The government’s reforms are picking up pace.
Almost every significant response to the Liberating the NHS consultation advised the Department of Health to slow down its programme. Instead, the coalition is tightening up the timetable.
The original reform chronology gave the government flexibility to keep the old system going into 2014, should GP commissioning struggle to take off. Now primary care trusts will be gone by April 2013 at the latest and strategic health authorities 12 months before that.
Very risky, but logical too. Running systems in parallel would have been confusing. The challenge now is to make the right decisions at the right time. For example, the national commissioning board will launch as a shadow organisation in less than five months. Should the government ensure it has a chair and chief executive by then, or wait for the right people? It is likely to wait.
Related to this quickening of pace is confidence that the Health Bill is guaranteed safe passage through Parliament. Ministers believe coalition backbenchers are supportive (not “shocked” or “surprised” as some have claimed) and the rougher seas of the Lords can be crossed given the following wind provided by strong commons backing.
Health secretary Andrew Lansley’s job will be made easier by his Labour shadow John Healey’s unwillingness to set out an alternative vision. Political attacks lose credibility when critics cannot suggest what they would do in their opponent’s place. The real Westminster action will be provided by the Commons health committee inquiry into commissioning.
There is one other potential obstacle, one Mr Lansley has created for himself. The Mid Staffordshire public inquiry will report in March. Its recommendations on the accountability of commissioners, regulators and politicians might sit uneasily with the health secretary’s desire to devolve responsibility.