This is a guest blog by Paul Corrigan, a specialist in health policy who was special adviser to two Labour secretaries of state for health, and then senior health policy adviser to prime minister Tony Blair. He was recently a speaker at a College of Journalism discussion on NHS reforms:
Most commentators now agree that the Government's biggest failure in relation to its NHS reforms has been its inability to provide a compelling narrative to explain why it is reforming the NHS and why its reforms are the solution to the problem.
For journalists whose job is to provide an explanation in 250 words of what these reforms are about, this creates an enormous problem. Journalists see it as their professional skill to simplify complex issues for the public.
This is just not possible with this reform programme because its complexity is compounded by the political journey the bill has been on: today's bill is the product of a series of political lurches and U-turns. The original white paper of July 2010 was styled as a revolutionary liberation of the NHS from central control. It aimed to move power out from the centre and into the doctors' consulting rooms. It felt - and was - very radical.
But, as the bill was published and started going through the Commons, the Government failed to establish a narrative as to its purpose and what it was going to achieve. There was growing opposition from inside the NHS, and by the beginning of April last year many people believed that the NHS was being privatised.
The lesson from this is that if a government fails to establish a narrative for a reform then the public thinks there must be a reason why it is not telling us. For this bill that was the privatisation of the NHS. As a result, the Government has had to spend time arguing what the reform is NOT about rather than what it is.
From last April the Government called for a 'pause' in the process and outsourced its policy making to a group of random people it called the Future Forum. Over two months this recommended quite a lot of centralisation that was then overlaid upon the bill's original decentralisation.
As the bill continues through Parliament, further amendments have been made by the Government (over 1,000), so that the bill now faces in several directions at once.
This is why it is not easy for journalists to explain what it is about.
The fact that the bill will have taken more than 15 months to go through Parliament has given the opportunity for the opposition to it to grow and to harden. By now nearly every major medical body has come out against the bill and their position is becoming ever more entrenched.
The big picture is the story of the nation's health is a positive one: more people are living longer. But negative stories are the consequence of that - because if you live longer you are very likely to get a number of long-term conditions with your heart, your lungs, rheumatism, blood pressure and depression. As a result, the demand for healthcare increases by about 4% a year. Over ten years that is an increase in demand for NHS services of at least 50%.
In any service this sort of imbalance between demand and supply would create a crisis. For the foreseeable future, the NHS will have to create significant increases in healthcare outcomes for the same amount of resource.
There are many ways in which this can be achieved, but most will involve moving care from its most expensive setting, the hospital, to its least expensive, the home.
That's why for the next couple of decades the story of improving outcomes will be set against that of constant and often painful change in the way services are delivered.
Unless the Government can establish a narrative about these necessary changes, there will be constant stories about cuts, with hundreds of political stories emerging across the country.
Each story will be different but nearly all will be part of this wider narrative about reshaping our health services to meet much greater demand.
In terms of the current reforms, there will inevitably be local and national stories about their implementation by GPs. In some places this will be a good news story and in others it will be a bad news story, where the local GPs don't want to do it. Many of the reforms are already being implemented, so these stories will start this summer.
Because of the depth of the current political story, we are in an odd period where every story will be linked with the political problems of the bill. This will continue for a while.
For journalists the challenge is to explain the complexity of the organisational changes in the NHS without the usual framework of a government narrative to place them in.
The easy option is to follow the cut and thrust of the political debate, but I would urge the media to supplement those stories with more ambitious coverage, to explain what's really happening in hospitals and GPs' surgeries.
Paul Corrigan writes about health matters on his blog.
