Comment / News review – reforms delay; nurses’ anger; and devolved elections

It’s been a turbulent few months for English health secretary Andrew Lansley, as he tries to pilot his reforms through Parliament, and April was no different. He began last month in bullish mood, listing the changes he had been able to make for the start of the new financial year, but these were soon overshadowed as the government sought to regroup on its NHS reform programme.

Mr Lansley formally launched his £200m cancer drugs fund, claiming the £50m interim drugs fund that has been in place since October last year had helped 2,000 patients. In addition, he listed a series of financial and performance changes implemented on 1 April. These included: a £250 a day fine for hospitals that breach single-sex accommodation guidelines; new rules on readmissions within 30 days of discharge; and the extension of the list of ‘never events’ to 25.

In Parliament, the health and social care bill was about to leave the Commons for debate in the Lords – where peers were said to be sharpening their knives – when the health secretary announced a hiatus in the passage of the bill. This would allow a two-month listening exercise to take place.

Mr Lansley indicated that a number of areas would be improved. He insisted choice, competition and the use of the private sector would only ever be means to improve services and not ends in themselves. Competition would be fair and not applied to services such as accident and emergency and major trauma; the private sector would not be able to cherry-pick treatments, which would undermine NHS providers; and governance and transparency in the proposed GP commissioning consortia would be improved.

NHS chief executive Sir David Nicholson wrote to the service saying it should maintain momentum on preparing for the reforms. However, he added the delay meant a number of changes – including the abolition of strategic health authorities, the full assumption of powers by the NHS Commissioning Board, and Monitor’s new powers – would be delayed by three months to July 2012 at the earliest.

Whether it’s a PR exercise or a genuine attempt to listen to and act on the concerns of NHS staff, patients and the public, the listening exercise began two days after the health secretary hit the pause button. In a show of support for the embattled health secretary, prime minister David Cameron and deputy prime minister Nick Clegg were at Mr Lansley’s side as the listening exercise was launched on 6 April.

As part of the listening exercise, a panel of clinicians and patient representatives – known as the NHS Future Forum and chaired by former Royal College of General Practitioners chairman Steve Field – would report to the government on the reforms. The Department of Health has also published a leaflet, entitled Working together for a stronger NHS, which sets out the need for reform. But the united front was soon called into question, as Mr Clegg’s political adviser and former Liberal Democrat health spokesman Norman Lamb attacked the reforms. In comments widely believed to have been cleared by the deputy prime minister, Mr Lamb said there was no evidence the reforms would work and threatened to resign if he felt that the bill had not been sufficiently amended. While he strongly believed in the principle of giving GPs a greater say in how NHS funding was spent, he warned that the implementation was being carried out too hastily.

Mr Lansley went to the Royal College of Nursing’s annual congress in Liverpool, but was derided for choosing not to address the conference. Instead, he met about 50 nurses as part of the listening exercise. He would surely have been given a rough ride in the conference hall. Nurses voiced their anger at reductions in their living standards through the two-year pay freeze and the Hutton proposals on public sector pensions. An RCN survey of 21 trusts in England found 54% of almost 10,000 jobs due to be lost were clinical posts, with nursing jobs accounting for 46% of the overall losses.

The UK’s first large-scale study into the impact of weight loss or bariatric surgery reported a large reduction in type 2 diabetes (which is associated with obesity) and other health problems. It also discovered that bariatric surgery (which can include gastric banding or bypass) paid for itself within three years by preventing the development of other weight-associated illnesses.

Scotland, Wales and Northern Ireland have been focused on the Parliament and Assembly elections that will be held on 5 May. Among Scotland’s key election pledges were the promise of an extra £1bn for the NHS from the Scottish National Party; a £10m a year cancer drugs fund from the Scottish Conservatives; and Labour’s promise of no compulsory redundancies.

In Northern Ireland, meanwhile, the debate is wrapped up with the size of the budget. Health minister and Ulster Unionist Michael McGimpsey argues more money is needed, while the Democratic Unionists believe several hundred million pounds could be saved through efficiencies that would not affect patient care. Sinn Féin believe savings could be generated by doing more to prevent ill health, while SDLP members argue that increased joint procurement and services with health services in the Republic of Ireland would save money and improve services to patients.

Cuts have dominated the debate at the Welsh hustings. While the Conservatives have pledged to keep NHS spending in line with inflation for the next four years, other parties have pointed out this will lead to cuts for other public services. Plaid Cymru said it would cut 10% of NHS middle managers and seek to renegotiate medical and dental contracts. Labour, meanwhile, said that it would preserve free prescriptions and try to reclaim the £70m-£85m a year spent in accident and emergency units treating alcohol misuse. The Liberal Democrats have proposed an Office of Health Spending to monitor efficiency.

The month in quotes

‘Our message is simple: no more taking advantage of your good will. No more treating your terms and conditions like they don’t matter. And no more financial pressures put on your bank balance. This has to stop and stop now.’ Royal College of Nursing general secretary Peter Carter reflects nurses’ anger at their annual congress

‘We've started to get reports over the past nine months that access to these services are being restricted. GPs were told not so send as many patients to hospital, maybe to delay referrals until the end of the financial year while perhaps introducing thresholds for surgery.’ Peter Kay, president of the British Orthopaedic Association, says patients in parts of England wait longer for hip and knee replacements

‘While surgery will always be an important part of dealing with increasing obesity, the most cost-effective solution is to make sure that people do not get to the stage of needing surgery in the first place.’ NHS Confederation Primary Care Trust Network director David Stout on the role of bariatric surgery

‘The principle at the core of this – giving GPs more power and responsibility – is absolutely right. But whenever you introduce new structures, of course there is no evidence, so the sensible thing to do after this period of reflection is test it, see if it works.’ Norman Lamb, Nick Clegg’s political adviser and former Lib Dem health spokesman, tells the BBC of his concerns about the health reforms