By Paul Goodman
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The Prime Minister writes in the Sunday Times (£) today that "the [NHS] bill will cut bureaucracy". It is one of the three big arguments he makes for it in his article (Tim summarised key themes earlier).
But if the bill is passed there will be, in addition to the Department of Health:
- A National Commissioning Board (which will do much of the commissioning that some of the bill's supporters believe will be undertaken by GPs).
- Some 50 or so PCT clusters.
- Hundreds of clinical commissioning groups (which will do less commissioning than some of the bill's supporters think will be the case).
- Dozens of clinical senates.
It is hard to see all this as a cut in bureaucracy.
David Cameron's second argument is that the bill "gives power to doctors and nurses". But Andrew Lansley told the Commons last April:
"As Secretary of State, I could have done most of this without the legislation: I could have just abolished most of the primary care trusts and strategic health authorities."
So doctors and nurses don't need to bill to take power. Indeed, they have quietly been doing so since the election. Reports of how groups of local doctors are taking control of commissioning were being published a year ago.
The Prime Minister's final argument is that "the bill identifies the public health challenge, funds it transparently and gives councils the powers they need".
In other words, only one of out of the three arguments that the Prime Minister makes in his piece really stands up. Perhaps he hasn't grasped that the bill has already seen concessions, a pause, and amendments – and no longer replicates the original vision of Lansley's White Paper.
Those who insist that it does should ask themselves why, if this is the case, Shirley Williams and the Liberal Democrat leadership now support the bill.
Most likely, the patient and doctor-driven choice that would have happened anyway will be slowed by an NHS Railtrack of new, overlapping and competing bureaucracies. Cameron will have to do better than this to persuade that the policy or political case for the bill now stands.