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Editorial | NHS overhaul: hospital pass

The bill’s very aims have changed and if the best-laid schemes go astray, plans made up on the hoof are almost certain to

Some reforms cause fury before they happen, and yet once they do nobody can recall why. So clear your own feelings about the NHS reforms out of your mind, and consider what would have to happen for them to be judged a success. That, after all, is the test that a self-interested government ought to apply.

The first obstacle in the way of success is the trusted professionals. The qualified resistance of some medical bodies won them admission to Downing Street while outright refusniks were kept outside, but we are talking shades of hostility. Rarely have medics been so united on a political question. The sole comforting thought is that professional opinion has been overcome before: medics have often opposed past reforms, including (on some accounts) the NHS’s creation.

It would take a braver politician to disregard the public hostility revealed by the new Guardian/ICM poll. Nobody enjoys being wrong, and the majority of voters who want the bill dropped will take a lot of persuading that things have improved if the legislation goes through. The toughest – and surely insurmountable – challenge is winning them round in the face of a spending squeeze that is unprecedented in the history of the NHS or any comparable service in the world. In place of the 3% annual growth which the NHS got during the crisis-prone Thatcher and Major years, a real-terms freeze will stretch deep into future. Making this feel anything other than brutal would require not merely decent reforms, but utterly transformative ones.

The sort of worthwhile efficiencies that an LSE study said competition within the public sector might achieve would be nothing like enough – and even these gains are unlikely to be had. For one thing, the same study found less benign results from private competition, which the bill would foster. And if the best-laid schemes often go astray, plans made up on the hoof are almost certain to. The bill’s very aims have changed, as its details have been rewritten. After 1,000-plus Commons amendments, ministers recently tabled over 100 more in the Lords. Crucial clauses on competition could be rewritten again. Parts of the final draft will not have been scrutinised properly, and that all but guarantees hiccups.

Last week the PM’s visit to a Newcastle hospital was reportedly tangled up in restrictions, affecting both reporters and dissident staff. This week he held an NHS summit that shut out professionals who beg to differ too much. Some Tories are now joining calls to publish the official “risk register” detailing what could go wrong, but ministers continue to sit on this. Even before Andrew Lansley was heckled on Monday, the case for backing off should have been perfectly audible. Sadly, the prime minister is closing his ears. © 2012 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds