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So, where exactly are we?

It’s all gone quiet on the NHS front. Hannah Boylin asks what is really going on.

Things seem to have gone a little quiet on the NHS front, after an eventful few weeks and much discussion over reform plans.

So what better time to pause, listen and engage? That is exactly what Andrew Lansley and the Government are doing: taking a step back from processing the Health Bill to indulge in a ‘listening exercise’ which could potentially inform amendments to the legislation already proposed.

Cameron, Lansley and their NHS Future Forum have been ‘listening’ for a few weeks now, but to what end? It would seem that no one is quite sure of what is actually going on, least of all those at the centre of the reforms, who continue to feed us with mixed messages.

Andrew Lansley began by implying that any changes to the Bill would be merely cosmetic, continuing to pledge his support to the key principles of the reform plans. David Cameron extended this slightly, claiming that, while he was behind the central ideas of the reforms (i.e. GPs taking control of commissioning budgets and hospitals being paid by results), changes to the Bill could well be “substantive”.

Sir David Nicholson – armed with a different hymn sheet entirely – argued, in a letter published just days after the pause was announced, that he will press on with the reforms; and is expected to broadcast details of the structure of the NHS Commissioning Board, draft versions of the consortia authorisation process and parts of the consortia performance regime any day now.

So the situation is this: the PM and his Health Secretary are taking a moment to reflect; while Nicholson ploughs ahead in full support of organisational change and instructs the NHS to simply “get on with it”. The GPs themselves seem to be heeding the advice of the latter and are pressing on full steam ahead with the reforms; although their conversational reactions remain somewhat varied, ranging from delight at the prospect of being able to reshape the local NHS and potentially earning extra performance-related cash, to frustration at being roped into management tasks and meetings a-plenty whilst earning a lot of extra reading and flack from patients.

However, some elements of the reforms do appear to be adhering to the ‘pause’ culture. The DH announced shortly after Lansley’s address that the abolition of SHAs would be moved back by three months, to July 2013; and it has since been revealed that more than a quarter of the acute trusts still bidding for foundation status have seen their application date slip by over a year.

With so many mixed messages from all areas of these reforms, it is difficult to know what the next step will be. Are we likely to see a U-turn from Parliament? Will this ‘listening exercise’ take on board the comments from the front line and actually impose substantive changes on the Bill? Or will things stay exactly on course and allow us to write off the pause as a simple PR stunt?

This is something we could speculate over for days on end; although that may prove to be a fruitless exercise, as it would seem our guess is as good as the rest of the NHS, Lansley and Cameron themselves.

It is apparent that answers are being sought, however. Just this week, yet another advisory board boasting the heavyweights of British healthcare convened for the first time. This panel will advise Cameron directly and, although it is completely independent from the NHS Future Forum’s ‘listening exercise’, will also consider the reforms and next steps, as well as focusing on the scale of the efficiency savings required.

So there is certainly a lot of talk, and there continues to be a lot of action; but it remains to be seen what the outcomes of all this will be. And with shadow Health Secretary, John Healy’s announcement that Labour is ready to “systematically dismantle the coalition’s” Health Bill, it seems that the games are not over yet.

Hannah Boylin is Editor & PR Manager at NHiS.

NHiS provides healthcare organisations with insight based solutions, to assist engagement with NHS customers and to ensure patient and commercial outcomes are optimised.

Contact the author: hannah.boylin@nhis.info

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