NHS Reorganisation

In a moment; the right hon. Gentleman must allow me to make some progress. I was talking about the principles of the White Paper. They are very clear. First, patients should be at the heart of the new national service, with a simple principle of ““No decision about me without me”” transforming the relationship between citizen and service. Secondly, we will focus on outcomes, not processes. We will focus on outcomes that capture the entirety of patient care, and quality standards and indicators that genuinely reflect what a high-quality service should actually deliver. We will orientate the NHS towards focusing on what really matters to patients, not narrow processes. Thirdly, we will empower clinicians, freeing them from bureaucracy and centralised top-down controls, so that change is genuinely driven from the grass roots, rather than driven, top-down, from above. The right hon. Gentleman's speech did not appear to recognise that central principle at all when he talked about people in the NHS Confederation and the managers who run the NHS. Clinicians are already the people who actually do the commissioning: general practitioners make the referrals and write the prescriptions, and consultants in hospitals make referrals from one consultant to another. In effect, cost and commissioning in the NHS is already controlled by clinicians, but they are divorced from the processes of combining the management of patient care with the management of resources. Whether in this country or in others around the world, it is perfectly clear that that divide is what breaks health care systems. What makes health care systems more effective is bringing together the management of patient care with the management of commissioning and resources on behalf of patients.