Annabel Ferriman: What a way to decide the future of the NHS

Annabel FerrimanSuddenly Health Secretary Andrew Lansley’s proposals to “reform” the NHS look safe. For more than nine months, since the publication of Liberating the NHS last July, doctors, nurses, think tanks, and academics have been begging Lansley to re-think his ideas. By the start of the “pause” in April, it looked as though the government would take some of these criticisms on board and make concessions.

Now that looks unlikely.  This week saw the return of tribalism in politics.  Lansley got a rapturous response from the 1922 Tory backbench committee on Wednesday night.  All the MPs banged their desks to show their support, cheered him to the rafters and lauded his reforms as the saving of the NHS.  Why? Had they been scrutinising new research about the effect of GP commissioning on health outcomes or the financial implications of all trusts getting foundation status?  No, of course not.  They loved him because he was one of them and not one of the “yellow bastards” (the Lib Dems), whom they are saddled with in coalition government.

Ever since the Lib Dem leader Nick Clegg said that the Health Bill had to be modified, support for Lansley has been growing. The Tories are no more convinced now that the reforms will work than they were before the AV referendum and the local council elections on 5 May, but they don’t want those Lib Dems to steal any credit for “saving the NHS.”  This is Tory politics blue in tooth and claw.  They hate Clegg for trying to exercise more power at a time when he and his followers should be accepting less, since the local elections showed the Lib Dems at a new low.

For a brief few weeks in April and May it looked as though the government might be swayed by research on healthcare to make some sensible changes. But now it is goodbye evidence based policies. Farewell rational decision making. Welcome tribal politics, wheeling and dealing on amendments to the Health and Social Care Bill, and fancy footwork on the part of Cameron and Lansley. 

All the research work done by the Nuffield Trust on the US experience of handing over commissioning budgets to doctors over the past 20 years might just as well never have happened (BMJ2011;342:d337). Carol Propper, of the London School of Economics, whose research showed that price competition in health services led to lower quality of care and higher death rates, might just as well have not bothered (BMJ2010;341:c7366). And the Health Committee need not have spent months taking evidence for their report in April,which warned that the reforms would demoralise the workforce and divide primary and secondary care further rather than bringing them together (BMJ2011;342:d2180).

No, all this is likely to go by the board because if the Tories are seen to concede anything on the Bill it will look like a feather in Clegg’s cap and a dent in Cameron’s virility.  What a way to determine the future of the NHS. 

Annabel Ferriman is the news editor, BMJ