Monday, 17 January 2011

Breakneck health reform: the dangers


Not the least of breakneck government's risks is that is exposes politicians, civil servants and (more importantly) the public to the high risk of policy failure. The Coalition is proceeding extremely fast on all fronts - schools reform, a new funding structure for Higher Education, very rapid deficit reduction, a programme of fundamental constitutional reforms - and some eggs are going to get broken.

The most unfortunate area of over-hasty action is in the National Health Service. Having promised little institutional innovation in either governing party's manifesto, the Government is now running pell-mell at the most far-reaching set of changes since the NHS was set up in 1947. General Practitioners will now commission most services. Pilot schemes? Market testing? Consultation? A Royal Commission? All a load of fuddy-duddy nonsense, according to Ministers. Let's let it rip!

The Prime Minister did his best to defend all this on Radio 4's Today programme this morning, but I'm not sure that he even sounded like he was convincing himself. Very fast reform? No, said David Cameron, it'll take two or three years - a blink of an eye in public policy terms. Untested change? No, apparently it's building on some of New Labour's innovations - despite abolishing the Primary Care Trusts that had at last seemed as if they were getting a grip after many years of Ministerial tinkering.

In fact, he is concerned behind the scenes - enough to make sure that the Tory and Lib Dem 'troubleshooters', Oliver Letwin and Danny Alexander, have been put in charge of making sure there's no disaster as the new regime comes into effect.

Is the idea seem as troublesome more widely? You bet. And the person it's most dangerous for is David Cameron himself. If there's a winter beds crisis, or a region or city where the GP commissioning regime collapses, or local hospitals shut (remember that Conservatives pledged to defend them), or specialisms that get hammered (speech and language therapy looks vulnerable) last year's student riots will look like a tea party. You can charge at students on Police horses... Just try it at patients or disabled people.

For the historian, this is all just so, so depressing. We've been here so many times. First it was the 'planning' regime of 1961. Then it was the three-layered mess proposed in 1968 and the dog's dinner of the 1973-74 reorganisation. Then that was unscrambled in the 'Grey Book' of the late 'seventies. Then we had GP Commissioning and the 'internal market'; then that was all taken apart again in 1997-98. And you know what? It costs tens of millions of pounds and leaves everyone confused and exhausted.

It's a cloud no bigger than a man's hand on the horizon right now. But it'll grow. Watch this space.

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