Editor's blog Monday 7 March 2011: What happens next in The Age Of Less

Health Secretaries redisorganising the NHS are like dogs licking their own arseholes.  Just because they can, it doesn't mean they should.

That did not prevent SOS Lansley from reversing the promises of the Coalition Agreement, and the pre-electoral assurances from That Nice Mr Cameron, to end top-down reorganisation.

There have been some shoddy attempts at revisionist history by Coalition ministers, but unless I somehow missed the widespread, proctologically bottom-up campaign among PBC consortia to abolish PCTs and SHAs, that was the first U-turn.

Yes, I'll get away from the anal metaphors soon. (Don't mention the U-bend.)

So now we are waving or have waved farewell to a lot of people who knew some things about how to rein in spending (as the NHS last had to do in 2006-7; some of which it did very badly, screwing public health).

Yet as the NHS Confederation members' survey points out, the need to control spending remains. Having spent a decade fully embracing The Age Of More, the NHS (just like the rest of us) now faces the challenges posed by The Age Of Less.

The Age Of Less refers, of course to public sector budgets. Demographics and expectations mean that demand-side, The Age Of More remains firmly in situ, emphasising the essential need for a real reform of healthcare delivery - rather than a nationwide NHS redisorganisation.

Last week saw the second U-turn - on the execrably-worded Health And Social Bill provisions over price competition.

And Sunday saw Tim Montgomerie, editor of influential Tory website Conservative Home write that it would be "wise" for PM David Cameron to do a U-turn on the whole unpopular NHS reform policy in the Telegraph (even though Montgomerie writes on Conservative Home that he actually supports it).

Where next?
Montgomerie is surely right that the Coalition will not want to U-turn on the overall NHS reform plans. Too embarrassing - particularly after PM Cameron chose to invest his political capital in supporting them following the Letwin Review.

More to the point, the old system is already dead. Many - but by no means all - of the good staff in PCTs and SHAs saw the writing on the wall and took first mover advantage.

In many senses, what is here now is NHS Supreme Soviet Chair Comrade Sir David Nicholson's dreams come true: top job of the new DH - the NHS Commissioning Board; all rivals destablilised by the abolition of SHAs; a more centralised , nice-and-easy-to-grip system of 50-odd clustered PCTs.

(Obviously, Comrade Sir David is not in any way a Stalinist, and he is only so titled on this blog in the spirit of achingly postmodern irony. But just think: if you were an unrepentant Stalinist, what would be not to like?)

So here's a reassuring thought for you: if NHS reform is seen to have failed, then we get that.

Doesn't that sound good?

Meanwhile, the BMA upped the stakes with consultant committee chair Dr Mark (not the TV one) Porter warning of variability under the new world equating to a 1930s-style NHS, prompting this comic riposte from Health Minister Simon 'Dale Winton on Valium' Burns.

I'm rather hoping the DH might make 'Simon Says' a daily thing: we could all do with a laugh.

The BMA is obviously cranking up the gears ahead of its forthcoming Special Representative Meeting, as it has got Labour MP Tom Blenkinsop to propose an Early Day Motion stating that "this House notes the current proposals to reform the NHS in England; believes that potentially positive elements of the NHS reforms  - giving clinicians responsibility for commissioning and shaping local health services, increasing public and patient involvement, and focusing more on public health - are threatened by other aspects, particularly those seeking to force and increase competition;

"further believes that clinicians who are responsible for commissioning should be free to work collaboratively with hospital and community care colleagues and patients to develop the care pathways that, in their clinical judgement, provide the best care for their patients, without fear of challenge;considers that the reforms should ensure proper accountability to prevent unacceptable local variation and the maintenance of a national approach to key issues such as education, training and workforce;

"and calls on the Government to ensure flexibility in the pace of implementation of the reforms".

What is particularly interesting is that two of the co-signatories of this EDM are Liberal Democrat MPs Andrew George and John Pugh.

Men overboard?