The simple explanation is 'Never trust a Tory'
"The NHS is safe in our hands"
"We will stop top-down reorganisation of the NHS"
The Government has started making changes to NHS structure on the assumption that the Bill will pass Parliament; they are effectively trying to burn the ground behind them as they move, to give the impression that the Bill cannot be stopped because there is no way to go back, and so the only way is forward on the path that they have set out. (It isn't true, as with so many of the things the Tories peddle about the NHS; there is still time to stop and take stock from the status quo)
Governments have authority to make changes in NHS structure, to a point, without primary legislation, which is what Lansley set in motion 2 years ago. The desire to streamline NHS management and put clinicians in more direct control of how the NHS works is a valid one; changes to effect that could be put in place without primary legislation. Previous Governments have done just that; in fact, a lot of the ground level changes taking place are inherited from the previous administration.
Primary legislation is needed here though because Cameron and Lansley are taking that further, to aim to take advantage of the political and economic environment to force through massive ideological change in the NHS. Their stated rationale for why the Health Bill is needed does not match their actions; if all they are trying to achieve are the reforms they've already put in place, they wouldn't need a Bill. They need a Bill because they are aiming to fundamentally reshape healthcare provision in the English NHS, to open it up to private competition and to do away with many of the fundamental principles the NHS was founded upon.
They are now rewriting the Bill on the run, with hundreds of amendments already hurriedly slapped into place to attempt to quell the rapidly growing unease and concern, which means that if the Bill does pass it will be riddled with loopholes and undefined areas. The Bill has always been about sleight of hand, about trying to push through legislation that looks relatively benign on the surface but underneath which lurks ideologically driven change which will unravel the NHS irrevocably.
Lansley commissioned a study to identify the risks inherent in his proposed reform; such a study is an essential part of any major proposed change. He is refusing to publish that study because it is likely that it highlights the huge risk to the NHS in carrying out these reforms.
All of this is being done at a time when the NHS is having to cope with the biggest financial constraints in its history. The Health Bill amplifies those difficulties and prevents clinicians and managers doing what they can to meet the economic challenges.
All of this is genuine concern. There is a further, unprovable, concern that Cameron and Lansley know that they are setting their new vision of the NHS up to fail; for GPs to fail to meet the challenge of being economists managing services. Were their new NHS to fail, it would allow them to further open up the NHS to private providers.
The NHS of 2012 looks different to the NHS of 1948. The NHS of 2048 will have to look different again to cope with the changes in medicine and society that will continue. Here and now though is where a genuine battle is being fought over what options of form that future NHS will have open to it to take. If Cameron and Lansley succeed now, and an Any Qualified Provider system is allowed to become established, the NHS will fracture, likely beyond the ability of any future Government's ability to reconstitute it.
There is a Number 10 e-petition for publication of the Risk Register here
. How useful that will be is questionable; Cameron promised any petition that got over 100000 signatures would get Parliamentary time - the petition calling for the Health Bill to be withdrawn has been signed by over 140000 and it seems to be having negligible effect on Cameron's plans.
There is an Early Day Motion for the same here
; you can, if you're so inclined, write to your MP to ask if they have signed it. 38 Degrees
is a website that helps make that easier for you.
Opposition to the Tory's Health Bill, and all it represents, has grown to massive proportions amongst those who work in the NHS. It has taken time for healthcare professionals, individually and collectively, to truly get to grips with what the Bill means for the future of the English NHS. As understanding has grown, the major organisations representing doctors, nurses and healthcare professionals in the United Kingdom have joined to say 'NO' to what is being proposed. It's not just them either - the Health Select Committee in Parliament, chaired by a previous Tory Health Secretary, has grave reservations.
This Bill is meant to be about listening to clinicians, giving clinicians the say in how the NHS is managed ... but Cameron and Lansley will not accept an answer they do not want to hear.
The NHS needs reform, across the whole United Kingdom. It needs to adapt to an ageing population, to ever-expanding new treatments, to limited economic resources. Tough decisions about what core services will comprise will have to be made, decisions about how revenue is channelled will need to be addressed. Hospital departments - whole hospitals - will need to close to provide a service that the country to continue to be proud of.
All of this will be tough, but it can be done, and it can be done without sacrificing the fundamental principles of the National Health Service which remains one of the world's most cost-effective and efficient deliverers of high quality medical care. We should remember that that, the NHS' inherent strength, in amongst all of the media-driven stories about failures and inadequacies, is rarely trumpeted. It should be.