19 Jan 2011

NHS reform will not lead to ‘two tier’ system, vows Lansley

Health Secretary Andrew Lansley tells Jon Snow that the NHS reforms will not lead to services in some areas being better than others, but instead improve services and accountability nationally.

The Health Secretary came on Channel 4 News to explain the Government’s thinking behind the reform of the NHS, which has been described as the biggest change to the system since its inception in 1948.

Doctors and MPs have raised concerns over the speed and scope of the reforms, particularly as some of the key detail was not set out in either the Conservative or Liberal Democrat manifestos – such as the abolition of Primary Care Trusts.

But Andrew Lansley told Jon Snow that the plan had always been to “devolve decision making to the front line”.

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Devolved decisions

He said: “Both our manifestos, the Conservative and Liberal Democrat manifestos, were absolutely clear that we were in favour of devolving decision making to the front line, both in favour of cutting out unnecessary admin and reducing bureaucratic costs, and very clear that we were going to give responsibility for designing services, for commissioning and purchasing services on behalf of patients, to groups of local clinicians led by GPs.

The job of Government is not only to support the NHS and also to be very clear about what the NHS should be achieving in terms of outcomes as good as any in the world. Health Secretary Andrew Lansley

He admitted that the pace of change had gone rather faster than some expected. There are rumours in Westminster that even the Prime Minister was somewhat taken aback by the scale and timing of the plans.

Mr Lansley said: “We thought we were going to do this in the context of Primary Care Trusts, at least for a while, but when we worked on it with our Liberal Democrat colleagues, it was very clear – and it strengthened our proposition – it was very clear we needed to have greater democratic legitimacy. That all of us, as members of the public, should feel that through our council there is a sense that it is directly involved in delivering better local health.

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“It is already responsible for social care, and it should have a democratic role in, say, how local health services are provided.”

Health Secretary Andrew Lansley on the NHS reforms (Reuters)

No two tier system

When Jon Snow raised the risk that such localised, devolved plans could lead to a “postcode lottery”, where services in some areas are worse than other areas or even not available, Mr Lansley responded: “Absolutely not.”

“It is a national health service and will be nationally funded, and need to meet national objectives in terms of outcomes we achieve and national standards,” he said.

“There will be a health service commissioning board so yes, it will be at arm’s length from politicians, and I actually don’t think – and we’ve been clear for years – that the job of Government is not only to support the NHS and also to be very clear about what the NHS should be achieving in terms of outcomes as good as any in the world.”

It is a national health service and will be nationally funded. Health Secretary Andrew Lansley

He said that the “NHS atlas of variation“, which was published for the first time before Christmas, sets out how there is a wide variation between services in different areas in the NHS at the moment – something the new system will improve, he said.

“It’s not going to get worse, on the contrary,” he said.

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“Quality standards, which is one of the things that I’ve now started to publish, these are things which are starting to be very clear about where we can drive up standards.”

Greater safeguards

Concerns that some areas will not provide services if they are not money-making are unfounded, Mr Lansley said.

“The GP-led commissioning consortia and local authorities can be very clear about services that have to be maintained,” he said.

“Legislation will actually give greater safeguards. At the moment, go across the country, go to Queen Mary Sidcup, there are people there that are very worried about the services that just got shut down. And from their point of view, and people across the country, people want to see – and in our legislation it will be there – their ability to see what services will be maintained.”