Is the NHS reform overhaul merely cosmetic?

The government has accepted "core" changes to its NHS reform -- but the coalition's NHS headache is

The Health Secretary Andrew Lansley has confirmed significant changes to the government's NHS reforms, following a 10 week "listening exercise".
This looks like a significant victory for the Liberal Democrats, who resoundingly voted against moves to introduce greater competition. Reportedly, Nick Clegg was cheered by his MPs last night when he told them their demands had been "very, very handsomely met". In another victory for Clegg, the bill will return to committee stage in the House of Commons, meaning that it will not become law until next year.

At a joint press conference with David Cameron and Lansley, Clegg said that the government now has a plan "we can all get behind". The two key changes are watering down Monitor's role in promoting competition, and relaxing the 2013 deadline for reform.

While this is a significant step forwards, however, the coalition's NHS headache is not over yet. Cameron now faces the challenge of winning over Tory backbenchers who are angry at the way Lansley has been treated. It is believed that he was subjected to unfair briefings, given that his white paper on health was agreed by Clegg and Cameron last year.

However, Lansley and Cameron have both stressed that while the detail has been modified, the fundamentals of the plan -- giving greater commissioning powers to GPs and allowing greater competition in the health service -- are unchanged.

Gary Gibbon suggests that even these changes to the detail could be merely cosmetic:

Changing the terms for Monitor, the NHS regulator, is an interesting one too. I just asked a very senior member of the NHS Future Forum what was the difference is between an economic regulator and a sector regulator. "There's no difference," he said. If Monitor is no longer about "promoting" competition, what is its role on competition I asked. "Enabling" competition, came the answer. These are "totemic" changes, he said. You don't need a regulator to "promote competition" if you've created the space for competition. It'll just come, like breathing.

My source said the Forum frequently felt it was trying to put the original plans into politically acceptable language, not make radical change to the original Lansley reforms.

All this could be wishful thinking by supporters of the original reforms but I pass it on.

Conservative MP Sarah Wollaston, a former doctor and critic of the original bill, described these new proposals as "a change in emphasis". The Lib Dems are certainly entitled to their jubilation at these concessions -- but at this stage, it is impossible to tell what this will mean in practice.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Manchester united: "A minority of absolute idiots are trying to break us apart"

At the vigil, one man's T-shirt read: "The only thing that's allowed to be separated by colour is the laundry."

A day after one of the worst atrocities in the history of the city, Manchester's people were keen to show the world the resilience of the Mancunian spirit.

Dom's, an Italian restaurant, is in walking distance from Manchester Arena, where 22 people lost their lives to a suicide bomber the night before. On Tuesday, the staff were giving out free coffee, tea and pizza to anyone who needed it. On a table outside, there was a condolences book, and teary passersby left RIP messages to those who perished. Under a bright blue sky, the community seemed more united than ever, the goodwill pouring out of everyone I met. But the general mood was sombre. 

"We need to make space for healing and for building up our community again, and just getting people to feel comfortable in their own city," the Dean of Manchester, Rogers Govendor, told me.

The terrorist has been named as Salman Ramadan Abedi, a 22-year-old Mancunian of Libyan descent. But with a population of 600,000, Manchester is a cosmopolitan hub, and proud of it. Throughout the day I encountered people of all skin shades and religions. On one of the roads off Albert Square, a couple of Orthodox Jewish boys set up a little stand, where people could grab a bottle of water and, if they so desired, hold hands and pray.

On the night of the tragedy, Muslim and Sikh cab drivers turned off the meter and made their way to Manchester Arena to offer free rides to anyone - many of them injured - who trying to escape the mayhem and reach safety. "It's what we do around here," my taxi driver said with a thick Arabic accent.

The dissonance between the increasingly frantic debate on social media and what was discussed on the streets was stark. I spoke, on and off the record, with about two dozen residents, eavesdropped on a number of conversations, and not once did I hear anyone speaking out against the cultural melting pot that Manchester is today. If anything, people were more eager than ever to highlight it. 

"Manchester has always been hugely multicultural, and people always pull together at times of trouble and need," said Andrew Hicklin. "They are not going to change our society and who we are as people. We live free lives."

It was also a day where political divisions were put aside. Theresa May and Jeremy Corbyn agreed to suspend their campaigns. For the next few days there will be no Labour vs Tory, no Brexiteer vs Remainer, at least not in this part of the country. This city has closed ranks and nothing will be allowed to come between that cohesion.

"I don't demonise anyone," said Dennis Bolster, who stopped by to sign the condolences book outside Dom's. "I just know a small minority of absolute idiots, driven by whatever they think they are driven by, are the people who are trying to break us apart."

Later in the day, as people were getting off work, thousands flocked to Albert Square to show their respects to the victims. Members of the Sikh community entered the square carrying "I love MCR" signs. The crowd promptly applauded. A middle-aged man wore a T-shirt which said: "The only thing that's allowed to be separated by colour is the laundry." A moment of silent was observed. It was eerie, at times overwhelmingly sad. But it was also moving and inspiring.

Local poet Tony Walsh brought brief respite from the pain when he recited "This is the Place", his ode to the city and its people. The first verse went:

This is the place In the north-west of England. It’s ace, it’s the best

And the songs that we sing from the stands, from our bands

Set the whole planet shaking.

Our inventions are legends. There’s nowt we can’t make, and so we make brilliant music

We make brilliant bands

We make goals that make souls leap from seats in the stands

On stage, everyday political foes became temporary allies. Labour leader Jeremy Corbyn, home secretary Amber Rudd, Lib Dem leader Tim Farron, Mayor of Greater Manchester Andy Burnham and house speaker John Bercow all brushed shoulders. Their message was clear: "we are Manchester too."

The vigil lasted a little over half an hour. On other occasions, a crowd this size in the centre of Manchester would give authorities reason for concern. But not this time. Everyone was in their best behaviour. Only a few were drinking. 

As Mancunians made their way home, I went over to a family that had been standing not far from me during the vigil. The two children, a boy and a girl, both not older than 10, were clutching their parents' hands the whole time. I asked dad if he will give them a few extra hugs and kisses as he tucks them in tonight. "Oh, absolutely," he said. "Some parents whose children went to the concert last night won't ever get to do that again. It's heartbreaking."

Felipe Araujo is a freelance journalist based in London. He writes about race, culture and sports. He covered the Rio Olympics and Paralympics on the ground for the New Statesman. He tweets @felipethejourno.

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