The NHS is paying a heavy, although largely unseen, price for the “pause” in the government’s health reforms.

The first half of 2011 is a crucial period for the NHS. Both providers and commissioners are beginning to feel the full impact of new cost constraints and are working out how to respond. The disruption caused by the reforms was damaging enough to the ferociously difficult decisions that need to be made, like those on pay that HSJ reports on this week. But now we have the prospect of further change, and the reality of further uncertainty.

At the Department of Health’s Richmond House HQ and in NHS organisations across the country, the ever dwindling ranks of managers are devoting increasing amounts of time to developing plans B, C and D. How far and fast will commissioning move to GPs, what will be the competitive environment for providers? These issues and others are the subject of time consuming “scenario planning”.

Politicians might believe they should wait for the outcome of their deliberations, but managers – as good public servants – will say they need to plan for all eventualities.

The government needs to make an unambiguous statement explaining exactly what parts of the reforms will be driven through regardless – and what specifically is subject to the listening exercise. They then need to make it clear how they will deal with the recommendations of the Future Forum and, crucially, by when.

Then it is up to the opposition forces to make their own judgement. The prospect of a year of wrangling as the bill drags through Parliament would place an intolerable burden on the service’s ability to plan effectively.

The NHS will always be a political football, but politicians need to be very mindful of the kicking that it is currently taking.