alarm, any prudent politician would listen.

Mr Lansley plans to abolish primary care trusts and to hand their £80bn annual budget and treatment commissioning powers to GPs by April 2013. But it is far from clear that family doctors are willing to perform these duties. And even if they were willing, it is unclear whether doctors would be capable of doing so. The Government suggests that professional health managers (presumably former employees of primary care trusts) would be hired by GPs' consortia to handle the more bureaucratic responsibilities. But even if this happens, the disruption would be considerable.

And what makes Mr Lansley's plan doubly reckless to many experts is that he is attempting this structural reform at the same time as the NHS is being forced to find efficiency savings in the order of £15bn to £20bn over the next four years. Overall health spending will be more or less flat in real terms during this Parliament, but thanks to rising costs (the NHS drugs bill in particular) and growing demand for services that will still necessitate hefty economies if the same level of care is to be delivered. The Coalition can have reform or it can have efficiencies, say the Government's critics, but it cannot have both.

The Health Secretary has attempted to turn this objection on its head by saying that reform is necessary to deliver efficiencies. It is a heroic, but ultimately unconvincing argument. It is impossible to see new GPs' consortia delivering vast savings at the same time as they are hiring staff and getting to grips with their new responsibilities. Structural reforms always end up exceeding cost estimates, at least in the short term.

In the longer term there might be merits to giving GPs responsibility for commissioning treatment. In theory, family doctors should make better decisions about what treatments their patients need than NHS managers who have no direct contact with the patients. But there could also be disadvantages. The head of the Royal College of GPs, Dr Clare Gerada, fears that the reform will lead to intense lobbying of individual doctors. Putting individual GPs, rather than a national rationing body such as the National Institute for Health and Clinical Excellence, in charge of deciding whether or not patients should receive expensive drugs could also exert unhealthy pressure on family doctors.

The truth is that we cannot know at this stage whether the advantages of GP commissioning will outweigh the disadvantages. Similarly, we cannot be sure that such a reform will result in cost-saving efficiencies. Mr Lansley should have announced that the green light for the policy would depend on the results of the regional trials he announced last week. But instead we are told that the reforms will be enacted by 2013 come what may. The health service certainly needs reform. It also needs to get costs under control. But this is a dangerous and reckless way for the Health Secretary go about achieving those ends.

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