There are two narratives running in parallel on the current NHS reforms. Within Whitehall and Westminster and among the health policy chattering classes debate rages over the exact intention of each clause of the Health Bill.
Number 10 advisers struggle with how to “detoxify” the reforms and are finding that tugging at one string threatens to unravel the whole patchwork. The changes signposted as arriving after Easter are likely to be more about pace and presentation than any kind of U-turn.
Out in the real world, the NHS is shaping itself to the new reality driven much more by well established local behaviours and pressures, with an increasing dash of central direction, rather than any allegiance to health secretary Andrew Lansley’s vision.
Dame Barbara Hakin, the managing director for commissioning development, makes it clear that she expects the new “system” to prevent any harmful consequences of the reforms - intended or unintended. It is increasingly clear that this system will be firmly governed by the new NHS Commissioning Board.
What is perhaps surprising is how widely welcomed this is. A senior GP leader told HSJ last week: “I trust [board chief executive-elect] David Nicholson implicitly”, expressing the view that his “belief in the NHS” would see the reforms implemented in a way that did not undermine its traditional values.
Our survey indicates the great majority of GPs and primary care trust staff think consortia will have taken on “material responsibility” for commissioning within 12 months.
This makes what is happening on the ground just as interesting as what is happening at the centre. For example, exclusive analysis by HSJ has revealed that while consortia are mostly forming along predicted lines, a number of well performing practices are banding together to the exclusion of less successful neighbours.
An early test, perhaps, for the wisdom and practicality of “system intervention”.