by Guest

contribution by Richard Blogger

2011 will be the year that the NHS collapses and it needs explaining, briefly, why this will happen. So far, health secretary Andrew Lansley has been rather clever and rather dim.

Take the “dim” first.

The NHS is a very large organisation to run. It is particularly difficult to run when the money is short. Lansley has taken the attitude that he does not want to run it. He’s refused to pay any attention to the financial issues in the service.



What’s worse is that his attitude is that it is nothing whatsoever to do with the government or the Department of Health. He takes the attitude that the financial problems are the problems of Primary Care Trusts (PCTs), NHS trusts, Foundation Trusts and GPs: he gives them money and if they generate a deficit that is their problem. (Of course, it is not their problem, it is our (patients’) problem)

The NHS will face a financial crisis later this year.

It will be one of the worst crises the service has ever faced because the NHS has never before faced a 4% cut year-on-year while having to re-organise itself. A 4% cut is bad enough, but the re-organisation is the real problem.

You simply cannot increase productivity and efficiency when there is the disruption of a large scale re-organisation. Do one or the other, but not both.

The historical precedent from its 60 year history shows that in the four other times the NHS had a financial crisis the only way to get the NHS working again was to raise funding. In those four cases the funding raise was between 8% and 12%. Can you imagine Lansley pleading with Osborne for another £10bn to save the NHS from collapse?

This incompetence on Lansley’s part has not gone unnoticed at No 10. This makes Lansley very vulnerable, and if there is a cabinet re-shuffle after the May elections Lansley will be top of the list.

My prediction is that Dorrell will be the next Secretary of State. As the chair of the Health Select Committee he’s made satisfying noises about the importance of focussing on the finances rather than Lansley’s vanity re-organisation.

Where has Lansley been clever? Well, announcing in July last year that PCTs and SHAs will be abolished, and then telling PCTs that they must prepare immediately for that event. Without any legislation, without Parliamentary approval, Lansley has already implemented GP Commissioning. That’s clever.

PCTs are in meltdown and it is a one way process: you cannot revive them now. The first 52 GP Consortia pathfinders are already in place and are commissioning for one quarter of the people in England, this will rise to half of England by the summer.

GP Commissioning is here. The problem is the cost: it has contributed to, rather than mitigated for the financial crisis later this year.

Lansley’s vanity project has been implemented, and it will be extremely disruptive to reverse it. Either way the NHS is heading for a very deep financial crisis.