Andrew Lansley’s opinion (We must not let the government seize back control from doctors, 17 July) is completely in line with government policy over the last decade and represents the ideology of decentralisation, the bonfire of red tape, and freedom to manage affairs at local and individual level.
His Health and Social Care Act 2012 was not the first but was maybe the most disastrous attempt of any Conservative government to decentralise and to allow local individual enterprise and autonomy. Other examples of this dogma include Kenneth Clarke’s discredited fundholding schemes and the wholesale sell-off of the NHS real estate, resulting in the ongoing burden of public-private partnerships.
Concealed beneath this apparent support for the NHS is the real reason for decentralisation and local autonomy. The 2012 reforms were a deliberate commercialisation and marketisation of the NHS, establishing commissioning groups to allow and encourage competition and drive down costs.
Lansley blames central control and espouses local powers. This sounds convincing, but in the current structure the only benefactors are private contractors, the collateral damage being fragmentation of the structure, closure of essential services to make savings, several markers of a sicker population than other European countries, and a seriously demoralised workforce.
As we have all learned during the Covid-19 crisis, the introduction of a market, through the Lansley changes and serial damaging reforms, has resulted in neglect. The “admiration for our health professionals” and the belated applauding comes too late from the mouths of those who have done much to dismantle the NHS.
The prospect of further restructuring should raise alarm, the irony being that the parlous state of the NHS results from misguided Conservative planning. The prospect of further “reform” is chilling.
Roy Robertson
GP and professor of addiction medicine, University of Edinburgh
• It has never seemed right in polite circles to reveal any form of support for Andrew Lansley’s ill-fated period as health secretary, but I would like to say a few qualified words in his favour. He had been the opposition spokesman for many years when appointed and had a good understanding of the problems of running the NHS. In proposing NHS decentralisation then, and confirming his view today, Lansley came to be grievously wounded by the Labour opposition in parliament for allegedly trying to escape ultimate accountability for the NHS. He even managed to be undermined by his own prime minister, who personally rejected the plan.
So the NHS still remains centralised and over-bureaucratised, with its leaders presiding over failed integration with local government services, primary care, and patients generally. It is very clear now that this state of affairs is not serving us well, helping to create the mess made of dealing with the current pandemic. What was really wrong with the 2012 act was the obligatory marketisation of healthcare provision, which Labour would have done much better to focus on and stop. Lansley deserved to pay a price for this.
Deep in the heart of all this is the chronic failure to recognise that there are things best done centrally in the NHS (such as setting standards of care, approving new drugs, planning medical training, securing adequate finance) and things best done locally, without interference, even by Whitehall civil servants (NHS England).
Allowed to build its own patterns of care, cooperation, and accountability to local citizens, a “local NHS” would surely by now have had instant capacity to test and trace in the current crisis, and recruit and use volunteers for effective community action.
It was not a crime for a secretary of state to want to give up power then, and Lansley is right this time to weigh in against the rumours reported in this newspaper that those in No 10 want more control of events. Heaven help us if they succeed.
Peter Thistlethwaite
(Former editor of Journal of Integrated Care), Saltash, Cornwall
• I was surprised to see the Guardian publishing advice from Andrew Lansley on how the NHS should be run. I look forward a contribution from Chris Grayling on the smooth running of railways.
Bashyr Aziz
Pelsall, West Midlands
• The headline in your print edition did not do justice to the content of Val Curtis’s article (The NHS failed me, along with thousands of other cancer patients, Journal, 17 July). “Successive Conservative governments failed the NHS and failed me, along with thousands of cancer patients” would have been more like it.
Jeyan Anketell
Lichfield, Staffordshire
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