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Editor's blog Thursday 31 March 2011: How many wheels are left on the NHS reform waggon?

Click here for details of 'Andrew Lansley's Millwall Tendency', via subscription-based Health Policy Intelligence.


A friend pointed me to this song by the New Christy Minstrels, 'Three Wheels On My Waggon'. It's co-written by Burt Bacharach, whom we could forgive almost anything - except maybe a collaboration with Ronan Keating. Oh ...

This friend suggested that the song offers a lovely metaphor for the current state of Our Saviour And Liberator Andrew Lansley's Health And Social Care Bill.

The Millwall Bill ends its Commons committee stage today, and thanks to Labour's health team, we got a mention this morning, for our exclusive on the DH cutting funding for the British Social Attitudes survey's health and NHS questions.

Health Minister Paul 'Who?' Burstow didn't know about the BSA survey funding having been cut - or 'saved', if you prefer. He also said that Health Policy Insight is not his preferred bedtime reading.

Obviously I'm wounded by that, but I should just about make it through if I dig deep.

NatCen response on BSA survey cut
We did get a response from the National Centre for Social Research on the funding cut, which is as follows: "We can confirm that DH has cut funding for BSA this year but no decision has been made about whether or not they might fund questions on future years of the survey.

"We are very grateful to DH for the support they have given to BSA over the years. It is widely recognised that the survey has provided an important means of tracking public attitudes to health provision for nearly 30 years, and we were clearly disappointed when DH decided not to continue its funding in 2011. So we are delighted that the Kings Fund has decided to fund questions about the NHS this year, although this will still mean some valuable questions won't be able to be included.

"NatCen recognises that DH, like all spending departments, has some very difficult decisions to make about funding for social research given cuts to public expenditure. However, as the leading independent provider of social research in the UK, we're concerned that individual departmental decisions protect the evidence base as far as possible. A co-ordinated response across departments is critical.".

So that leaves our chums the Kings Fund looking very good ... and the dear old DH looking like an organisation that knows the price of research, but not its value, Which might explain the DH's extraordinary behaviour and process around the set-up of the CHSEO under their ex-chief economist Professor Barry McCormick.

Of which more soon.

Ground Control to Andrew Lansley
Meanwhile, credit to the NHS Confederation for once again attempting to get through to Our Saviour And Liberator the urgent need for major reforms.

Everything they have put down is sensible, sane stuff. They have to keep trying (and trying is exactly what it must be).

And unfortunately, they have probably wasted their time slightly. Since the theory is firmly entrenched in Number 10 and on Planet Lansley that the Bill's issues are essentially presentational.

Which they are not. From details small (such as getting the date of abolishing the National Patient Safety Agency wrong) to much larger ones, the Bill is not in good shape.

Analysis by Dave West and Simon Lewis for Health Service Journal shows that consortia appear to be selecting out challenged practices. It should scarcely seem surprising that people respond to incentives.

In HSJ, Dame Barbara Hakin offers a spirited  attack on commentators and critics, but alas her Indiana Jones Defence ("trust me") may not win the day. The issue is not whether people drafting the Bill are working hard; it is whether they are getting it right.

A new peak of surrealism is reached in the Telegraph, as Robert Winnett reports that Health Secretary Andrew Lansley has written to Labour leader Ed Miliband, criticising what Labour would have done if it were still in government.

Yes, you read that right. The Secretary Of State For Health has nothing better to do than write to the leader of the opposition, hypothesising what Labour would have done if it had won the last election under a different leader - which is not necessarily what it said it would do.

No, me neither. It's like 'Second Life' politics.

(The letter was co-signed by health minister Paul 'Who?' Burstow, and yes, I think I can feel Ed Miliband's pain.)

Friendly fire
The article  suggests, as The Times leader did yesterday, that the reforms could and should be abandoned.

It is worth considering that a Conservative Health Secretary is getting messages from both The Times and Telegraph that his plans are wrong. These papers are the Conservative Party's cheerleaders.

Mr Lansley is a man of great conviction that he is right, and that his plans are right. He is equally convinced that his opponents are "absolutely wrong".

It makes one wonder why more of us simply haven't got it.

'No turning back'
There is of course a slight problem with going back on the reforms. PCTs and SHAs have already been decimated of staff who have seen the writing on the wall and been able to go elsewhere.

There is also a deep reservoir of anger among those who have kept the show on the road; at ministers' and Coalition MPs' anti-management 'wasteful bureaucracy' rhetoric among these people. Not only do they want to see ministers who have pedalled this line eat their words, they would not be averse to watching them choke on them.

Were it not for the loyalty to their teams and organisations on the part of these managers - who have had no thanks, been trashed and promised likely redundancy by ministers - the situation would already be far worse.

Many are in their 50s, with decent pension pots, and substantial equity in their homes. Several who have spoken to me would not take another job in the NHS under any circumstances. And quite a few of these people do understand commissioning and demand management.

So. How many waggon wheels do you think Andrew Lansley has got left?