Trouble over the NHS reforms – inevitable or not?

Was the stooshie over health reforms inevitable? From much of the coverage, you’d think it was always going to end in tears, as people line up to criticise Lansley and rumours about Number 10’s search for a dignified exit strategy (£) swirl around the Westminster village.

But it didn’t have to be like this. For a start, the basic idea is one that should be easy to sell to the public. Matthew Parris has pointed out (£) that people intuitively look to their GP as the route into healthcare. It shouldn’t be hard to convince the public they should lead commissioning.

It’s been difficult mainly because the health professionals aren’t on-side. This could have been largely avoided.The major health lobbies all agree with the principle of clinical leadership in structuring services. Unease and dissent has increased thanks to the scale and pace, tight budgetary context, and telling lack of detail in DoH plans. The NHS Confederation’s report this week on the future of the reforms was a calm, measured contribution: a reminder that sensible support for the reforms exists.

What’s more, you don’t need every last GP to agree with the new system to make it work in practice. You need a hardcore, a kernel in each area. Finding, nurturing and publicising that core of supporters (and they are out there) would have gone some way to dismissing the idea every last doctor across the land hates the reforms.

The reforms have caused controversy (and vocal criticism from the left) over the proposal that service providers compete for contracts from commissioners. This is the hardest thing to sell, but far from impossible. Services will still be free at the point of use, after all, and still commissioned (ie controlled) by public servants. And most people care about quality of care, not how they got it.

The same goes for the related criticism: that busy GPs will delegate to external commissioners. GP consortia will still be the boss. Why shouldn’t they hire someone to coordinate commissioning?

Instead, we have a narrative about a private-sector carve-up of the health service – some wild-eyed free-market bonanza that belies where power will lie in the new system. The reforms are, no doubt, controversial. Vested interests will always oppose, and there are a lot of concerns about the implementation and the detail. Even supporters should worry about some of the finer points.

But the scale of opposition is out of proportion to the policy disagreements. The reason is basic politics: the urge to reform has trumped engagement with the health community. Goodwill has been squandered as a result. Over-ambitious timelines, fatally vague consultations, a perception of government high-handedness and a grandiose Ministerial tone have all undermined reforms that would, in the cold light of day, have more instinctive support.

A sense of drifting chaos emanates from Richmond House. That, rather than the broad policy aims of the reforms, is why the Bill is in trouble.