Chris Lancelot on...The Conservatives' NHS Plans

I have just read the Conservatives' new plan for the NHS - 'NHS Autonomy and Accountability'. To say that I am underwhelmed would be putting it mildly.

In a nutshell, the Tories' proposals are: 'We love the NHS', 'We want to stop it being a political football so we will take it out of direct government control'; 'We are going to put clinicians in charge of local budgets'; and 'We are going to fiddle with the bureaucracy (again)'. All in a complex, unreadable document the effect of which puts temazepam to shame.

The thrust of the plan is clearly to establish that the NHS is safe in the Conservatives' hands, and that David Cameron is the true heir of Blair in the centre ground of politics. I'd have thought that after the mess Blair has made of the NHS, no-one would actually want to be his heir, but there you go.

If you read the document I guarantee you'll be bored silly by about page five. There's a lot of fiddling with existing bureaucracy, a patient watchdog, and several nods to consumer choice, but nothing to fire the imagination.

Taking the NHS out of direct government control? That's already been mooted by Gordon Brown. In truth this is not a bad idea if it really can be achieved, but undoubtedly 'NHS quango' will be leaned on heavily by the government of the day over funding and outcomes. So not much change, despite the window-dressing.

Making commissioning clinicians responsible for achieving outcomes as opposed to targets, and docking their salaries if they don't deliver?

Complex, and difficult to measure, though it would be good to have clinicians in ultimate charge once more. But believe it or not, payment is at one point linked to 'patient self-reported outcomes'. Words fail me.

There's really very little to get excited about in the Tories' plan, which is a pity, because the NHS desperately needs a far-reaching overhaul which hugely simplifies and streamlines its structure and grasps the nettle of demand management. The document pays lip-service to all these things but its proposed solutions seem too complex to be truly practical: I see nothing within it to change the NHS in a radical way.

Come on, Dave - after 10 years in opposition, can't you think of anything more scintillating?

- Dr Lancelot is a GP from Lancashire. Email him at

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