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Make no mistake: if essence of reforms goes, Lansley will too

By Richard Hoey

MPs set out an alternative vision for reforming the NHS this week. It's one the health secretary will reject if he can, but the decision may be taken out of his hands, says Pulse editor Richard Hoey

Health secretary Andrew Lansley will have had better weeks.

He was forced to launch a listening exercise on Monday as the Commons health committee's report into his NHS reforms called for ‘significant changes' to the planned legislation.

The committee is led by former Conservative health secretary Stephen Dorrell, but this was no spot of friendly advice from one senior Tory politician to another.

MPs weren't recommending Mr Lansley modify, revise or even rethink his reforms. They were suggesting, whether they care to admit it or not, that he should screw up his blueprint for the NHS into a ball, chuck it in the bin, and come up with something entirely fresh.

Consider their recommendations just for a moment. GPs shouldn't be in charge of commissioning – they should be just one group of many represented on new NHS commissioning authorities.

Diluting the GP role removes many of the concerns over conflict of interest, so the new authorities are able to take on commissioning of general practice, and most other areas of care that had been denied to consortia.

PCTs are too risky to scrap entirely, so they stay on in the form of clusters beyond the 2013 deadline. But NHS commissioning authorities have patient and elected representatives, so there's no need for those complex health and wellbeing boards, which join GP consortia on the scrapheap.

And then of course there's any willing provider. MPs aren't against it in principle, which is hardly surprising given it's been the policy of all three main parties for most of the last few years, but they are suggesting significant constraints in how it is used.

There should be no assumption, under European competition law, that it is applied to the majority of healthcare services, but instead the commissioning authorities should decide whether and when to employ it, as an alternative to tendering.

So then, exactly what do you have remaining of the original Lansley concept? Clinicians still having a stronger role in commissioning? Well, perhaps, but while that was a key part of the health secretary's sales pitch, his plans absolutely required those clinicians to be GPs, rather than anyone else.

The reason is that they were all about aligning ‘clinical and financial responsibility', as the jargon goes, by making the people with greatest power to affect the demands placed on hospital services also in charge of the budget to pay for it.

Those people are GPs, not consultants, or nurses or representatives of social care, many of whom are recipients of referrals from GPs, rather than referrers themselves.

Without that key element of GP commissioning, the reforms lose their central attraction to Mr Lansley, which was the ability to control costs by placing finance at the centre of GPs' referral decisions.

So where does that leave the chances, when the Government ‘addresses the concerns' over its plans, of it adopting MPs' recommendations? Dead in the water? Certainly one of Mr Lansley's advisers was adamant last week that there would be no such dramatic changes to the bill.

So too was a leading GP with close connections to the health secretary who I talked to recently. I simply got no sense that Mr Lansley had any intention of abandoning the core essence of his reforms.

But of course, he may not get to be the one who decides. I'm hearing tentative rumours, no more than that at this stage, that Mr Lansley could be shifted to another department once the current row over the NHS is out of the way.

With Mr Lansley in place, it is hard to see the current listening exercise amounting to much more than a PR exercise.

But if Mr Lansley did lose his job as health secretary, the reforms that have been so closely associated with him right from the outset really could be scrumpled up and thrown out too.

Richard Hoey, Pulse editor