NHS Reforms - Legitimate and Illegitimate Concerns

I left this comment on a Conservativehome article yesterday about Andrew Lansley. They are essentially my views on which concerns about the NHS reforms are legitimate and need to be addressed in the listening exercise, and which aren't:

Being immersed in the NHS I can say that there are a range of views/ groups on this issue in the NHS community:

1. Totally against it without looking at it or have political motivations not to engage. There will always be people like this, and we have to just accept that and carry on.

2. Are worried about "privatisation". This is unfounded.

3. Agree in principle with clinician led commissioning, but believe it should not just be GPs. This is a legitimate point of view (and in Health Select Committee recommendations). The best commissioning to date is in clinical networks and they have multi-professional clinical engagement and also public health.

4. Agree in principle with competition and some private sector involvement but concerned about cherry picking by private sector and training. These points were made by Norman Tebbitt and this is a very legitimate point.

5. Agree in principle with more responsibility for GPs in commissioning but concerned about issues of accountability and conflicts of interest. The plans produced out so far have not really reassured this group who again have a legitimate point. This is a large amount of public money and how it is spent is subject to scrutiny, transparency and have accountabilities appropriate to the clinical and financial risk involved. There must be clear rules here.

6. There are also those who work in the NHS who feel that they are under attack for no good reason. There are some good hard working managers who are regularly insulted in the House of Commons, as "pen pushers, bureaucrats", and accused of awarding themselves all sorts of things (which they can't). This does not exactly inspire them with gratitude. There are hard working clinicians who have produced the rapidest falliing heart attack rate in the western world only to be told their heart attack outcomes are shocking and that they haven't done well enough. This has upset a lot of doctors and nurses.

The point is that reform is needed, and there are different groups out there who aren't completely happy with the plans - some just need to feel valued, listened to, and engaged with. Some are just trying to improve on the detail of the plans. Some (but only a minority) are out to cause trouble.

What DC and AL need to do is engage with those who want these reforms to work well. That includes dealing with the details in points 3, 4, 5 and 6. That has been the main problem, and it is that that needs to be addressed, by AL, DC, the DoH and others.