Nhs

What is going on with the government’s health reforms is highly unusual. Normally, once a bill has gone through second reading and committee stage in the Commons there are very few changes made to it. But the coalition is considering some fairly significant changes to the Health and Social Care Bill in a bid to make it more politically palatable. It is hardly a model of good government.   This state of affairs provides ample opportunity for Ed Miliband to land some blows on the coalition, as he did in this morning’s speech delivered — symbolically — at the RSA, the new home of Blair’s former policy chief Matthew Taylor.

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

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.

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.

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,

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

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? Normally, another “union opposes coalition”

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

Last week, Reform published its 2011 public service reform scorecard. It judged each major government department against the three criteria set out by David Cameron: accountability, flexibility and value for money. The report finds the Home Office’s policing reforms succeeding on all three fronts, but inconsistency across other government departments. The Government’s health reforms are awarded grade D overall, with an E for accountability, a D for flexibility and a D for value for money. Here’s how the coalition can get its NHS reforms back on track.   The government has recognised the need for fundamental reform of the NHS. The proposals announced in the July 2010 White Paper are

Last November, Margaret Forrester, a mental health worker for the Central North West London Mental Health Trust in Camden was suspended for giving a colleague a charity booklet called “Forsaken – Women From Taunton Talk About Abortion” to a colleague –  they’d been discussing the information they offered to patients. It had the stories of five women who had experienced what the author describes as ‘post-abortion syndrome’, including depression, relationship issues, suicidal feelings and fertility problems. So, the downside of abortion, then. To begin with – no problem. Her colleague didn’t seem offended. But a few days later her manager told her she was being sent home on ‘special leave

It is imperative that the coalition keeps its nerves and its composure during the months ahead. 2011 will try the coalition’s fortitude, its deficit reduction plan and its public service reform programme will both come under sustained attack. It is vital that the coalition continues to explain clearly and patiently why it is doing what it is doing. Watching the Andrew Marr show this morning, I was struck by how tetchy Andrew Lansley was during his interview. Right from the off, he seemed irritated at Marr’s questions. Some of this irritation was understandable. Lansley’s reforms are always treated as if they have come out of the blue, when Lansley talked extensively

A consensus has formed in the commentariat that besides George Osborne’s stewardship of the economy, Andrew Lansley’s healthcare reforms could become the government’s vote-loser. The political facts are as simple as the forms are complex. One, David Cameron ran a campaign based on a promise to protect the NHS. Many people thought that meant from cuts and culls alike. The Health Secretary’s reforms look, whatever the truth may be, like they are going back on the PM’s promise. Second, the reforms can only be successful if a range of stakeholders – voters, practitioners, analysts – have been brought along, and had a chance to debate the issues. What Michael Gove