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

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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.

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