This is a guest blog by Nick Seddon, deputy director of the independent think-tank Reform. He took part in a recent College of Journalism discussion about coverage of the Government's reforms to the NHS in England, along with health specialist Paul Corrigan who has also written a blog post on the subject.
Paul Corrigan is right that the Government's problems in health reform have much to do with its lack of a narrative. The Government's failure to make the case for change has made life easy for the critics of reform and allowed the debate to become dangerously polarised.
It has also resulted in sequences of news reports on television or radio in which, first, unsatisfactory standards of care are exposed, while in the next someone argues that there is no need to change the system. Perhaps it's time for media editors, producers and presenters to join up the dots?
Simply put, the challenges facing the NHS are about quality and money, with quality issues thrown into relief by the financial challenge. Demand will outstrip supply every year of this Parliament unless big changes are made to the way the NHS works.
The last Labour government tried to solve the problems of the NHS in two ways.
First, a remarkable increase in public spending. The NHS budget more than doubled in real terms between 1999-00 and 2009-10.
Second, an injection of new ways of working, especially using competition to drive efficiency and get more for less.
The NHS budget is certainly not going to double in this Parliament and the next. If the Coalition turns its back on efficiency reforms, what else can it do? If it doesn't have another idea, then it will get a deteriorating service with rising waiting times and a steady withdrawal of services from the public. Images of patients waiting on stretchers for overdue care, of GP surgeries going into receivership, and the unions on strike, could become familiar to us all.
The BBC would be doing something exciting if it showed the public some of the new ways of working which hold out hope for the future, both in the UK and abroad.
Last week Reform published ten case studies of healthcare innovations enabling better care for patients while saving money. The Nuffield Trust and The King's Fund have such case studies, too.
The narrative the Government needs is right here: when spending cuts act as a driver to do things differently, they are improving the quality of services at the same time as reducing their costs.
The care model needs to be turned upside down. Hospitals are so rooted in the public and political psyche that we allow them to keep taking on more services whether or not they are solvent or safe. Yet, as Paul Corrigan estimated in a recent Reform report, the unnecessary cost of keeping all hospitals open will be around £5 billion per year by the end of this Parliament.
We need to care for older people in nursing homes and enable people with chronic conditions to manage their conditions at home. The BBC could do some great feature pieces about the excellent care being provided in new ways and new settings, which patients love because it's just what they want (for example, home dialysis, telecare programmes etc).
The bad news for everyone who is bored of the healthcare debate is that when the bill gets through Parliament the real job will be just about to start - the job of innovating and developing new business models in this most fast-moving of scientific fields. This will be difficult. The last government was accused of constant "re-disorganisation". This government has created a pile of organisational shanty towns in which structures and systems are cobbled together or thrown up hastily in the knowledge that they will be torn down in due course.
The public doesn't understand all the watchdogs, new boards, council functions, commissioning groups, and more. Equally, according to most surveys, they don't care how their healthcare is provided; they just want it to be high quality and accessible.
Showing some of the alternatives might perhaps open up a useful national debate. If the Government wants people to support change, it has to tell them why change is needed, give them a vision of the future, and then repeat this vision so their eyes are fixed firmly on the prize.
