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: Panel & Cabinet Wireman

£20000 per annum: Recruitment Genius: Panel Wireman required for small electro...

Recruitment Genius: Electronics Test Engineer

£25000 - £27000 per annum: Recruitment Genius: An SME based in East Cheshire, ...

Recruitment Genius: Marketing Assistant

£18000 - £22000 per annum: Recruitment Genius: Do you have previous experience...

Recruitment Genius: Accounts Administrator

£16000 - £18000 per annum: Recruitment Genius: This is an exciting opportunity...

Day In a Page

Read Next
Peter Mandelson first resigned from the cabinet on 23 December 1998  

2015's dim-sum index has too many courses

John Rentoul
One in seven British beer buyers bought non-alcoholic varieties in 2013  

A booze-free Christmas: It would have been more socially acceptable to spark up a crack pipe

Fiona Sturges
War with Isis: The West needs more than a White Knight

The West needs more than a White Knight

Despite billions spent on weapons, the US has not been able to counter Isis's gruesome tactics, says Patrick Cockburn
Return to Helmand: Private Davey Graham recalls the day he was shot by the Taliban

'The day I was shot by the Taliban'

Private Davey Graham was shot five times during an ambush in 2007 - it was the first, controversial photograph to show the dangers our soldiers faced in Helmand province
Revealed: the best and worst airlines for delays

Revealed: the best and worst airlines for delays

Many flyers are failing to claim compensation to which they are entitled, a new survey has found
The stories that defined 2014: From the Scottish independence referendum to the Ice Bucket Challenge, our writers voice their opinions

The stories that defined 2014

From the Scottish independence referendum to the Ice Bucket Challenge, our writers voice their opinions
Stoke-on-Trent becomes first British city to be classified as 'disaster resilient' by the United Nations

Disaster looming? Now you know where to head...

Which British city has become the first to be awarded special 'resilience' status by the UN?
Finally, a diet that works: Californian pastor's wildly popular Daniel Plan has seen his congregation greatly reduced

Finally, a diet that works

Californian pastor's wildly popular Daniel Plan has seen his congregation greatly reduced
Say it with... lyrics: The power of song was never greater, according to our internet searches

Say it with... lyrics

The power of song was never greater, according to our internet searches
Professor Danielle George: On a mission to bring back the art of 'thinkering'

The joys of 'thinkering'

Professor Danielle George on why we have to nurture tomorrow's scientists today
Monique Roffey: The author on father figures, the nation's narcissism and New Year reflections

Monique Roffey interview

The author on father figures, the nation's narcissism and New Year reflections
Introducing my anti-heroes of 2014

Introducing my anti-heroes of 2014

Their outrageousness and originality makes the world a bit more interesting, says Ellen E Jones
DJ Taylor: Good taste? It's all a matter of timing...

Good taste? It's all a matter of timing...

It has been hard to form generally accepted cultural standards since the middle of the 19th century – and the disintegration is only going to accelerate, says DJ Taylor
Olivia Jacobs & Ben Caplan: 'Ben thought the play was called 'Christian Love'. It was 'Christie in Love' - about a necrophiliac serial killer'

How we met

Olivia Jacobs and Ben Caplan
Bill Granger recipes: Our chef's breakfasts will revitalise you in time for the New Year

Bill Granger's healthy breakfasts

Our chef's healthy recipes are perfect if you've overindulged during the festive season
Transfer guide: From Arsenal to West Ham - what does your club need in the January transfer window?

Who does your club need in the transfer window?

Most Premier League sides are after a striker, but here's a full run down of the ins and outs that could happen over the next month
The Last Word: From aliens at FA to yak’s milk in the Tour, here’s to 2015

Michael Calvin's Last Word

From aliens at FA to yak’s milk in the Tour, here’s to 2015