The coalition’s honeymoon is in danger of being called off
Momentum is a priceless asset in public sector reform. New governments tend to have momentum - commonly called “the honeymoon period.”
The coalition is enjoying a strong honeymoon period and the health reforms appear to be playing their part. A MORI poll suggests that GP commissioning is the policy the public have greatest awareness of.
‘The common view is that the reforms are in serious danger of being upended by the tactics adopted to implement them’
So far, so good? Unfortunately not. Only 7 per cent of MORI’s sample thought the change would improve care.
What is more, the opinion expressed anywhere but the platform at this week’s Conservative Party conference is that the reforms - appropriate and welcome in principle - are in serious danger of being upended by the tactics adopted to implement them.
Backbenchers are confused, while Number 10 and the Treasury are growing increasingly nervous. The party’s grandees, who had assumed that health secretary Andrew Lansley had defused the NHS as an issue, are now paying greater attention.
What they hear as they consult is that the reforms are running into the mud because responses to the white paper from a wide range of groups give the same lukewarm support for its principles, before moving sharply on to concerns about implementation. The background music is provided by the significant cuts that all know are on their way.
Mr Lansley persuasively argues that the NHS must answer many of the outstanding questions itself, rather than waiting for the government to fill in the blanks. Time will be needed to find the right solutions, which will differ across the country.
However, the fundamental mistake of announcing the scrapping of primary care trusts - and as a result weakening management control - before better establishing the new system, is that it created a hurdle to progress it is not certain the government can or will clear.
Read more
PCTs make slow progress with QIPP
Michael White: Rattled by reform
Have your say
You must sign in to make a comment.
Share
Readers' comments (8)
Star Geezer | 7-Oct-2010 7:47 pm
Its was an illicit honeymoon and some dodgy drunken (how else could they be explained ?) amourous promises were made in some backroom bars.
Its was never much of a honeymoon out in the liberal constituences, hundreds of their counsellors have gone idependent or joined labour, they are imploding in local areas and have no defence. Ed took the carpet from under their feet by decrying the Iraq war, now they are up a dead end street with no reverse gear and the driver is delirious with delusions of power. Come on Vince you know this is bad for the country and your instincts are telling you,pull the plug and you would be the greatest Liberal since John Stewart Hill!
Unsuitable or offensive?
Clive Peedell | 8-Oct-2010 1:20 am
Lansley is a bright bloke, but his underlying political ideology and beliefs are not suited to healthcare reform.
He is so convinced of the power of the market, that he thinks it can function anywhere. Unfortunately, the NHS provides an essential service and although there are many business aspects to running the service, it doesn't necessarily follow that the market mechanisms of patient choice, PbR with a PP split, and competition between a plurality of providers represent the best way to deliver the service.
On the contrary, delivering a healthcare service to the population requires collaborative working. GPs and consultants want to build local services together alongside strong management teams. This is fundamentally anti-market. If GPs do choose to work this way and somehow wangle their way around EU competition law and the wrath of Monitor and the NHS Commissioing board, then the expensive market system will be redundant. If on the other hand the the market is forced, then the notion of GP "empowerment" will be a nonsense, as will the idea of integrated services.
Healthcare requires planning to deal with the needs of the local populations. Patients moving around regions doesn't help this process and will destabilise services. Creative destruction in a single payer system is a nonsense. The start up costs of new providers and the costs of exit are prohibitive in healthcare. The market may create pockets of excellence as in the USA , but the overall system becomes a costly failure to the majority.... "Islands of excellence in a sea of misery"
The underlying political agenda is to reduce the number of public sector workers and shrink the state in order to cut the public sector pensions burden and provide a stable economic environment for the City of London's Finance sector (i.e low taxation and control of inflation). We will also end up with a mixed funding system (another investment opportunity).
This will be achieved through FTs becoming SEs, dissolution of PCTs/SHA and replacement by private sector commissioners, and the use of social capital (third sector). Best practice tariffs, and price competition will lead to "a race to the bottom", which will place FTs/SEs under huge financial pressure and force them to utilise the abolition of the cap on private incomes to generate more income to survive. This will be aided by patient held budgets, which will inevitably require top ups, which in turn will create a new health insurance market.
