Chris Lancelot: Coalition collapse will crush any NHS reforms

The honeymoon is over. The unguarded and inappropriate remarks of a number of Lib Dem ministers - of whom Vince Cable is the most prominent - have demonstrated the extent to which cracks are appearing in the coalition government.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

This is a sad state of affairs, because at first it seemed that our politicians had actually matured enough to govern in the national interest using cool debate, honourable compromise and shared cabinet responsibility for difficult decisions.

This appears to no longer be the case. So what is likely to happen next? How long before the coalition disintegrates? Not before May at the very least, I suspect, because that's when we are due for a referendum on the holy grail of Lib Dem policy - voting methods. No dyed-in-the-wool Lib Dem will want to jeopardise that.

Equally, if the Lib Dems try to force an early election they risk annihilation in the polls, together with the possibility of a return to a Labour government - which will doubtless change everything around yet again.

This is all desperately important for the NHS because an early general election risks dropping the NHS in it, totally. Because of the radical nature of the White Paper changes, existing managerial structures are fast disintegrating as everyone looks to the future. Some PCTs have given up and are simply planning for a hassle-free wind-down. Others risk outright collapse as their more competent managers leave for greener pastures, many in the burgeoning consortia.

Yet most consortia are nowhere near ready to take over, and won't be for 18 months.

For the next two years a paralysed cabinet or a change of government would throw the NHS into chaos - increasingly destabilised by the decline of the PCTs, but not yet in a position to experience any clinical benefits or financial savings from the reorganisation. Whether you support the reforms or not, it is not in anyone's interest to leave the NHS in this condition - falling between two stools, stuck in managerial limbo.

If the Lib Dems play their part honourably and fully in the coalition then this danger will be avoided. Conversely, if they decide to indulge in petty party politics, or force an early election, the consequences both for them and for the NHS could be devastating.

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