3 min read

Editor's blog Wednesday 25 May 2011: New NHS Confederation report Rowshamboes Andrew Lansley

Poor old Andrew Lansley. He's got a great career behind him as opposition health spokesman.


Click here for details of 'Lansley: the NHS is not a mobile phone; I am not Henry V', via subscription-based Health Policy Intelligence.


After the Conservative Party's 1922 Committee meeting's support last week gave him a short-lived dead cat bounce, the NHS Confederation have today published their submission to the Future Forum listening exercise; a summary version of which is available here.

The Confed's document, The Right Reform For Patients, Rowshamboes Mr Lansley's NHS reform proposals in truly spectacular terms.

Rowshambo explained
Health Policy Insight readers of long-standing will recall that Rowshambo is a game whose rules I have previously explained. (Fans of South Park will need no explanation.)

Rowshambo might be politely explained as a classic game based on the concept of 'first mover advantage': the first player kicks the unsuspecting second player "square in the nuts" as hard as possible; the last player standing loses.

With the greatest of respect, Secretary Of State ...
Very politely, the document starts off by agreeing that reform is needed as pouring ever-more cash into the NHS isn't viable, that the NHS should be more patient-centred, etc. This is the health equivalent of saying "with the greatest of respect ...": the literal translation is probably "your ideas resemble the brown stuff that emerges from the rear of dogs".

The text reads, "we do not believe that reforming the NHS requires us in any way to abandon the notion of a universal health service, available to all irrespective of the ability to pay. These ideas, set out in the NHS Constitution, are integral to how the public feels our health system should function. They should be enshrined in the Bill, which should make clear, for instance, that: 'The Secretary of State for Health is accountable to Parliament, and through Parliament to the voters, for the promotion of a comprehensive health service and for the use of public money'.

"While supporting the need for reform in general, we believe the case for these reforms has yet to be clearly made. Indeed, we are concerned that the current reforms are not sufficiently focused on the big problems the NHS faces ... On their own, the current reforms will not tackle these immediate or long-standing problems. They will not deliver the productivity gains and financial savings needed. And they will not help the system to provide consistent care across the country, or provide better integrated care for individual patients and their families".


Planning blight
Health Policy Insight has been one among a plethora of observers who noted that Mr Lansley's proposed reforms amount not merely to Government getting itself out of the healthcare provision basis wholesale, but also to largely absenting itself from planning.

The example of the proposals for workforce planning, which SHAs currently do, is a classic case where the bits of the Lansley proposals that are unclear are non-existent.

The Confed's document also states, "The Government must therefore consider carefully how the different national and local organisations making up the new system will behave. It must encourage them to pull together to meet the big challenges". It then goes on to list a series of good examples of real issues - every single one of which require planning and collaboration. A competition fundamentalist regulator could veto the lot.

The introduction to the summary version correctly concludes, "the fact that the Government has had to pause its reforms reflects the fact that insufficient attention was given to drawing on the knowledge of the people who work at both the coalface and in the management of the NHS".

Pages 10-15 of the summary document give bullet-point summaries of the recommendations, but the whole thing is worth reading.

If Andrew Lansley's tenure as Secretary Of State For The Time Being (after six years shadowing the job) has taught us anything, it is that plans involving absolute certainty of correctness (and opponents being "completely wrong") should be viewed with the greatest suspicion. Demonising managers is also a fairly dire idea, if you need them to make your new system work. And repeatedly promising 'no more top-down NHS reorganisations' before pulling probably the biggest one ever is manifestly going to leave you a dead politician walking.

Poor old Andrew Lansley. He's got a great career behind him as opposition health spokesman.

He's only got more humiliation ahead.