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David Cameron's speech today on NHS reform has one familiar element: the extent of his personal attachment to the health service.
"It is because I love the NHS so much that I want to change it," he says. That is an argument familiar from the election campaign, when Mr Cameron emphasised that the NHS was safe in his hands precisely because he had personal experience of its excellence during the tragic illness of his late son, Ivan. Indeed, it underlay the Tories' commitment not only to exempt health from spending cuts, but to increase its funding.
Few doubt the NHS needs reform and that spending at present levels is unsustainable given the demands of an ageing population and the expansion in expensive new treatments. But accepting the need for reform is not the same thing as welcoming the Government's health bill. This is a complicated set of proposals in one piece of legislation, which gives GPs more control over spending and commissioning services and at the same time seeks to take out layers of bureaucracy and increase competition. Many people, including health professionals, who would happily give GPs a greater say in the service, baulk at the extension of commercial competition. And Mr Cameron's decision to "pause" the reforms - but not, as he says today, to stop them - is a measure of the public disquiet about the Bill and its implications.
Mr Cameron makes a good case for the necessity of reform but a less good one for this Bill and its radical, even destabilising, ambitions. There have now been many submissions from professional bodies including the King's Fund and the BMA in respect of the detailed proposals, and it would be no shame for the Government to withdraw the Bill in order properly to take those criticisms into account.
Indeed, there are some good things in the proposals, including an emphasis on preventative medicine, which should be retained. Whether the Bill should be extensively revised or withdrawn, then replaced, is a moot point. Compromise on the means of achieving NHS reforms while retaining the end, would be no bad thing.
Strauss-Kahn's crisis
This is not a good time for the colourful head of the IMF, Dominique Strauss-Kahn, to find himself in custody in New York on attempted rape charges: he should be at a meeting of eurozone ministers on the crisis in Greece. The IMF has been a prime mover in the eurozone crisis; Mr Strauss-Kahn favours more state-sponsored bailouts for Greece in contrast to the Germans, who suggest Greece renege on its bank debts to private lenders.
But if his departure from the IMF is now hastened and the upshot is a reassessment of the fund's operations, that would be healthy. His alleged offence took place in a £1,850-a-night hotel suite, an indication of the lavish expenses available. What's more, this is an institution which got the credit crunch wildly wrong. It may be time, as the Government suggests, to rethink the unwritten rule that the IMF is headed by a European/American double-act and to consider a candidate from the Far Eastern economies instead - preferably someone reform-minded.
Short-changed
Most of the passengers who were trapped underground for four hours last month because of Jubilee line failures and then forced to walk to safety have been given paltry compensation by Transport for London. Hundreds of passengers got an average of just over £2. That, frankly, is adding insult to injury: Tube users deserve better.
Reader views (2)
What has mostly been missed in all the protests is that this Bill not only restructures health care services, it also repeals legislation that has safeguarded the NHS since its beginning. Most importantly, it abolishes the Secretary of State’s legal duty to provide a comprehensive health service, together with his or her powers of direction over NHS bodies and providers. It doesn't really matter what compromises Cameron is prepared to make - if the law is changed so that the government no longer has to provide a health service, he can bide his time and radically change things later when we think we've won enough and our guard is down. The only thing to do is to abandon the Bill entirely. As a nurse I know there are better ways to improve the NHS. Demonstrate tomorrow (Tuesday 17th) to 'kill the Bill'. Meet at University College Hospital, Gower St at 5.30pm and march to the Dept of Health in Whitehall.
- Gay Lee, London, 16/05/2011 22:45
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We the British public love our NHS, more than you Mr Cameron and Mr Clegg, and that is why we do not trust you to change it. It is obvious that you wish us to have a u.s style insurance system, we the public will never forget either of you as the gangsters who tried to privatize our beloved NHS.
- R Carter, Liverpool Merseyside, 16/05/2011 12:33
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