Nick Bashes Bill – Reforming the Reform?

Deputy Prime Minister Nick Clegg threatens to veto the Health bill proposed by Lansley. His main grievance is Lansley’s plan to place all healthcare commissioning in the hands of GPs; Clegg, who previously demanded that the responsibility be handed to GP Consortia ‘only when they are ready’, has now added that it should only be handed ‘to those GPs who are able and willing’. Yet what would making commissioning responsibilities optional mean?

Lansley’s bill clearly states that all GPs must eventually become part of commissioning bodies. He stressed that to allow GPs to ‘opt in or opt out’ would create a ‘two-tier system’, which he believes will only damage the quality of service. While some clinicians will fervently support this freedom of choice, who will commission the care in those areas where GPs are unwilling? Would the Strategic Health Authorities and Primary Care Trusts be kept after all, rather than sent to their gallows as previously planned? Or would the new commissioning boards take on the responsibility? How will they achieve that with negative funds?

Coalition Compromise

Westminster’s apparent indecision reveals the healthcare reform as a battling ground for coalition tensions.

The Lib-Dems are calling for a re-write of the reform they had originally agreed to, maintaining the bill does not comply with the initial understanding. Many Tories are meanwhile backing Lansley, who adamantly insists ‘the reforms are not about me’; several Tories expressed regret that Lansley is being ‘sacrificed to the Lib-Dems’, saying it will weaken Cameron’s image, who supported Lansley for years. Yet Cameron is so far backing Clegg, who insists on emptying the reforms of their commissioning core; Downing Street is considering scrapping the bill altogether, despite implementation having started already. Lansley made only one rebuke: ‘if they don’t want patients and nurses and doctors in charge of the NHS, who do they want?’

Some claim that giving in to Lib-Dem demands and passing a ‘watered down’ version of the new legislation would be much worse than dropping it altogether. Lansley’s bill will distance politicians from day-to-day running of the health service, and strengthen clinicians’ decision power; Clegg’s changes would return significant power to the local councillors, and limit the powers of the economic regulator intended to monitor the competition, which in turn might be made impossible. Such a compromise would leave the NHS neither here nor there, essentially requiring the upheaval of reform without the final result being clear.

Whereas if the bill were dropped, Lansley himself admits, many changes could still take place under reforms that do not necessitate legislation; the reorganisations can still be achieved, at a slower pace. This will allow the coalition government to regroup, and give the health services time to ready themselves for monitored competition; learn how to evolve and let providers fail when necessary. Perhaps the NHS needs to be given time to focus on the financial savings it needs to supply without such drastic, simultaneous reorganisation.

Will the bill be dropped? amended? Would that please everyone? or no one?

(FT, May 9^th & 10^th)

Health Service Best Practice Groups on Commissioning