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Editor's blog Sunday 15 May 2011: Cameron's comic Monday speech looks beautifully confused

Goodness me. This speech that PM David Cameron is to give tomorrow morning at a hospital in West London looks amusing. If the Telegraph's briefing is right, which I think we can assume it is.


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So, then.

What is That Nice Mr Cameron's argument?

He is going to outline the "real problems" in the NHS. Good stuff. So he will talk about shutting hospitals; about wasteful over-treatment at the end of life; about the failure to ensure that NHS treatments are manifestly cost-effective as well as clinically effective?


The latest round of havering about over Chase Farm simply highlights the tragic ongoing political dishonesty over what is a sustainable hospital estate. Mr Cameron's chosen liberator of the NHS Andrew Lansley and his colleagues promised while in opposition to stop Labour NHS closures.

Meanwhile, on wasteful end of life over-treatment and cost-effectiveness, the ridiculous National Cancer Drugs Fund offers the perfect example of how to waste over half a billion pounds over three years. It is even more ridiculous when considered in tandem with the Coalition pitch to move to value-based pricing of pharmaceuticals, when the only NHS scheme to attempt this at scale was evaluated by the BMJ as "a costly failure".

Mr Cameron's case for change apparently involves a "vast mailbag" (stop sniggering at the back). It's fascinating that the authors of this "vast mailbag" have been pretty much silent as the Lansley reform plans have unfolded.

But Mr Cameron's speech keeps on giving, since he is reportedly going to tell us a love story, rather like his pitiful 'we love the NHS' pamphlet.

He will apparently say “It is because I love the NHS so much that I want to change it, because the fact is the NHS needs to change … It needs to change to avoid a crisis tomorrow ... The NHS is the most important thing to Britain’s families. It’s the most important thing to my family too. We save the NHS by changing it. We risk its long-term future by resisting change now".

OK, let's go through this slowly.

Is 'I love the NHS' supposed to reassure anyone? I mean, I love beer - but because I haven't got the capital, premises or knowledge of brewing, I'd be a pretty useless brewer; and strangely enough, I therefore don't try.

Sorry to go dissing Lennon and McCartney, but when it comes to really reforming the NHS, love is not all you need.

For real NHS reform, you need understanding; the ability to genuinely listen; political acumen; an understanding of how to make a highly educated and trained workforce do things that will be uncomfortable and inconvenient; a respect for the evidence base; an understanding of health economics, programme budgeting, marginal analysis; an acceptance of rationing as a fact of life; an ability to communicate why your reforms are vital; the willingness and ability to engage with and debate your critics; and a knowledge of where the bodies are buried.

Oh, and you also need some more political acumen.

As for the NHS needing to change tomorrow, The Bosanquet Hypothesis that the NHS is going to run out of cash isn't scheduled to kick in until 1 November. (Though as we will reveal this week in our interview, Nick now thinks there may be enough top-slices to postpone the real crisis to 1 November 2012.)

The NHS is the most important thing to British families? Doubtful. If you're heavily reliant on the NHS, then it's hugely important - whether you're a family or an orphan or singleton. (This bit also smacks of the Blairite / Brownite rhetoric about "hardworking families" - which as a man who aspires towards laziness, I always felt awfully disenfranchising). I'd argue that the rate of VAT and economic policy in general is probably more important to British families (and indeed orphans and singletons) than the NHS - unless you work in or supplying the NHS.

The NHS is the most important thing to Mr Cameron's family? Perhaps it is: it seems beyond question that his personal family experience of the NHS care for his late son Ivan has left an indelible legacy on Mr Cameron.

The rhetorical flourish that "we save the NHS by changing it. We risk its long-term future by resisting change now" betrays a Pollyanna-meets-Micawber optimism that the reforms will work. As NHS Supreme Soviet chair Comrade Sir David Nicholson has said, this is a change so big you could see it from space - and most major change programmes fail. Its pay-off live echoes the TINA (There Is No Alternative) rhetoric used in the Coalition Agreement.

Yes, the same Coalition Agreement which promised no top-down NHS reorganisation.

The leaks are positively flooding in now, with The Guardianrevealing the line, "Last year, the health select committee said 'primary care trust commissioning is widely regarded as the weakest link in the English NHS', citing their 'lack of clinical knowledge' in particular. This is what top-down control is doing to our NHS – and I believe it should change. Then there's the inflexibility of the NHS – and this is what frustrates so many patients, and indeed nurses and doctors".

It's not clear how (or indeed that) top-down control caused PCTs to lack clinical knowledge, but there you go. It's also mildly ironic that top-down reorganisation is abolishing top-down PCTs ...

It gets better: the Prime Minister who is set to liberate consortia to retain surpluses for local service reinvestment is set to criticise the postcode lottery: “Too much comes down to luck and where people live… I don’t think people should have to put up with this unfairness”.

Reading this, you have to wonder if Mr Cameron has read the White Paper or the Bill. Even the executive summary would make it reasonably clear that the direction of travel will permit a broader spread of performance.

You see, the job of abolition-facing PCTs (see The Independent point above) and SHAs was in part to hold the ring between better-performing health economies and worse ones. They did it imperfectly, but that was part of their job. The Bill proposes that choice and competition will do the heavy lifting here. It's world-class optimism.

He also seems to be going on the 7,000 lives saved number from the crappy little pamphlet, which will cause a wry smile to play around Ben Goldacre's features.

The speech looks likely to be ... interesting.

And possibly funny.