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Dismantling Labour’s NHS legacy

As healthcare decisions made by the previous administration are exposed as dangerously flawed, will the new Government take the opportunity to start making the right choices?

We're only two weeks or so into our new coalition Government, and already what remained of Labour's NHS legacy is falling apart. Our previous administration committed huge extra sums of money on the health service, but in return it assumed the right to take sweeping, centrally imposed decisions on its future. Last week, two of those decisions, to roll out polyclinics across London, and to sign long-term, national deals with private firms to take on hospital care in the community, were exposed as deeply, dangerously flawed.

For months, the Department of Health had been under pressure to publish a report by US consultancy McKinsey that formed the basis of NHS London's reckless plans to shift more than half of outpatient and A&E appointments to GPs. But when the political parties clashed over the issue during the election, nobody could have guessed it would not be this McKinsey report that would prove dynamite on publication, but a follow-up given secretly to NHS managers, evaluating progress in implementing the recommendations.

If new health secretary Andrew Lansley hadn't already decided to call an immediate halt to reconfigurations, he certainly would have done after reading NHS London's extraordinary mea culpa. Its Healthcare for London efficiency plans, driven by former minister Lord Darzi and so influential across the UK, have cost more than they have saved, and fallen far short of their stated ambitions for driving down hospital activity.

The coalition Government has promised to evaluate evidence and consult with GPs before allowing any further reorganisation of services. It's an immensely sensible decision, but not one that will suddenly remove the financial pressures to reduce hospital activity by shifting work into the community. That places the future of a second Government initiative – the rollout of independent sector treatment centres (ISTCs) and related out-of-hospital services – in the spotlight, as it too is battered by evidence of serious failings. The DH signed a series of deals with private firms lasting up to seven years, to provide secondary care services in the community. Yet Pulse reveals that an NHS investigation into the death of a patient at one such service has identified 24 separate failings in its operation. The service has been suspended, but such is the inflexibility of the DH contract that managers may not be able to cancel it.

It some ways it was an easy call for Mr Lansley to end the polyclinic rollout, since his Government has set itself from the start against its predecessor's centralised approach to public services. But the ISTC debacle presents a far trickier ideological challenge. The Conservatives in particular are passionately committed to a plurality of providers and an open NHS market – and have encouraged companies to believe they will play a growing, not a shrinking, role in the health service. But ministers must appreciate that to drive private-sector involvement from the centre, and sign up firms for years to come, serves only to close down the market and shut off competition. It must be another of the last Government's legacies to be consigned to history.

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