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Lansley’s not for listening

It certainly is a fair assumption that the current Cameron/Lansley ‘listening exercise’ is not about listening, anything but. It is a transparent device, under spurious democratic cover, to change course. It is playing for time so as to get past the local elections as well as a damage limitation exercise to enable No.10 to gauge how the opposition to Lansley’s extremism can be handled with least risk. Those risks come chiefly from two sources: the Royal Colleges and the medical establishment on the one hand and the LibDem threat to pull the plug on the bill in its current form after their spring conference turned it down flat. In the last analysis arguments about the relative merits of the bill are not what counts: it’s a power issue. Having said that, today’s PAC report has produced some dramatic new evidence which could influence the power struggle.

A fundamental weakness of all private markets is that there is no guarantee of continuity. Private providers can always go bankrupt; what then happens to the hundreds or even thousands of patients in their care? This has already happened on a lesser scale in private residential and nursing homes. Elderly patients have had to be transferred at very short notice, and many have not survived the move. Could this be allowed to happen in the case of hospitals and their ancillary functions? If not and they are bailed out by the tgaxpayer, isn’t that a clear signal that the private system has irreparably failed?

And there are other central questions that are still unresolved. If all hospitals are forced into foundation trust status, how will they be able to provide the requisite standard of care if they inherit expensive PFI contracts that top-slice their available revenues, leaving significantly less for patient care than in other trusts? Who pays for the treatment of the rarest conditions? How is a postcode lottery to be avoided when local GP commissioning offers or vetoes different drugs or treatment, with serious risks to trust in local GPs at the heart of the service?

Worst of all, is profound structural reform of the NHS compatible with simultaneous unprecedented £20bn cuts in its revenues? Will this not hugely exacerbate market failure which is already the central flaw in the Lansley model?

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