Leading article: The Government's reform juggernaut begins to move

The truth is that Andrew Lansley's health bill represents an experiment

Share
Related Topics

The response to the Coalition's health reforms summons to mind the parable of the blind men and the elephant: opinions as to what we are grappling with are hopelessly conflicting. Some have presented the health bill, introduced to Parliament yesterday, as a revolution; a big bang which will transform the National Health Service out of all recognition.

Others describe it as an evolutionary change; a natural continuation of structural reforms that have been running, at various speeds, for two decades. David Cameron himself seems unsure of how to describe what the Health Secretary, Andrew Lansley, has come up with. At times the Prime Minister has presented it as a once-in-a-generation overhaul. At others, he has tried to reassure patients and health workers that their lives will be little changed.

But just as the blind men in the parable were unwittingly describing different parts of the same animal – a trunk here, an ear there, a tail at the back – it is possible that both perspectives on NHS reform will turn out to have an element of truth in them. It is true that devolving healthcare commissioning responsibilities to family doctors, the central thrust of the bill, is not new. GP fundholding was established by John Major's government in the 1990s. And Labour introduced practice-based commissioning and encouraged GPs to work in partnership with neighbouring practices. The previous government also tried to increase the role of private health care providers in the system, something the Coalition wants to push further. And when Primary Care Trusts have been abolished, it is perfectly possible that managers will end up being re-hired by GPs consortia, doing very similar sorts of care commissioning jobs. So far, so organic.

Yet though it might be less of a structural shift than some imagine, the impact on incentives in the system could still be radical. Family doctors would have a financial incentive to perform more elective surgery in local clinics, rather than sending patients off for expensive stays in hospital. Putting more control in the hands of doctors and patients, rather than managers, should drive efficiency in all sorts of areas. And if the role of private health providers expands considerably, that really would amount to a revolution.

The truth is that this bill represents an experiment. There is a large amount of waste in the NHS's £104bn budget at the moment. And Mr Lansley says this reform will help the health service deliver the £20bn of savings it needs to make by 2014. But this seems naïve. The likelihood is that, as the House of Commons Health Select Committee argued this week, the inevitable disruption of the restructuring will impede the search for those savings.

And it is impossible to know whether the new safeguard regime for patient care will be effective. Stripping the National Institute for Health and Clinical Excellence of its role in evaluating the cost-effectiveness of new drugs is a gamble. The Department of Health will, in effect, be relying on GPs to ration medicines. And we cannot tell whether GPs, who are to be handed responsibility for £80bn of health spending, will prove to be competent managers. It remains unclear as to what would happen if a consortium of GPs overspent and went bust.

Mr Lansley has inaugurated a pilot scheme. But the legislative juggernaut is on the move before the results are in. Primary Care Trusts have been told that they will be abolished by April 2013 come what may. Doctors are going to have these new responsibilities thrust upon them whether they are ready for them or not. Whatever the merits of reform, this is a reckless way to go about implementing it.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Ashdown Group: Helpdesk Analyst - Devon - £20,000

£18000 - £20000 per annum: Ashdown Group: Helpdesk Analyst - Devon - £20,000 ...

Ashdown Group: Data Scientist - London - £50,000 + bonus

£35000 - £50000 per annum + generous bonus: Ashdown Group: Business Analytics ...

Ashdown Group: IT Project Coordinator (Software Development) - Kingston

£45000 - £50000 per annum: Ashdown Group: IT Project Coordinator (Software Dev...

Ashdown Group: Editor-in-chief - Financial Services - City, London

£60000 - £70000 per annum + benefits : Ashdown Group: A highly successful, glo...

Day In a Page

Read Next
 

If I were Prime Minister: I'd end the war on drugs

Patrick Hennessey
 

General Election 2015: Politics is the messy art of compromise, unpopular as it may be

David Blunkett
General Election 2015: Ed Miliband's unlikely journey from hapless geek to heart-throb

Miliband's unlikely journey from hapless geek to heart-throb

He was meant to be Labour's biggest handicap - but has become almost an asset
General Election 2015: A guide to the smaller parties, from the the National Health Action Party to the Church of the Militant Elvis Party

On the margins

From Militant Elvis to Women's Equality: a guide to the underdogs standing in the election
Amr Darrag: Ex-Muslim Brotherhood minister in exile still believes Egypt's military regime can be replaced with 'moderate' Islamic rule

'This is the battle of young Egypt for the future of our country'

Ex-Muslim Brotherhood minister Amr Darrag still believes the opposition can rid Egypt of its military regime and replace it with 'moderate' Islamic rule, he tells Robert Fisk
Why patients must rely less on doctors: Improving our own health is the 'blockbuster drug of the century'

Why patients must rely less on doctors

Improving our own health is the 'blockbuster drug of the century'
Sarah Lucas is the perfect artist to represent Britain at the Venice Biennale

Flesh in Venice

Sarah Lucas has filled the British pavilion at the Venice Biennale with slinky cats and casts of her female friends' private parts. It makes you proud to be a woman, says Karen Wright
11 best anti-ageing day creams

11 best anti-ageing day creams

Slow down the ageing process with one of these high-performance, hardworking anti-agers
Juventus 2 Real Madrid 1: Five things we learnt, including Iker Casillas is past it and Carlos Tevez remains effective

Juventus vs Real Madrid

Five things we learnt from the Italian's Champions League first leg win over the Spanish giants
Ashes 2015: Test series looks a lost cause for England... whoever takes over as ECB director of cricket

Ashes series looks a lost cause for England...

Whoever takes over as ECB director of cricket, says Stephen Brenkley
Fishing for votes with Nigel Farage: The Ukip leader shows how he can work an audience as he casts his line to the disaffected of Grimsby

Fishing is on Nigel Farage's mind

Ukip leader casts a line to the disaffected
Who is bombing whom in the Middle East? It's amazing they don't all hit each other

Who is bombing whom in the Middle East?

Robert Fisk untangles the countries and factions
China's influence on fashion: At the top of the game both creatively and commercially

China's influence on fashion

At the top of the game both creatively and commercially
Lord O’Donnell: Former cabinet secretary on the election and life away from the levers of power

The man known as GOD has a reputation for getting the job done

Lord O'Donnell's three principles of rule
Rainbow shades: It's all bright on the night

Rainbow shades

It's all bright on the night
'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power