Leading article: NHS reform: ideology, rather than pragmatism

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It is a serious matter that the British Medical Association has called an emergency meeting – the first of its kind for nearly 20 years – to warn the Government to think again about the pace and scale of its reforms to the National Health Service. The aims of those reforms might be laudable. The Health Secretary, Andrew Lansley, says he wants to set the NHS free from political interference and make it more responsive to patients. And he is right to say that with an ageing population making increasing demands on services, and the cost of drugs and new treatments rising, change is needed.

But he has set in train the biggest reorganisation in the 62-year history of the NHS – at a time when it is being asked to save £20bn from its £100bn budget. And he has done so despite a Tory pledge before the election that there would be no major overhaul of the health service. Doctors' leaders have rightly complained that the detail on the massive changes were not available at all until the Bill was published two months ago. Mr Lansley's reforms have been premised on ideological conviction rather than pragmatism; pilot projects should have been trialled first rather than in parallel with the passage of a Bill which is already well on its way through Parliament. No wonder Liberal Democrat delegates rejected the plans at the party's spring conference last weekend.

The plan to shift 80 per cent of the NHS budget from primary care trusts to GP consortiums is immensely radical. Mr Lansley hopes it will save £5bn by 2015. But it will, in the short-term, cost £1bn in redundancy payments, and another £400m on new IT and buildings. The upheaval and reorganisation will cause huge strain, coming in tandem with £20bn of cuts. And there are legitimate worries that the greater competition to be introduced will allow private health firms to "cherry-pick" the work that produces quick profits, leaving complex cases to an overburdened NHS.

Earlier concern from nurses and NHS managers could be dismissed as self-serving. But GPs are the ones, in theory, set to benefit from the new reforms. If they are cautioning a rethink, David Cameron would be wise tolisten.

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