Leading article: The real health challenge has been ignored in this debate

Share
Related Topics

The Coalition wanted a revolution in health care. The Health and Social Care Bill would have scrapped a vast tier of bureaucracy in the shape of the primary care trusts and put their powers and budgets in the hands of thousands of GP consortiums. And this would all have been done by 2013. The Bill would also have required the NHS regulator, Monitor, to promote private-sector competition in the health service. The Bill was underpinned by a philosophy that saw the proper role of central government in health care as essentially limited to signing the cheques.

But what was proposed yesterday by the NHS Future Forum – the independent group of health professionals and experts set up two months ago by the Coalition to review the Bill after it ran into heavy opposition – was a very different beast. The Forum recommends that GPs should take up commissioning duties only when they can demonstrate that they are competent to do so. It also says that GPs should be required to consult with other health workers before making decisions.

And rather than just promoting competition, Monitor will also have an obligation to promote collaboration and integration within the NHS. The Forum further recommends safeguards to prevent private providers from "cherry-picking" profitable low-risk patients and leaving those with more complex and expensive conditions in public hospitals.

The philosophy underlying this document is a striking departure from that of the Coalition's original plans. The Forum wants the NHS to remain a cohesive whole, rather than to be just an agglomeration of competing providers. And it stresses that the Health Secretary should have a responsibility to ensure that the service remains comprehensive. The Coalition will give its formal response tomorrow. But judging by the frantic efforts by David Cameron and Nick Clegg yesterday to claim credit for a change of course on health, the Future Forum's proposals are likely to be broadly accepted.

That is welcome. The original Bill constructed by the Health Secretary, Andrew Lansley, was an example of reckless overreach. The 2013 deadline for the nationwide introduction of GP consortiums was always unrealistic. There was no way that GPs, most of whom have no management experience, would have been ready to take up their new role by that early date.

Yet the Forum's acceptance that the private sector has an important role to play in the delivery of health care is also to be welcomed. Despite what some healthcare unions claim, competition can benefit patients. Indeed, some 3.5 per cent of all non-emergency operations are already handled by private firms. But competition in healthcare is not a panacea, as some in the Conservative Party believe. Nor is it a magical way to bring down costs, as the experience of the private and hugely expensive US health system amply demonstrates.

Indeed, one of the frustrating things about this row is that it has distracted political and clinical professional attention from the challenge of bringing down costs. A painful slog lies ahead if the NHS is to achieve the £20bn in savings that it needs to make by 2015. The debate about the Bill has focused on elective surgery. But 70 per cent of health expenditure goes on elderly patients with chronic diseases. And that is where demand will explode over the coming years as our population ages. This debate has often felt like a way of ignoring these difficult facts.

What the NHS requires is not wild-eyed revolution, but calm evolution – and a focus on the challenges that really matter.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Recruitment Genius: Digital Account Manager - OTE £40,000

£25000 - £40000 per annum: Recruitment Genius: This web-based lead generation ...

Tradewind Recruitment: Intervention Teacher Required To Start ASAP.

£125 - £150 per day + Negotiable: Tradewind Recruitment: A 'wonderful primary ...

Tradewind Recruitment: Maths Teacher

£90 - £140 per day: Tradewind Recruitment: Our client is an 11-16 mixed commun...

Recruitment Genius: PHP / Drupal / SaaS Developer

£32000 - £36000 per annum: Recruitment Genius: A rapidly developing company in...

Day In a Page

Read Next
Benedict Cumberbatch attends a special screening of his latest film The Imitation Game  

Benedict Cumberbatch race row: What's the actual difference between 'coloured' and 'person of colour'?

Matthew Norman
Pressure is growing on Chris Grayling to abandon the Government bid to advise Saudi Arabia on running its prisons (Getty)  

What in sanity’s name is Chris Grayling doing in the job of Justice Secretary?

Matthew Norman
Greece elections: In times like these, the EU has far more dangerous adversaries than Syriza

Greece elections

In times like these, the EU has far more dangerous adversaries than Syriza, says Patrick Cockburn
Holocaust Memorial Day: Nazi victims remembered as spectre of prejudice reappears

Holocaust Memorial Day

Nazi victims remembered as spectre of prejudice reappears over Europe
Fortitude and the Arctic attraction: Our fascination with the last great wilderness

Magnetic north

The Arctic has always exerted a pull, from Greek myth to new thriller Fortitude. Gerard Gilbert considers what's behind our fascination with the last great wilderness
Homeless Veterans appeal: Homeless in Wales can find inspiration from Daniel’s story

Homeless Veterans appeal

Homeless in Wales can find inspiration from Daniel’s story
Front National family feud? Marine Le Pen and her relatives clash over French far-right party's response to Paris terror attacks

Front National family feud?

Marine Le Pen and her relatives clash over French far-right party's response to Paris terror attacks
Pot of gold: tasting the world’s most expensive tea

Pot of gold

Tasting the world’s most expensive tea
10 best wildlife-watching experiences: From hen harriers to porpoises

From hen harriers to porpoises: 10 best wildlife-watching experiences

While many of Britain's birds have flown south for the winter, it's still a great time to get outside for a spot of twitching
Nick Easter: 'I don’t want just to hold tackle bags, I want to be out there'

'I don’t want just to hold tackle bags, I want to be out there'

Nick Easter targeting World Cup place after England recall
DSK, Dodo the Pimp, and the Carlton Hotel

The inside track on France's trial of the year

Dominique Strauss-Kahn, Dodo the Pimp, and the Carlton Hotel:
As provocative now as they ever were

Sarah Kane season

Why her plays are as provocative now as when they were written
Murder of Japanese hostage has grim echoes of a killing in Iraq 11 years ago

Murder of Japanese hostage has grim echoes of another killing

Japanese mood was against what was seen as irresponsible trips to a vicious war zone
Syria crisis: Celebrities call on David Cameron to take more refugees as one young mother tells of torture by Assad regime

Celebrities call on David Cameron to take more Syrian refugees

One young mother tells of torture by Assad regime
The enemy within: People who hear voices in their heads are being encouraged to talk back – with promising results

The enemy within

People who hear voices in their heads are being encouraged to talk back
'In Auschwitz you got used to anything'

'In Auschwitz you got used to anything'

Survivors of the Nazi concentration camp remember its horror, 70 years on
Autumn/winter menswear 2015: The uniforms that make up modern life come to the fore

Autumn/winter menswear 2015

The uniforms that make up modern life come to the fore