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Editor's blog Tuesday 8 February 2011: SOS Lansley defends his reforms; we analyse his points

Goodness me. SOS Lansley is defending his reforms in The Guardian.

So,  what does he have to say?

"There is mounting support within the NHS towards the government's plans to modernise the service. The NHS is full of highly skilled, dedicated people. Parts of it provide world-leading levels of care. But too often, the system itself can act as a barrier to the kind of progress that doctors and nurses want for patients.

Assertions: 4. Facts: 0.

"Last week, Denis Campbell said in this paper that few in the medical profession seem convinced of government plans. And yet 141 "shadow" GP consortia, covering 28 million people have already stepped forward to voluntarily wrest responsibility for local health services away from primary care trusts."

Oh Andrew. With PCTs clustering into 50 groups to control the money (regardless that DH couldn't get its own clustering guidance right), the idea that they have "stepped forward to voluntarily wrest responsibility for local health services" from PCTs is just silly. And you're not a silly man, nor a stupid man.

But this effort to put a 'Big Society' spin on things is not going to fly. It has the wings of a brick.

Moreover, it's unwise to confuse pragmatism with enthusiasm.

"With every new day, more of the people who matter – local GPs, hospital doctors, community nurses – are embracing the opportunities presented by our plans. Howard Stoate, GP, former Labour MP and elected chair of Bexley's shadow GP consortia, said recently that, in his experience, GPs "reveal overwhelming enthusiasm for the chance to help shape services for the patients they see daily".

Are you sure about community nurses embracing the plans? DH figures show that the take-up of your continuation of Labor's social enterprises plans is miniscule.

And hospital doctors' enthusiasm?

Howard Stoate did indeed say that: there is a significant minority of enthusiasts for more clinical involvement in commissioning. They'll do good things. But they may well be pretty far ahead of the average.

"Campbell's other claim was that our plans will create a "democratic deficit". He quoted the London Health Emergency campaign, which said that our plans would be a "disaster for local accountability". If our plans were remotely similar to what it claims, it might have a point. But they are not."

Well, eight prominent charities do fear a democratic deficit in your plans, and the DH called their contribution "constructive".

But anyway, you have points to make: as Diaghilev told Jean Cocteau"Etonne-moi!"

"The NHS will be legally obliged to involve patients, the public and local authorities when planning and implementing significant changes to local services."

PCTs already are, under the Section 242 'duty to consult' of the 2003 and 2006 NHS Acts.  In future this duty to consult will only apply to services designated by Monitor. There is no lay or patient representation in consortia, unlike PCTs.

"Foundation trusts will become more accountable to their governors and members. Who are these people? If you want, they can be you.

They already are under the 2003 NHS Act. FT membership levels have not really taken off.

"We will significantly extend local authority powers. For the first time, they will be able to scrutinise any NHS funded services, whoever provides them."

But local authorities will only be able to refer decisions about designated services – a wider scope, but less power.

"We are already working with 25 councils to help them design their new health and wellbeing boards, which will bring unprecedented levels of local democratic accountability to the NHS. By April, we expect to be working with up to half of all local authorities."

Everyone knows that the NHS has a severe democratic deficit, and always has done. A right to scrutiny is not the same as a right to change: consortia will be obliged to have regard to HWBs and health OSCs. That's not strong accountability.

"The new consumer champion, HealthWatch England, part of the Care Quality Commission health regulator, will be able to quickly deal with any concerns about the quality of health and care services."

Mmmm. Perhaps you should spare a moment to look at Rich Watts' recent guest editorial, which points out three key issues with the Bill's proposals over HealthWatch - regarding money, independence and advocacy.

You'll still be appointing the chair (as you do with Monitor and the NHS Commissioning Board).

"But beyond institutional accountability, genuine patient choice will bring a dramatic level of direct accountability to NHS providers."

Genuine patient choice has existed since 2006. The recent Kings Fund's research presents a mixed picture of its impact.

"A range of new quality standards will show just what excellent care for cancer, diabetes and over a hundred other conditions should look like."

Just like National Service Frameworks and networks did?

"We will then publish just how good NHS services really are."

Some disciplines, like cardiac surgery, already do. Others are on the way with the arrival in the 2009-10 Operating Framework of patient-reported outcome measures (PROMs), and have to take clinicians' confidence with them.

"If a hospital is not up to scratch, then patients can vote with their feet and go elsewhere."

And have been able to do since 2006, but as the above Kings Fund research shows, most do not.

"'No decision about me, without me' is not empty rhetoric, it will be the normal experience in a renewed NHS. Where this sort of openness has already happened, its impact has been dramatic – death rates for cardiac surgery have halved in just five years".

Yes. It works, but it took nearly a decade. The Bristol Inquiry was 1999. And crucially, cardiac surgeons drove it themselves. Ask Bruce Keogh.

"As an ex-US supreme court judge once said: "Sunlight is the best disinfectant." We will shine this light more widely and brightly throughout the NHS."

I don't want any ex-US supreme court judges in charge of infection control where I'm treated, thanks: give me bleach every time.

Glasnost is good: we're very pro-open-ness round here, but for the next two financial years of PCT clustering and what NHS Supreme Soviet Chair Sir David Nicholson calls "tight Stalinist controls", it's not what we're likely to have.