Editor’s blog Sunday 17 April 2011: Why Deputy PM Clegg's five NHS reform red lines are all pointless

In the Independent On Sunday today, political correspondent Matt Chorley reports that Deputy Prime Minister Nick Clegg has written to all Lib Dem MPs setting out his five red lines for NHS reform.

The IoS reports that "Mr Clegg set out five key demands which he insists are 'non-negotiable' ... that competition should be driven by quality, not price; family doctors should not commission services alone; GP consortia must not go ahead in 2013 if they are not ready; the principles of the NHS constitution must be protected; and GPs must work ‘hand in glove’ with councils".

More in sorrow than in anger, let us have a look at the reasons why this letter was a waste of paper and stamps (or hopefully, emails). More in sorrow than in anger, because some Lib Dems seem really decent, smart people - both right inside the camp such as Norman Lamb and outside such as Dr Evan Harris.


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Click here for details of 'The limits of satire meet Dadaist policy - Andrew ‘Transport’ Lansley apologises to the nation for its stupid failure to grasp his genius', via subscription-based Health Policy Intelligence.

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This analysis proceeds from tweaking the infamous politician’s syllogism from Yes, Minister (which appears to be the guiding principle behind this bout of effort at NHS reform)
1. Something must be done.
2. This is something.
3. Therefore this must be done.

Thus -
1. People are not that stupid.
2. Lib Dem MPs are people.
3. Therefore Lib Dem MPs are not that stupid.

Clegg’s five red lines
1/5 - Competition should be driven by quality, not price
This is already happening, as has been clear since the start of March.

Its inclusion is therefore pointless.

2/5 - Family doctors should not commission services alone
This was never, ever going to happen. The Bill acknowledges that managers from PCTs and SHAs would be required to work in or for consortia (as would private sector consultants). It is a nod to the Health Select Committee report on commissioning, which recommended that commissioning consortia must have in law a multidisciplinary team (and as we pointed out, rather a large one). This is a political straw man.

Its inclusion is therefore pointless.

3/5 - GP consortia must not go ahead in 2013 if they are not ready
Back in February, NHS chief executive and NHS Commissioning Board CE-designate Comrade Sir David Nicholson made this explicitly clear in a Health Service Journal interview .

This is already happening.

Its inclusion is therefore pointless.

4/5 - The principles of the NHS constitution must be protected
Not only are the NHS Constitution and its principles well-beloved of NHS generalissimo present and future Sir David Nicholson, it is explicitly mentioned on pages 330, 332, 333, 340, 365, 375, 395 and 402 of the revised Bill. (Notwithstanding Andrew ‘Transport’ Lansley thinking it is dentally-challenged). We can assume both the NHS Constitution and its principles are safe.

Its inclusion is therefore pointless.

5/5 - GPs must work ‘hand in glove’ with councils
The principle of consortia (it won’t be just GPs, as point 2 above makes clear) working with local authorities is enshrined in the Bill’s plans for Health And Wellbeing Boards. Even if the Select Committee approach of including a local authority elected representative on consortia boards is adopted and thus HWBs are not needed, that covers this too.

This is already happening, either way.

Its inclusion is therefore pointless.

Unless Deputy PM Clegg gets serious, and responds to his own party's policy, he risks splitting his own party.