An informed view on health reform (a comment on a comment)

Guardian Cif posted a fascinating comment piece the other day under the title To avoid NHS privatisation, Lansley must change course. The author is clearly well-informed and provides a thoughtfully balanced assessment of the need for change. She demonstrates a sound grasp of the risks associated with a rushed or botched approach to reform. The piece argues that unless the Government is very careful there is a risk that people’s genuine concerns about Andrew Lansley’s fundamental reorganisation of the NHS – that it is in fact an attempt to privatise the system – will turn out to be well-founded.

So who is this commentator providing us with such insight? Step forward Dr Sarah Woollaston, Conservative MP for Totnes.

I found it hard to disagree with much of what Dr Woollaston writes. I feel that should make me a bit uncomfortable. Or perhaps Dr Woollaston is in the wrong party.

The only point on which I disagreed with the piece absolutely and fundamentally was its premise. The piece assumes that Andrew Lansley wishes to avoid the risk of privatising the NHS, and hence needs to take steps to avoid doing so inadvertently. My starting point would be entirely the opposite.

As we all no doubt recall, this reorganisation directly contradicts assurances made by David Cameron before the election that there would be no top-down change to the NHS, and is therefore entirely without mandate.  At a time of fiscal constraint it is acknowledged that the changes are going to cost billions to implement. Cuts elsewhere will have to be correspondingly more severe. That the reforms will deliver a more efficient structure post-reorganisation is a matter of faith rather than evidence. There is almost no informed commentator in favour of the Lansley proposals. And some of those one might expect to be highly diplomatic and circumspect in their criticism have been out-spoken in opposition. Clearly, members of Mr Lansley’s own party are not entirely convinced. The only person who seems to think this is a good idea is Lansley himself.

All the circumstantial evidence points in the direction of a policy that is primarily driven by ideology and a desire to parcel up bundles of public-sector NHS activity in order to pass them to the private sector. In that respect it is of a piece with rushed restructuring elsewhere in the public sector. If it walks like a duck and quacks like a duck …

If these reforms play out as the critics anticipate, and I fear they will, they could turn out to be extremely politically costly for the Conservatives. That it will be politically costly for the Liberal Democrats is self-evident. But they’re in such a jam already I’m not sure that NHS privatisation will make things appreciably worse. And that is to say nothing of the likely negative impacts upon the British health care system itself. This is a crucial time for one of Britain’s best loved, and internationally respected, institutions.

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