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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The big problem for the NHS? Local government cuts

Even a U-Turn on planned cuts to the service itself will still leave the NHS under heavy pressure. 

38Degrees has uncovered a series of grisly plans for the NHS over the coming years. Among the highlights: severe cuts to frontline services at the Midland Metropolitan Hospital, including but limited to the closure of its Accident and Emergency department. Elsewhere, one of three hospitals in Leicester, Leicestershire and Rutland are to be shuttered, while there will be cuts to acute services in Suffolk and North East Essex.

These cuts come despite an additional £8bn annual cash injection into the NHS, characterised as the bare minimum needed by Simon Stevens, the head of NHS England.

The cuts are outlined in draft sustainability and transformation plans (STP) that will be approved in October before kicking off a period of wider consultation.

The problem for the NHS is twofold: although its funding remains ringfenced, healthcare inflation means that in reality, the health service requires above-inflation increases to stand still. But the second, bigger problem aren’t cuts to the NHS but to the rest of government spending, particularly local government cuts.

That has seen more pressure on hospital beds as outpatients who require further non-emergency care have nowhere to go, increasing lifestyle problems as cash-strapped councils either close or increase prices at subsidised local authority gyms, build on green space to make the best out of Britain’s booming property market, and cut other corners to manage the growing backlog of devolved cuts.

All of which means even a bigger supply of cash for the NHS than the £8bn promised at the last election – even the bonanza pledged by Vote Leave in the referendum, in fact – will still find itself disappearing down the cracks left by cuts elsewhere. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.