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Editor's blog Tuesday 10 May 2011: Schrödinger's Bill

I have used this analogy before, but more than ever before, the Health Bill reminds me of Schrödinger's Cat: it is potentially both alive and dead at the same time, depending wholly on random events, until the box is opened. (The box, we must presume, is on loan from Pandora.)

NHS reform may not be rocket science, but this attempt at it is definitely quantum physics.


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The book of the dead
When the Financial Times leader comes out and says that it is time to simply stop the Bill and accept re-inventing the old system rather than pass a bastardised compromise, the game is much nearer to its end than its beginning.

Steve Richards in The Independentsees the taxi for Mr Lansley as puttering around The Mall. He correctly states that "as long as the NHS is financed centrally and free at the point of use, the Government cannot step back and allow a free-for-all, administered by quangos".

Contrastingly, Guardian deputy editor and political sage nonpareil Michael White thinks Liberatin' Lansley may bow to the changes to his Bill and thus keep his Cabinet seat - for now.

The zombie Bill
Elsewhere, the resurrectionists seek to find what compromises might be made to disguise the health status of this Norwegian Blue of politics and policy.

The Independent's Whitehall editor Oliver Wright has an authentic-looking summary of current negotiations, which emphasise Lansley's resistance to puttling hospital clinicians onto consortia boards. Wright's sources also repeat the line that Jeremy 'Spoonerism' Hunt is under active consideration if the Liberator defenestrates himself in discontent.

Wright also sees the rhetoric about competition being scaled back, and the timescales lengthened. He suggests that consortia commissioning may not be mandatory for all GPs. This causes big problems.

What shadow health secretary John Healey yesterday termed "pre-legislation implementation" is well under way. Much-castigated "bureaucrats" have packed their bags and cleared their desks.

In many areas, the PCTs who used to ration the money (with varying but growing effectiveness, as HSJ analysis last August showed) are already functionally dead. The PCT clusters working at levels of abstraction from the front line that would severely disadvantage areas where GPs did not want to get involved.

There could also be legislative challenges as many as the day is long to the legal status of a two-tier NHS that having two differently-scaled and funded commissioning breeds in the English NHS.

The mess is not getting any less messy. You can say a lot of things about the Health And Social Care Bill, but it does not seem to be 'wanted, dead or alive'.