Too far, too fast?

It is hubristic of David Cameron to talk of his ‘legacy’ at this stage in his premiership, not least because he invites criticism that the government’s public service reforms are going too far, too fast. The leaders of six health unions have reacted to the imminent publication of the Health and Social Care Bill with a concerned letter to the Times (£); they argue that price competition is divisive and that the reforms promote cost above quality.

Dissent has spread far beyond the usual union suspects. Dr Sarah Wollaston, the Tory MP for Totnes, has expressed her misgivings and there have been numerous accounts of GPs’ reluctance to embrace commissioning reforms – GP consortia are going to handed nearly 80 percent of NHS funding to manage and spend. Local government is to be involved in the local wellbeing boards, which will regulate local health strategy, is yet to complain with any conviction but can only be a matter of time – they are being asked to share responsibility and therefore the blame as well.

So, our national religion is as strong as ever. The Today programme’s spin is that the government is divided, suggesting that Andrew Lansley ‘ran away with himself’ and that Cameron is now trying to ‘row him back’. Speaking to Today (in a difficult interview), Cameron reiterated that his politics revolve around those three letters: NHS. He expressed his conviction that patient choice and inter-service competition would improve standards, ending the false hope offered by targets. He endorsed Lansley’s argument that these reforms are evolutionary not revolutionary – the culmination of market reforms introduced by Kenneth Clarke, Virginia Bottomley and Alan Milburn over the last 20-odd years. He also described them as immediately necessary, citing an OECD report that damned Britain’s cancer survival rates and coronary care, as well as raising the spectre of budget black holes and ever more expensive treatments. There is no more money; there can only be reorganisation. But the pace and scope of change is very much open to debate.