Feeling better?

IT wasn’t just trade unionists who objected when Health Secretary Andrew Lansley’s proposed NHS reforms were first published last year. Not only did Mr Lansley want to hand over most of the total NHS budget to groups of self-employed business people (otherwise known as GPs), but he wanted to make the primary duty of the NHS regulator Monitor that of promoting competition.

Another clause of the new Health and Social Care Bill called for NHS contracts to be awarded to “any willing provider”, something that could potentially open up the NHS to privatisation.

Most members of the public hold GPs in high esteem, and giving them the bulk of NHS budgets to spend on their behalf did not seem so revolutionary, considering the key role played by family doctors as “gatekeepers” of NHS secondary care.

But the idea that competition should be enshrined as one of the main tenets of the new look NHS stuck in the craw of many people.

Most Brits regard the NHS with great affection and look with bemusement at the struggle President Barack Obama has had to set up even the most basic form of national health service in the US.

Our health service is one of our most cherished and valued institutions. The idea of a free at the point of use, comprehensive health service available to all UK residents is deeply engrained.

And central to that idea of a unified, single service is the idea of collaboration and public service with the interests of the patient paramount.

So, the idea that familiar, local NHS hospitals could be put out of business or be taken over by private companies was simply unacceptable to most people.

The scale of the outcry against this new dogeat- dog NHS shocked the Government.

Virtually the entire medical and nursing profession lined up to criticise aspects of the proposals – with the most embarrassing moment at the Royal College of Nursing conference in April, where a motion of no confidence in Mr Lansley was carried overwhelmingly by delegates.

At this point, the Prime Minister stepped in, called a halt and started a listening exercise, which resulted in more than 6,700 face-to-face interviews with people and more than 29,000 emails, comments and questionnaires.

Yesterday, the NHS Futures Forum, the semi-independent body of experts which carried out a two-month public consultation on the reforms, reported back. It recommended that the proposals must undergo significant changes before they can become law.

The forum said the aim of improving services was universally supported, but genuine and deep-seated concerns needed to be addressed.

The main thrust of the report did not come as a complete surprise, considering David Cameron’s speech last week, in which he admitted that ministers “had learned a lot about how to make our plans better” and that “real changes” were being made to the health proposals to reflect the concerns of patients, doctors and nurses.

The engine room of Mr Lansley’s proposals – abolishing primary care trusts and handing over the bulk of NHS budgets to GP consortia – is still in place, but the forum is recommending some important changes.

Instead of the NHS regulator being given the principal task of promoting competition, Monitor must support choice, collaboration and integration.

Combined with this changed role for Monitor, the NHS Forum is recommending that the Government should ban private firms from cherry-picking the most lucrative NHS contracts.

While the Government is being urged not to seek to increase the role of the private sector, the report recommends that the concept that contracts should be be awarded to “any willing provider” in healthcare will remain, although, paradoxically, the report says companies should not be able to compete on price.

As a response to widespread professional concerns that hospital doctors and nurses were being sidelined by an over-reliance on family doctors, the forum suggests that GP consortia should take advice from other professionals before taking decisions on commissioning.

And to answer criticism that the reforms are being pushed through too quickly, the forum recommends that the deadlines of 2013 for GP consortia to take over budgets should be scrapped.

The proposals now have to be considered by the Government and there is no guarantee that they will remain unscathed. But, given the steer by Mr Cameron last week it is likely that the report’s recommendations will shape legislation currently stalled in Parliament.

MANY critics of the Government’s original proposals might find some of the proposed changes unconvincing. How will Monitor manage to combine promoting choice with supporting collaboration and integration?

If private companies are not allowed to compete on price, on what criteria should they be judged – isn’t one of the aims of the NHS reforms to encourage efficiency and made the health service more affordable?

These central issues remain unclear, but most neutrals will welcome the report’s call for increased transparency about how the NHS is run, including the decisions of GP consortia, who will be in charge of more than £60bn of taxpayers’ money.

So will this be enough to get the watereddown proposals into law?

It remains to be seen whether the health professions accept what could be seen as a glorified fudge, but one thing is certain, the electorate will be monitoring the future performance of the NHS like a hawk.

If the reforms falter, if the performance of the NHS starts to decline, or if there are scandals about the quality of care from private providers, there will be a terrible backlash at the polls.

Mr Cameron knows that this is probably the biggest gamble of his Prime Ministerial career.

For his sake, he needs to get it right.