Lansley needs a better grasp of both 'apology' and 'reform'

Lansley needs a better grasp of both 'apology' and 'reform'

Despite substantial, detailed criticism and concern from the medical profession, health planners and the public over his Health & Social Care Bill, Secretary of State Andrew Lansley has shown few signs so far that a genuine rethink will emerge from the government's "listening exercise".

Following the massive vote of no-confidence from the Royal College of Nursing (not a body noted for its radicalism or rashness) on 13 April 2011, Mr Lansley has been reported as having made a presentational apology.

What he actually said was, "I'm sorry if what I'm setting out to do hasn't communicated itself" (emphasis added).

In other words, in his primary statement in response to a series of powerful messages from the RCN (and many others) he 'apologised' that his message was not, well... self-communicating. This will strike many as a curious form of contrition. Indeed, delegates at the nursing conference said that, frankly, Mr Lansley didn't look too bothered at what was, to all intents and purposes, a public humiliation. Over time, most governments become intellectually and emotionally isolated and arrogant. This one seems to be moving apace on that front, sadly.

We need to be clear. Doctors, nurses and other health professionals are not opposing change or modernisation. The issue is: change of what, by whom, by what means, and in whose interests?

The principles of improving services for patients and empowering staff are ones the British Medical Association (BMA), the RCN and others agree on. Similarly, the notion that clinicians might have a central role in delivering services - which the government says is at the heart of its reforms - has a good deal of support, albeit with serious questions about the commissioning process and the need to ensure evenness of provision across different localities and sectors.

But a clinician-focused approach would be possible without the central features of the current Bill - which are about something quite different. They involve a statutory duty to promote competition in the NHS (with the accompanying risk of fragmentation of care); forcing NHS Trusts to become Foundation Trusts (about which the Nuffield report has raised major issues); the abolition of "certain public bodies"; a particular model for the delivery of education and training, and other features which - while not amounting to privatisation of the health service per se - point inexorably down that road, some critics suggest.

The RCN and others are also publishing evidence that front-line services are being directly impacted by the current policy drift. Information from 21 NHS trusts in England shows that 54 per cent of nearly 10,000 posts due to be cut are key clinical posts. The RCN also found that nursing posts account for 46 per cent of identified workforce cuts. These and other findings put further pressure on the government to say how patient services will be protected, as trusts in England alone are required save £20 billion by 2015.

Moreover, this Health and Social Care Bill is one of the largest ever bills to be introduced in parliament. The idea that it can be tweaked in a couple of months while those with detailed concerns are patronisingly told that the message has obviously "not communicated itself" to them (that is, that their objections are based on ignorance) simply will not do.

"We believe the Bill as it is currently written is taking the NHS in England in the wrong direction," said BMA Chair of Council Dr Hamish Meldrum last week. The RCN has said something similar. Health Service Journal contributors, too. The list goes on and on.

Yet Mr Lansley seems not to have fully grasped the concept of 'apology'. What he and his government must have pressed upon them is a semantic realisation over an equally (perhaps, in this context, more) important word: 'reform'. These 'reforms' need to be reformed - radically. Or the consequences for the health of the nation (all of it, not just those who can afford or access it most readily) will be imperiled.

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(c) Simon Barrow is co-director of Ekklesia.

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