A commissioning consortium in the west country declares it “does not believe in the purchaser-provider split”, the Foundation Trust Network warns of “serious financial stress” and the membership of the British Medical Association warms up to declare outright opposition to the Health Bill.
Despite all this, according to one senior policy figure fresh from a meeting with the health secretary, Andrew Lansley is apparently displaying “an almost preternatural calm”. One can only assume he is screaming inside.
Last week’s Nuffield Trust summit offered the chance to discover how the health sector’s policy makers and influencers judged the progress of the reforms. Almost as one, they were scratching their heads over how plans with which they agreed in principle had attracted such virulent criticism. Health committee chair Stephen Dorrell spoke for many when he said the cack-handed management of the reforms had allowed opponents to “dig up old arguments” that had been consigned to the dustbin of health policy history before he became health secretary in the mid-1990s.
He also warned that the government had less than 18 months to deliver some good news from the NHS to avoid undermining its chances at the next general election.
A thickening strand running through the reform’s difficulties is the health secretary’s inability to get his preferred candidates into positions of power.
He wanted KPMG’s Mark Britnell as chief executive of the NHS Commissioning Board, he ended up with Sir David Nicholson. Both are men of talent and experience, but anyone who knows them will tell you their approaches are chalk and cheese.
Mr Lansley had hoped former Monitor executive chair Bill Moyes would return to take up the reins of the new economic regulator. Instead he apparently found himself powerless when the appointment board recommended Monitor chief executive David Bennett.
Now, Mr Lansley’s attempt to develop a consensus around the health reforms by inviting another former health secretary, Alan Milburn, to apply to be chair of the NHS Commissioning Board has been rebuffed. Mr Milburn is a political communicator par excellence and it is significant that his greatest criticism of the reforms is not their substance, but the way in which they are being sold.
All of which makes it even more surprising that the health secretary - 10 months after the election - has failed to confirm David Kerr as his adviser.
Professor Kerr is no superman, but he does have two things these reforms desperately need: clinical credibility and a track record of successfully developing and communicating significant changes in healthcare.
One of the world’s leading cancer doctors, he was closely associated with many of the New Labour health reforms, famously writing to MPs arguing the clinical case for foundation trusts just before the crucial commons vote which narrowly passed the proposals. He showed his versatility by heading north of the border in 2005 and producing a report on the future of Scotland’s health services - a report that significantly won cross party political backing and the support of the British Medical Association. Four years later he took a leave of absence from his position as head of clinical pharmacology at Oxford University and headed for the Middle East to advise Qatar’s government on its health service plans.
In February last year Mr Lansley pulled off a major coup in persuading Professor Kerr to support his vision for the NHS and act as his adviser. The then shadow health secretary said: “David’s expertise and knowledge will be crucial in helping us to create an NHS which has patients at its centre.”
Professor Kerr returned to Oxford and waited for the call. He’s still there, still waiting.
Mr Lansley and his reforms are not over-endowed with credible and heavyweight advocates. Whatever the barriers to Professor Kerr’s appointment as an adviser, the health secretary needs to remove them now.