Leading article: The health service needs evolution, not revolution

These reforms are not going to be successfully enacted without the support of health workers

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The Government's grand consultation exercise on NHS reform has not got off to a very good start. After much prevarication, Andrew Lansley finally travelled to Liverpool yesterday for the Royal College of Nursing (RCN) conference. But rather than addressing all the delegates, the Health Secretary chose to meet a select group of just 60 nurses.

Mr Lansley explained that he wanted to listen, not lecture. But the nurses interpreted this as a way for the Health Secretary to avoid engagement. And his reward was a resounding vote of no-confidence: 478 delegates voted in favour of the motion, just sixz against. Such a comprehensive rejection from what is widely seen as one of the more moderate and pragmatic health unions is a serious blow for the Heath Secretary.

Mr Lansley maintained yesterday that the RCN supports the principle of his Health and Social Care Bill, which proposes to give consortiums of GPs the responsibility to commission care and the private sector a greater role in the delivery of health services. And it is true that the complaints articulated by nurses in recent days have been of a general nature, rather than related to specific details in the health Bill. Some fear the impact of more private care on the wider NHS. Others have suspicions about Mr Lansley's motives. Many voiced concerns about the prospect of the NHS being destabilised by the reforms.

Yet this generalised distrust among nurses of the Coalition's direction on health reform matters a great deal. It is a feeling shared by the British Medical Association and other associations of health workers. They all subscribe to the need for reform, but have grave doubts about what the Coalition is proposing. And these reservations matter because Mr Lansley's reforms are not going to be successfully enacted without the co-operation of those who work in the health sector.

There is a way out of this mess for the Coalition. There need to be safeguards in the NHS reform Bill to prevent private sector specialists cherry-picking "profitable" patients and leaving the NHS with the most expensive and complicated cases. More work needs to be done to ensure the accountability of these new consortiums of GPs. The Commons Select Committee's recommendation that other NHS stakeholders – hospital doctors, public health chiefs, social care workers and councillors – be given a role in these consortiums seems sensible. Further, the 2013 deadline for the implementation of GP commissioning needs to be dropped. The Department of Health should give consortiums the right to apply to commission care when they are ready to do so, rather than insisting on this "big bang" approach to reform. That would also give time to evaluate pilot projects – and to see where improvements or extra safeguards are needed. What makes delay even more desirable is the fact that the NHS, over the coming four years, is being forced to make huge efficiency savings merely to deliver the same level of services as at present.

The Bill can be salvaged, but only if ministers are prepared to adopt a policy of pragmatic evolution, rather than macho revolution. They also need to grasp that substantive changes are called for, not just a better public relations exercise. David Cameron and Nick Clegg have accepted the need for an alteration of course. So the question then becomes: is Mr Lansley capable of making the necessary changes and also convincing the health profession and the public that he understands their concerns? The Health Secretary's woeful handling of the early stages of this consultation process suggests that the answer might well be no.

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