Nhs

Reassurance — that's what the happy trio of David Cameron, Nick Clegg and Andrew Lansley sought to emit during their NHS event earlier. And reassurance not just about where the coalition is taking the health service (although there was plenty of that), but also about the "listening exercise" they are engaging in now. Although all three men suggested that the broad scope of the NHS reforms would remain — decentralisation, greater responsibilities for GPs, and all that — they also hinted that "substantive" changes will be made to the Bill as it stands. As for what those changes will look like, there were few specifics. Yet it did sound as though the coalition is dwelling on the recommendations made by the health select committee yesterday.

Get your guide to body language out for tomorrow morning Cameron, Clegg and Lansley will be doing a joint event on NHS reforms. The three men all have subtly different messages to get across and there are concerns in Tory circle that Clegg will use the occasion to present himself as the defender of the NHS against these Tory reforms. Cameron will be walking a tightrope at tomorrow’s event. He will have to show that he is listening, that this whole exercise is not a sham, but without abandoning the principles on which the reforms are based. Expect Cameron, who will only have arrived back in the country hours before the event, to emphasise his personal connections to the NHS as he tries to build support for the policy.

The NHS is, as Nigel Lawson once remarked, the new national religion of this country. This makes it difficult to discuss the subject in a rational matter and any attempt to reform it is likely to run into its own Pilgrimage of Grace as Andrew Lansley and the coalition are discovering. The government’s problem is that it can’t do a simple u-turn. As I say in the Mail on Sunday, Cameron can’t shelve this scheme without bringing his own judgement into question. Once Cameron and Clegg signed the introduction to the white paper setting out these reforms, they crossed the Rubicon. So instead the coalition is left trying to tinker and slow down the reforms to make them more politically palatable. But this brings with it its own risk.

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.

Let's make one thing clear right from the off: the IFS did not just say that the government would break its pledge to increase health spending in real terms. What it did say is that the government is coming close to breaking it — and that's the truth. Here's the graph that we've put together to compare the real terms health spending figures in last October's Spending Review (the green line, calculated using last November's inflation figures) with those in yesterday's Budget (the red line, calculated using yesterday's inflation figures):   Hang on. Doesn't that show health spending going down in real terms, after this fiscal year? Well, yeah, kinda. But the IFS was reluctant to describe this as a definite "real terms cut," and for three main reasons.

I am in two minds about Andrew Lansley’s proposed reforms of the National Health Service, the cornerstone of which is the transfer of commissioning responsibility from Primary Care Trusts to GP-consortia. On the one hand, the NHS desperately needs radical reform. On the other hand, I’m not sure these are the right reforms, and I’m not sure they are sufficiently radical to deliver a real difference to patients. Let’s start with why the NHS needs reform. Firstly, it is eye-wateringly expensive at 8.1 percent of 2010 GDP, or £120bn a year. Costs have skyrocketed since 1999, doubling in real terms in the 10 years to 2009. Over that same period, productivity fell. We are spending more and more, and getting less for our money.

Andrew Lansley’s health reforms have never been in the rosiest of health; but, as Pete observed yesterday, the current malaise may leave permanent damage. Paul Waugh has been speaking to Alan Milburn and the modernising former Health Secretary’s words speak volumes about Lansley's trails: "I'm amazed they allowed themselves to get into talk about privatisation and cuts. Having originally said this was a revolution they're now saying it's just evolution of Labour's reforms. Politically, it doesn't make sense. "Look, a managed form of competition is fine. The problem is that the lynchpin of the reforms was GP commissioning. "It's a good idea to get family doctors to be aware of the financial consequences of their decisions. So that's a tick.

And so it came to pass. After sniping at Andrew Lansley's health reforms from the day they were announced — at one point describing them as a “slash and burn approach” — the British Medical Association has today voted to call on the Health Secretary to withdraw his Bill entirely. The speech that the BMA Council Chairman, Hamish Meldrum delivered this morning captures the tenor of their opposition: “…what we have is an often contradictory set of proposals, driven by ideology rather than evidence, enshrined in ill-thought-through legislation and implemented in a rush during a major economic downturn.” So what to make of it all?

An anti-cuts campaign website, False Economy, claims that 50,000 NHS jobs will be lost over the next four years. It’s a bald, headline grabbing figure and the response has been predictably feverish.   But tug a little, and the numbers unravel. One of the key points is made by False Economy themselves: that "most of the cuts are likely to be achieved through natural wastage" – in other words, by people moving on, or retiring, of their own accord. In figures highlighted by the Department of Health, for instance, one foundation trust expects to shed 14 per cent of its workforce through natural wastage by 2013. The health service may choose not to fill the vacancies that result, but this is hardly a wave of mass sackings.