As the Government's contentious NHS reforms return to the House of Lords today, the row over the proposals to cut bureaucracy, boost the role of GPs and increase private sector competition shows scant sign of resolution. Rather, the complexities of both the NHS as is, and the planned changes to it, are increasingly reduced to a single divide: for or against the Health and Social Care Bill. It is the wrong question. And its dominance underlines how badly the Government has bungled the attempt at reform.
A year on from the Bill's introduction, it is more controversial than ever. Most damaging of all for the Health Secretary is the growing queue of medical practitioners' groups – the British Medical Association, the Royal College of Nursing, the Royal College of General Practitioners, to name but three – lining up to call for the Bill to be rejected. Doctors remain among the most trusted people in the country. If they are against, surely there must be real dangers?
Not so. As a profession, doctors are highly resistant to change. Almost every attempt to reform the health sector produces squeals of anguish and warnings of imminent catastrophe. Indeed, opposition to the creation of the NHS in the late 1940s was so strong that the BMA voted nine-to-one against and some even drew dark comparisons with the National Socialism so recently overthrown in Germany. While the rhetoric may have changed in substance, the predisposition to protect their privileges remains. Not only do the large medical unions give an erroneous impression of unanimity among the professions – in this case against Andrew Lansley's reforms – but the vested interests of powerful blocs are too often glossed over by an assumption of professional distance that may not always be deserved.
The potential conflict of interest for GP practices, revealed in this newspaper today, is a case in point. If passed, Mr Lansley's reforms will not only hand family doctors far greater responsibilities in terms of commissioning care for their patients; as private partnerships, they may also lose out financially from proposals to encourage commercial competition.
Doctors can, of course, have legitimate concerns; but they must be understood in context. To do so is far from giving uncritical support to the Government. Far from it. The Health Secretary's handling of NHS reform has been startling in its incompetence, the opportunity for much-needed improvements in the health service all but squandered through a string of wholly avoidable mistakes.
Perhaps most egregious was the spectacular failure to get the support of those same professions now causing such problems. Meanwhile, bundling GP commissioning along with yet another major reorganisation, while simultaneously requiring £20bn worth of savings, was ambitious to the point of irresponsibility. And packaging all together into a single, sprawling piece of legislation was equally ill-considered. Neither have the series of concessions made since improved the situation. On the contrary, the reforms have been enfeebled and, all too often, critics not won over.
Even so, the fact remains that the NHS needs reform. It is neither possible, nor effective, to keep increasing the health budget year after year, and the tenets of Mr Lansley's proposals are the right ones. Enormous changes have already been made, in expectation of the Bill being passed. That is still the most likely outcome. That being so, the medical professions' energies would be better spent finding a route through than in the blanket defence of an unsupportable status quo. The legislative debacle may be down to the Government, but the doctors must help to resolve it. Reducing all to a simple yes or no to the Health and Social Care Bill is not the way to do it.