14 Jun 2011

The three amigos sell NHS reforms

This is the view from the 29th floor of Guy’s Hospital where the 3 amigos are at it again – selling the NHS reforms.

Has the NHS revolution really been scrapped? Changing the description of the duties and responsibilities of the Health Secretary doesn’t make a whole load of difference if the levers for action have all been devolved elsewhere … It could be argued it’s a bit like saying the Scottish Secretary remains responsible for Scotland when many powers have moved to Holyrood.

In Whitehall negotiations this concession, I am told, was known as “one for Shirley”, as Shirley Williams had made it a particular cause of her own. It did not, I am told, give backers of reform many sleepless nights to change it.

Changing the terms for Monitor, the NHS regulator, is an interesting one too. I just asked a very seniorĀ  member of the NHS Future Forum what was the difference is between an economic regulator and a sector regulator. “There’s no difference,” he said. If Monitor is no longer about “promoting” competition, what is its role on competition I asked. “Enabling” competition, came the answer. These are “totemic” changes, he said. You don’t need a regulator to “promote competition” if you’ve created the space for competition. It’ll just come, like breathing.

My source said the Forum frequently felt it was trying to put the original plans into politically acceptable language, not make radical change to the original Lansley reforms.

All this could be wishful thinking by supporters of the original reforms but I pass it on.

Nick Clegg just took issue with all of this with his answer to me in the press conference, insisting that there is “the world of difference” between a sector and an economic regulator and that there was a wealth of “mind-numbing” legal advice to support that view.

Andrew Lansley has just taken issue with the Monitor “no real change” point. He said the introduction of “any qualified provider” bidding would now be phased in and there would be restrictions on the break-up of integrated services and the handing over of NHS assets to private providers.


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