Lansley is taking us back to medical domination - Lord Crisp

Speaking to HSJ ahead of the publication of his latest book, 24 Hours to Save the NHS, Lord Crisp said the health service had been dominated by managers for the last 15 to 20 years and before that by doctors.

Instead, he argues, the focus should be on empowering patients as a counterbalance to the vested interests within the health service which act to maintain the status quo.

Lord Crisp, who served as NHS chief executive and Department of Health permanent secretary between 2000 and 2006, told HSJ that “rather than imposing a model” of GP commissioning the government should have spent “a bit more time looking at what’s working” in terms of integrated care.

He said the government was right to try and make services more local through GP commissioning but should not put GPs in exclusive charge of local leadership. He also welcomed the move to open up some community services to “any qualified provider”, although he suggested commissioners should be able to use local providers rather than the big chains “wherever possible” without fear of competition law.

However, he says his main criticism of the government is “they haven’t told the story” of why reform is needed - in direct contrast to the development of the NHS Plan by then health secretary Alan Milburn in 2000.

The NHS Plan was developed by a group of 135 patients, professionals, politicians, advisers and civil servants who worked across five distinct areas to draw up policy, in a similar manner to how the Future Forum is working today.

Lord Crisp said: “With the last set of reforms Alan Milburn got people together and got this sense of momentum which lasted for three or four years…What’s happened with Andrew Lansley is he’s started off by getting everyone against and now he’s having to get everybody on side.”

However, he said there had been so many compromises around the Health Bill it had become “evolutionary” and was not radical enough to tackle the problems faced by the NHS.

He added: “I don’t see the cutting edge; I don’t see where the big changes are going to come from.”

“The two biggest things I would do right now is get an independent group to look at what healthcare might look like in 10 years time and somebody else to do the Wanless exercise [where Sir Derek Wanless was commissioned by the Treasury to work out how much healthcare should cost].

“If someone were able to do that then when it came to the crunch of an individual hospital’s A&E or paediatric department closing you’d be doing it against a strategic background. Part of the problem is that going to take another three years. It would have been easy to start it last May but it’s difficult to start it this September,” he said.

Lord Crisp, who retired five years ago and sits as a crossbencher in the House of Lords, now spends a lot of time advising African governments on the development of their health services. He decided to write the book in response to repeated requests for advice from colleagues in the developing world going through reforms and building health services.

• Read Patrick Keady’s review of Nigel Crisp’s book for HSJ

He predicts the biggest issues preoccupying his Lords colleagues during the bill’s passage will be the role of competition, GP conflicts of interest and the implications of changes to the secretary of state’s duty to provide NHS services.

Although he approves of the separation of the NHS and the DH, allowing the department to “concentrate on the long term”, he is sceptical that even if the duty to provide was changed it would make much difference in practice.

In the book he reveals that on appointment in 2000, he was introduced to a “high profile private sector leader with the suggestion we might somehow work together”. However, following a “cordial meeting” the idea was abandoned.

Speaking to HSJ he said the idea stemmed from the then government’s desire, in common with governments of the last 20 years, to inject some private sector nous into the NHS. He predicts the private sector involvement in the new system will come through the chair of the NHS Commissioning Board.

He added: “They have never managed to get [a private sector leader] because most private sector people aren’t willing to take the risk.”