Editor's blog Tuesday 26 October 2010: The confidence interval over Mr Lansley's NHS reforms

Regular readers of Health Policy Insight are clever types, and will have picked up that we believe Health Secretary Andrew Lansley's plans for 'Liberating The NHS' involve significant downside risks, to put it mildly - involving as they do an enormous top-down structural reorganisation and boundless faith in the three Cs of choice, competition and commissioning to drive the new system.

More to the point, we have to date far too little detail about crucial elements of the proposed new system. Alan Maynard has pointed out that there appears to have been no thought about the regulation of GP commissioning consortia, who will control almost all the money.

The level of management allowance for consortia will allow both potential leaders and potential staff and suppliers to decide if there is a game worth the candle. We will not get the figures until this December, Sir David Nicholson told the health select committee last week.

Economic regulation in the New World is wholly opaque. One example: what do we do about the fact that most hospitals are de facto geographic monopolies?

Taken to its logical conclusion, the 'any willing provider' regime could see the equivalent of local loop unbundling for BT in the broadband telecoms sector, as Super-Monitor (featuring special guest the Co-operation and Competition Panel) forces NHS trusts (including foundation trusts) to open their facilities to teams from Spire, Circle and Care UK.

The potential for costly litigation is vast.

People have noticed
Responses to the White Paper, ranging from the BMA to the NHS Confederation , RCGP, Kings Fund and NHS Alliance, all indicate that the risks are not hard to notice.

In the Kings Fund's opinion survey with doctors.net.uk published yesterday, just 24% of 1,000 responding doctors from primary and secondary care (sampled to reflect the UK's medics) 24 per cent) "believe that the proposed reforms will improve the quality of the patient care provided by their organisation or practice ... 22 per cent of the doctors surveyed believe that the NHS will be able to maintain its focus on increasing efficiency while implementing the proposed reforms".

Of the component changes in the White Paper, "32 per cent said they believed none of the components will help to improve the overall level of patient care".

The study also found that "only 22 per cent of our respondents believed that the NHS will be able to maintain its focus on increasing efficiency while implementing the proposed reforms. Fifty per cent of our respondents believed it could not, and GPs were somewhat more pessimistic than hospital doctors on this issue".

Today's Financial Times carries a column by Philip Stephens which indicates that the risks of Liberation A La Lansley are becoming more widely recognised. Stephens' piece is titled, "NHS reform: an accident waiting to happen". It is well worth a read.

Today too, the Kings Fund's iridescent chief economist Professor John Appleby told The Independent “waiting times will go up, and NHS management may end up telling ministers ‘we simply cannot do the job, given our resources’. The funding gap in the NHS could rise to as much £6 billion a year over the next five years, just in terms of what the service needs to keep up with existing demands and to maintain existing standards”.

Home advantage?
But one of the most telling bits of information came from a colleague who recently went to see his local MP to discuss concerns about the NHS reforms; specifically, the proposals over competition law, and the veiled threats in the spending review ("proportion of public services that must be provided by independent providers") was also raised.

This MP told their constituent that they were not personally in favour of these aspects of the policy, as they would badly affect their local hospital - which is a foundation trust. The MP even told their constituent that they thought the proposed hospital funding policy (minimum tariff and a quality payment) would not work.

The MP in question is a Conservative MP.

The individual in question is not a rebel; not a newbie; not backbench cannon fodder.

They are one of Mr Lansley's home team.

This is a sample of one MP (albeit one who is better-then-averagely clued-up about the workings of the local NHS). So it's symbolic more than it is predictive. But of course, symbols matter.

The confidence interval for the White Paper
Confidence matters, too. In statistics, a confidence interval is used to indicate the reliability of an estimate. In Bayesian statistics, it is referred to as the credible interval.

Politics is a rough old game, and if more Conservative MPs start to calculate that Mr Lansley's proposals for reform don't feel confident or credible, in a time when PCTs are explicitly starting to ration normal procedures as winter approaches,  then their patience may wear thin. The interval may be vanishingly short.

And Health Select Committee chair and former health secretary Stephen Dorrell may start to look like a very safe pair of hands.