It is a year since the general election that brought the coalition to power and Andrew Lansley to Richmond House.
This week’s HSJ focuses on the successes and failures of the NHS reforms that have assumed growing importance during that first year – although not in a way the new administration would have wanted.
Two former health secretaries – one Conservative, one Labour – and two other senior figures, who were summoned to Number 10 this week to give their views, pick apart Mr Lansley’s record. Their verdict? The principles are, mostly, right; the execution has been woefully lacking; and the efficiency/cuts drive is where the real action is.
Just under a year ago, after the publication of the coalition agreement, HSJ wrote: “Judging from the feedback on HSJ’s website, the broad sweep of policy is seen as logical and appropriate to the challenges ahead.”
So why did things go so badly wrong?
Well, while praising this “impressive start” for its “speed and consistency”, HSJ suggested 20 questions the coalition needed to address to “achieve its goals.” Analysis of the government’s success in answering those questions shows us why the NHS reforms are now floundering.
For a start – and to be fair – one question has been fully answered. Transforming community services has been continued and, largely, delivered.
In five cases partial answers have been delivered. We know the plan for non-foundation trusts, how GPs are meant to sign off hospital reconfigurations, that primary care trusts are expected to develop GP commissioning capacity; that the government is still keen on personal budgets and, theoretically, the use of non-NHS solutions to personal health records.
But for the great majority of questions, an entire year has passed without convincing answers.
The plan to increase patient choice and information has gone – effectively – nowhere, with the thorny questions about the practicalities of choice of consultant and GP practice virtually ignored.
Confusion reigns over the involvement of the private and third sectors in NHS commissioning and provision with the government tearing itself in two trying to reassure every pro- and anti- interest group and convincing no one in the process.
The questions over the accountability of GP commissioners have actually multiplied tenfold, although the government has avoided having to work out how to incentivise a change in the GP contract by deciding not to renegotiate this year.
Our question about election to PCT boards – which should now be redundant – has found a new lease of life in the debate about patient and public representation on commissioning consortia.
Most tellingly of all, the government seems to be in denial about the fierceness of the efficiency agenda, which ratcheted up a notch with Monitor’s latest intervention. Even Mr Lansley – who should know better – believes the rapid loss of management capacity is irrelevant; that marginal financial tweaking will counterbalance the knock-on effects of local authority cuts; and that clinical posts are safe from the efficiency drive.
This denial is one reason for the creation of the prime minister’s new NHS “advisory panel”. It is a response to concerns expressed by some of the most ardent reformers in the NHS that by ignoring the harsh financial realities – and failing to answer important questions – that the reform baby is in danger of being ditched with Mr Lansley’s bathwater.
HSJ predicts the panel’s experience and willingness to address the tough reform questions will make it highly influential in the weeks and months to come.
How telling that four of the eight members are present or former NHS managers and that a fifth – Nigel Edwards – is the most effective spokesman for good management. Sense at last.