Chris Lancelot: These complications might derail Health Bill

The 'pause for reflection' has given everyone time to think about possible errors and omissions in the Health Bill.

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

Yet the pause itself has caused problems by derailing the Bill's tight timescale. PCTs and shadow consortia are now experiencing a planning blight, with no budgetary certainty and too few staff to run the existing NHS efficiently, never mind plan for the future.

But an even bigger danger awaits. Delay is said to be the deadliest form of denial, but denial through overcomplexity is even more devastating. Here, a potentially sensible idea is brought to a standstill by the imposition of too many conditions (and note, this imposition can be entirely well-meant).

At the moment, the Health Bill puts GPs in charge, a brilliant idea to ensure doctors rather than managers control the health service; this also depoliticises the NHS. But if a revamped Bill were to add large numbers of political and other non-medical representatives to consortia boards in the name of 'democracy', we will be back to non-medical control of the NHS, which will become a local political football as well as a national one.

The current Bill intends competition to drive down costs and improve standards. But the benefits of the free market can only occur if the market is truly free. Surround it with limitations, such as forbidding competition on price, and its benefits are reduced.

Medical education is not mentioned in the Bill - it should have been. But the legislators should be wary. They could insert clauses requiring all commissioning contracts to contain a teaching element. This might work for the bigger hospitals but would prevent many smaller providers, such as cottage hospitals and independent physiotherapists, from tendering - few of these will have the opportunity to teach, or the time to acquire the (presumably mandatory) diplomas.

Post-'pause', every pressure group will be clamouring for its own ideas to be written into the Bill, to bind every consortium and provider. If this is allowed to happen unchecked, the Bill, already complicated, will become unworkable. We will then have achieved the worst possible scenario: expensive upheaval in the NHS that produces no benefit by becoming gummed up by its own subclauses.

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