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 future of policing is still at risk even after George Osborne's U-Turn

The police have avoided the worst, but crime is changing and they cannot stand still. 

We will have to wait for the unofficial briefings and the ministerial memoirs to understand what role the tragic events in Paris had on the Chancellor’s decision to sustain the police budget in cash terms and increase it overall by the end of the parliament.  Higher projected tax revenues gave the Chancellor a surprising degree of fiscal flexibility, but the atrocities in Paris certainly pushed questions of policing and security to the top of the political agenda. For a police service expecting anything from a 20 to a 30 per cent cut in funding, fears reinforced by the apparent hard line the Chancellor took over the weekend, this reprieve is an almighty relief.  

So, what was announced?  The overall police budget will be protected in real terms (£900 million more in cash terms) up to 2019/20 with the following important caveats.  First, central government grant to forces will be reduced in cash terms by 2019/20, but forces will be able to bid into a new transformation fund designed to finance moves such as greater collaboration between forces.  In other words there is a cash frozen budget (given important assumptions about council tax) eaten away by inflation and therefore requiring further efficiencies and service redesign.

Second, the flat cash budget for forces assumes increases in the police element of the council tax. Here, there is an interesting new flexibility for Police and Crime Commissioners.  One interpretation is that instead of precept increases being capped at 2%, they will be capped at £12 million, although we need further detail to be certain.  This may mean that forces which currently raise relatively small cash amounts from their precept will be able to raise considerably more if Police and Crime Commissioners have the courage to put up taxes.  

With those caveats, however, this is clearly a much better deal for policing than most commentators (myself included) predicted.  There will be less pressure to reduce officer numbers. Neighbourhood policing, previously under real threat, is likely to remain an important component of the policing model in England and Wales.  This is good news.

However, the police service should not use this financial reprieve as an excuse to duck important reforms.  The reforms that the police have already planned should continue, with any savings reinvested in an improved and more effective service.

It would be a retrograde step for candidates in the 2016 PCC elections to start pledging (as I am certain many will) to ‘protect officer numbers’.  We still need to rebalance the police workforce.   We need more staff with the kind of digital skills required to tackle cybercrime.  We need more crime analysts to help deploy police resources more effectively.  Blanket commitments to maintain officer numbers will get in the way of important reforms.

The argument for inter-force collaboration and, indeed, force mergers does not go away. The new top sliced transformation fund is designed in part to facilitate collaboration, but the fact remains that a 43 force structure no longer makes sense in operational or financial terms.

The police still have to adapt to a changing world. Falling levels of traditional crime and the explosion in online crime, particularly fraud and hacking, means we need an entirely different kind of police service.  Many of the pressures the police experience from non-crime demand will not go away. Big cuts to local government funding and the wider criminal justice system mean we need to reorganise the public service frontline to deal with problems such as high reoffending rates, child safeguarding and rising levels of mental illness.

Before yesterday I thought policing faced an existential moment and I stand by that. While the service has now secured significant financial breathing space, it still needs to adapt to an increasingly complex world. 

Rick Muir is director of the Police Foundation