The debate on the Government's health reforms in the House of Commons yesterday, despite the mini-revolt by a number of Liberal Democrat MPs, was never going to change anything. It was little more than a gesture. Matters will be different, however, when the Health and Social Care Bill continues through the House of Lords where more amendments are on the cards in addition to the 140-odd that have already been written in, some of them at the behest of the Liberal Democrat leader, Nick Clegg. Thus controversy about the plans appears to be growing, rather than receding, by the day.
The NHS needs reform. It is neither possible nor effective, as we have said before, to keep increasing the health budget year after year. The desire to cut bureaucracy, boost the role of GPs and increase competition is sound. But, as we have also observed before, far too much has been crammed into this behemoth of a Bill, and radical reforms do not sit well alongside the £20bn squeeze on NHS budgets. The Government has bungled the opportunity for change, with a string of wholly avoidable mistakes, not the least of which has been the spectacular failure to win the support of the professions that have to implement the changes.
There have been improvements to the Bill. The amendments secured by Mr Clegg have made it better, albeit marginally, even if he failed to persuade his own party of that at its spring conference at the weekend. In addition to serious opposition by rank-and-file Liberal Democrats and a number of their MPs, there have also been rumblings from the Tory benches, with the influential ConservativeHome website suggesting that no fewer than three Tory cabinet ministers have private reservations.
Controversy has grown with the news, elicited by a Freedom of Information request, that some senior GPs are spending just one day a week treating patients because they devote most of their time to setting up the new organisations that are key to the reforms. The British Medical Association and Royal College of Nursing remain implacably opposed to the proposals. The Royal College of General Practitioners wants the Bill withdrawn as unnecessary and over-complicated.
Amid all this, there is a growing sense that the process of constant amendments is introducing unhelpful contradictions into the Bill. It calls for the devolving of power to GPs and yet it creates at its heart the biggest unaccountable quango in the UK. It wants to promote competition yet now places increasing restrictions on the private sector. It intends to cut bureaucracy and yet increases layers of management. It aims to save money and yet will cost billions to implement.
Now a tribunal has ruled that the Government must publish the risk register – outlining the potential pitfalls of the NHS reforms – which civil servants drew up for ministers. In the past, we have argued that publication of these worst-case scenarios could destabilise rather than inform the debate. But now the Government has lost that argument, it must publish the register swiftly. If, instead, it chooses to mount a further appeal to the High Court, it should, as David Owen, the former Labour Health minister, has suggested, delay the third reading of the Bill. For the risk register to be eventually published – but too late to inform public debate on the plans – would rightly outrage critics of the Bill.
Reform of our health service is necessary and inevitable but there is also now an urgent need to secure the stability of the NHS by building greater consensus. The Prime Minister should call an urgent summit, not just of those already signed up to his specific proposals, but of all the royal colleges, professional bodies, patients' organisations and others who will be involved in making reform work.