NHS Reform: everybody's shouting, but is anyone paying attention?

If, as Andy Burnham claims in Liberal Democrat Voice, this weekend sees the last opportunity to 'save' the National Health Service, then I find myself in the eye of the proverbial storm. Which, all things considered, is an intriguing place to be.

If, as is suggested, most people have taken sides, then my support will be somewhat in demand, as I genuinely haven't made up my mind.

As a fiscal conservative, I look at comparative rates of inflation within the health sector and the economy as a whole, and I shudder. We will, as a society, have to decide what we are willing to provide and what we can afford to. And, with increased longevity and the additional costs that go with it, the demands on the NHS are bound to outpace growth in the economy. Such a debate will not be pretty. New 'superdrugs' and complex but lifesaving medical procedures don't come cheap either.

Therefore, finding new, more cost-effective ways of doing things is an imperative. But this isn't like widget manufacturing - people's lives are at stake.

And because of that, all changes to the NHS are emotive. Private versus public, access to treatment, questions of waiting times and rationing, all provoke an awful lot of heat and very little light, it would seem to this rural bureaucrat.

And this is where our coalition with the Conservatives makes reform difficult. Sadly, nobody trusts them with the NHS, and despite some fairly herculean attempts to address the issues that have been most difficult, we are left with some major problems;

1. The Coalition Agreement seems quite clear that there would be no top-down reorganisation. You can argue that all the change is actually bottom-up, as change will be driven by local GPs, but few people really believe that, and there are plenty of GPs who would rather not be empowered, thank you very much.
2. Andrew Lansley has the bedside manner of Dr Crippen. It has become so bad that I suspect that if he was announcing record new investment in the NHS (genuinely record new investment, that is, not the spin master version), he would still cause a drop in support for the Coalition.
3. The Opposition have every incentive to wave shrouds and none whatsoever to engage. And, as everybody loves the NHS, and nobody remembers what they did to it when they were the Government, they can get away with it.
4. The original bill was clearly drafted by people who go private, or would be happier if more people did. Given Andrew Lansley's links with the healthcare industry, one perhaps shouldn't be too surprised.

As a Party, we haven't been terribly sure-footed either. The political antennae of our leadership were evidently not operating well before the initial draft came out. Someone, somewhere, should have spotted the various bear traps and sent it, and Mr Lansley, back to the drawing board.

It must be admitted that, at that stage, there was little sense still that when it came to converting ideas into deliverable legislation, the Conservative policy wonks were a menace to society due to their apparent failure to understand how real people behave in real situations. After all, we test our policies at Party Conferences, where people get up and make comments such as, "I think you'll find that the requirements of the 1885 Paper Clips (Amendment) Act are a barrier to progress in that direction." - and are often right.

As a result, the proponents of the legislation start any argument with a significant disadvantage. Having conceded the pause in the legislative programme, and encouraged people to express their fears, the Coalition fell foul of the widespread misunderstanding of the word 'consultation', a personal bugbear of mine.

There was still time to withdraw the Bill, put it out to pre-legislative scrutiny, preferably in the Lords, and see what emerged. It might not have been what those behind the original Bill would have liked, but it would have been something more circumspect and obviously coherent.

Instead, opposition to the Bill has been allowed to grow unopposed, and whilst Liberal Democrat Peers have sought to build in safeguards addressing any reasonably based concerns, the likelihood of reasoned argument getting a look-in at the public debate is either slim or none. Indeed, that might be slim leaving town as I type...

So, I'm hoping to hear the arguments, find out more about the legislation, and weigh up the politics of where we are.

But somehow, I'm not minded to do it because Andy Burnham wants me to. After all, if he and his friends hadn't opened up the NHS to the private sector in the first place, we wouldn't even be having this argument now...