What has Field delivered for the NHS?

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Prof Field and the Future Forum have reported on Lansley's NHS reforms and found them wanting. Badly wanting.

It does look like there will be some real changes. For these we should be grateful. As a result although health care will now be organised on local authority lines (which is going to mean almost all pilot GP consortia will need to be scrapped and start again - at what cost?) responsibility for health care will still rest with the government. We will still have a National health service. That's vital.

Supposedly integration is more important than competition: but I am not convinced there. Integration can mean many things and I have a strong suspicion this is about ensuring competing functions that will spend most of their time trying to undermine each other to cherry pick the easy budgets still talk to each other over the 85% of the NHS that is non-elective and deals with old people who are "off their legs" on a daily basis.

Consortia of GPs go in favour of  a wider base - and with more accountability. The latter is an essential change: putting £80bn beyond accountability was a strange part of Lansley's first attempt.

But there remain massive problems in all these changes, and no one should be celebrating the fact we're still going to get the wrong reform of the NHS.

GPs, hospital doctors and nurses do not know how to run consortia, budgets and contracts. They're medics. Great medics most of them. Who I admire, a lot. But I don't go to them to get management advice. So they'll have to go elsewhere. And if that's the private sector - and KPMG and others remain hovering in the wings - heaven help us all.

And competition remains a key element in all this. Competition between hospitals, competition between outsourced providers, and financial incentives remain strong to save whether appropriate or not - which is what the budget cutting is all about. It's likely that cherry picking will remain. And health outcomes either now or in the future will be compromised badly. I'll offer just one example - the hospital I've been told about that is stopping using trainee doctors for many tasks and using nurse practitioners instead as they're cheaper. The only trouble is that those trainee doctors will never as a result have felt an inflamed appendix by laying a hand on a patient's stomach beofre they go out and become a GP. What good will they be then?

This is the logic of the new NHS: expediency for short term, budget driven gain.

I've said it before, and I'll say it again: health care needs did not change because the banks reduced their profitability. They increased: yes, I mean that. They increased. Unemployment increases health care demand.

But we're not meeting it because we refuse to tax and we refuse to close the tax gap.

That's the wrong choice. And sometime we'll realise it. I just hope not too many die before then. But some will: of that I have no doubt.