Poor Andrew Lansley. His plans to liberate the NHS have coincided with the biggest ‘fiscal tightening’ in its history. Even without the reforms, flat-line funding over the next few years will lead to unpopular service cuts and angry demonstrations. But his proposals have the attracted such hostility, it’s likely he’ll carry the can rather than the credit crunch.
‘Once in a lifetime’ reform of the NHS is nothing new. Tony Blair, Lord Darzi and David Cameron have all promised it in the last 12 years. Either we’re being lied to, or life expectancy will soon plummet to four years. But the biggest failing of the Health and Social Care Bill is that it’s unreadable. At 353 pages it’s bigger than the Bill that founded the NHS. By page 19, I’d given up the will to live. It’s an impossibly complex mix of regulations, substitutions and amendments. No GP can possibly digest them, and for us to take control of rationing the NHS is a huge leap of faith. It’s like being handed the steering wheel of a runaway coach as it plummets over the cliff. Oh, and here’s the instruction manual. In German.
The phrase ‘any willing provider’ suggests doctors in supermarkets, with loyalty cards for liposuction, two diagnoses for the price of one and a checkout for six symptoms or less. Price completion works when you’re buying things – curtains, soap, Cornflakes – but not when you’re buying complex treatments for patients with several diseases. The NHS improved under Labour, but not as much as it should have done. Lansley’s idea of staff and patients designing services and deciding how the money is spent is spot on, but we need time to sit down and share ideas and experiences. It’s pointless ‘giving patients a voice’ if they don’t know how to be heard. GP Consortia have ridiculously confusing names like Bexley Clinical Cabinet and Cumbria Senate, and patients aren’t guaranteed a seat on the board.
Health reform, like healthcare, relies on trust. Who should we trust to make the best use of NHS resources? Lansley believes that ‘GPs know what patients want’, but some doctors are very bad at listening to patients and a medical degree is no substitute for clairvoyance. What the NHS needs more than anything is to rediscover its humanity. Staff and patients need time together, and services need to collaborate rather than compete in difficult times, without the insecurity of rapid change. Political dogma dictates that if you don’t blow the NHS out of the water in the first year of office, you won’t be able to touch it at all. But the Tories have now realised they need to slow down, if only to placate the Liberal Democrats. Even better, they can blame their more cautious partners when the NHS hits the buffers next year.