There is nothing surprising about this. It represents the fundamental ideology behind modern conservatism - Roll back the state, utilise the power of the market, utilise social capital (i.e the Big Society), reject the public service ethos in favour of market discipline (public choice theory).
This is why Lansley is in such a pickle. He has let his ideological convictions overide his considerable intellect and ability.
This is also why so many groups are opposing the reforms.
Unsuitable or offensive?
Anonymous | 8-Oct-2010 7:34 am
I agree with both the above commentators, it is not only the pace of change but the lack of explicit willingness of the GP community that remains the two biggest hurdles. PCTs are already coalescing as we speak so whats that all about e.g. a return to the old HAs.
Lack of will, lack of commissioning experience of GPs and a relentless drive to cut manpower in PCT closures are more than just hurdles!
Unsuitable or offensive?
Anonymous | 8-Oct-2010 10:38 am
Feel a bit sorry for the Lib-dems, in that they are in a no-win situation.
Disillusioned Tory voters will see that voting for them just gets a Tory government so they might as well vote for that.
Likewise, disillusioned Labour voters (like me) will see that a vote for Lib-dems is a vote for the Tories and vote Labour.
I think the party will be lucky to survive if they don't start openly challenging some of these Tory led policies, however this sort of action could lead to a breakdown of the coalition.
Interesting times indeed...
Unsuitable or offensive?
Anonymous | 8-Oct-2010 10:33 pm
Not sure where the evidence for Mr Lansley being a "bright man" comes from? during interviews Mr Lansley is unable to answer basic questions without becoming highly agitated (ie where was the abolition of PCTs and SHAs in the Coalition agreement? what is the public's appetite for more top down restructuring in the NHS?) it would be easier to feel optimistic that the changes that were being proposed were being advocated purely in the interests of patient care if Mr LAnsley were able to answer such questions calmly, and articulate his rationale clearly - unfortunately it does seem that this is a case of pursuing an ideological agenda, which might be being influenced, dare i say it, by his GP wife?
Unsuitable or offensive?
Joe Bloggs | 9-Oct-2010 1:49 pm
I agree with 10:33. Lansley is an A-typical politician. The sort you can usually see coming. Whilst he started well, making many changes the majority agreed with (except those affected but those changes) he seemed to be winning support. But then something went wrong. He has given more power to DH something everyone thinks is a bad idea; such as appointments to Trusts and more direct centralised control. This plays to the power mongers at DH but is inconsistent with Big Society. And so the cracks appeared. For the last two months we have had nothing from DH or Lansley in terms of detail apart from a White Paper that generates more questions than answers. Lansley needs help or he risks war with TUs and 1.3m staff who only see chaos in planning, pensions cuts, child benefits cuts, and no return, no recognition, no exchange. With no exchange it's a one sided deal. The balance to this equation is civil action: strikes and judicial review. But at the very basic level is the move towards working to rule. The NHS has been going that way for decades but it still relies on it's people giving more than their Job Descriptions says. Lansley's dislike for the people is starting to show. But without them he is lost.
Unsuitable or offensive?
Anonymous | 12-Oct-2010 8:40 am
Lansley is determined that the market should reign without hindrance.
PCTs originally had their wings clipped but remained, providing among other things continuity, commissioning skills and organisational memory.
They were not put on death row alongside SHAs until the BMA recommended GP support NHS rather than private providers for commissioning support.
In one knee-jerk move (not his only on-the-hoof response) Lansley takes this option away from GP consortia and throws them into a pack of wolves.
Unsuitable or offensive?
Anonymous | 12-Oct-2010 11:02 am
To quote Professor Margaret Whitehead, from her paper, NHS reform: untried remedies for misdiagnosed problems? "The White Paper’s proposals are ideological with little evidential foundation. They represent a decisive
step towards privatisation that risks undermining the
fundamental equity and effi ciency objectives of the NHS.
Rather than “liberating the NHS”, these proposals seem to be an exercise in liberating the NHS’ £100 billion budget to commercial enterprises"
Unsuitable or offensive?