Editor's blog Monday 9 May 2011: D-Day or Groundhog Day for NHS reform?

It has been quite a weekend, with Deputy Prime Minister Nick Clegg making bullish noises on the BBC Andrew Marr Show, including stating that "no bill is better than a bad Bill ... getting these changes right is now my Number One priority".

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But wait! As if to forestall attempts to make political capital out of the changes ahead, Restoration-faced Chancellor George Osborne was also interviewed, and he and David Cameron want changes to the Bill too. "We want to reassure people that we are not and never have wanted to privatise the NHS; we believe in the NHS as a public service free at the point of use; we want to reassure people about that.

"We want to make sure the health service is able to do this in a timely way ... but this is a decision that David Cameron took, that I took, that Nick Clegg took working together, so let's try to get this Health Bill right and to deliver evolutionary change".

Clegg's consiglere Norman Lamb has also had his say, as has John "I Love The NHS" Redwood.

Meanwhile, Dr Clare Gerada of the Royal College of GPs has pushed her damehood a few years down the track, with this shopping list of nine key changes to the Bill.

Gerada and the RCGP call for guarantees on:
1.      Comprehensive healthcare
2.      Charging for healthcare
3.      Issues relating to market forces in healthcare
4.      Issues relating to EU competition
5.      Accountability and conflicts of interest
6.      Resource allocation and risk pooling
7.      Practice boundaries
8.      Workforce and training issues
9.      Confidentiality

And today, the House of Commons will debate NHS reform, under the following Opposition Day Motion: “That this House notes the growing concerns over the government's handling of the NHS and the effect its policies are having on hospitals and patient care; and calls on the government to uphold the Coalition Agreement promise to stop the top-down reorganisations of the NHS which have got in the way of patient care, to use the present pause in the progress of the health and social care bill to make fundamental changes, including dropping the damaging and unjustified market-based approach, and to concentrate efforts instead on achieving sound efficiencies, better clinical quality and improved integration of services”.

The debate is scheduled to begin at 3.30 and you will be able to watch the live streaming here.

The threat level
Anyone who regularly visits DH buildings will know that, as for any central government offices, the threat level is prominently displayed in reception.

The metaphor is apt. While the core business facing the NHS is The Nicholson Challenge of how to save £4 billion a year for each of the four coming financial years (and with no prospect of a financial 'breathing out' at the end of that), we have been pissing around with a badly-drafted Bill based on tenuous evidence and happening at the same time as a 'see it from space'-sized top-down redisorganisation of the management systems and structures. Which does not even know whether it is evolutionary or revolutionary.

At the time when the Bill has been making its way through Parliament with such distinction that it has actually had to stop its progress for re-assessment and fresh spin-doctors ("new balls, please!), the NHS structural reforms have already started under the existing system whereby the NHS is whatever the Secretary Of State For Health decides it must be.

This Bill is, to put it kindly, a dog. It does not promise to grip the real issues facing the NHS: of outmoded models of long-term conditions care delivery in acute settings where telecare and self-care and remote monitoring should be saving billions; of outcome and activity variation; of appropriate workforce substitution; of ensuring that people are supported to liver independently as long as possible or to return to independent living as soon as possible; of supporting and strengthening NICE rather than undermining it with a tokenistic Cancer Drugs Fund; of the catastrophic pile of poo that is medical self-regulation.

The Bill is not totally devoid of any merit, but it has far more wrong with it than it has right. I have said this before and will say it again: the Health Bill as it currently stands is stupidly dangerous. Therefore going ahead with it would be dangerously stupid.