NHS reforms that could be on the way out

Laura Kuenssberg
Political editor
@bbclaurakon Twitter

A doctorImage source, Getty Images

The Lansley reforms, remember them? Those changes to the NHS that reorganised everything, cost lots and lots and lots of money, and really stretched David Cameron's perpetual efforts to show he loved the NHS? Well some elements of them might, just might be on the way out.

In 2012 the government, after months of arguments, brought in huge changes to the way the NHS in England is run.

The idea was to give GPs more power to spend the cash - the argument being they understand the needs of patients better, so would allocate cash more widely.

Six years later, that is not quite how it has come to pass, with the reforms criticised far and wide for being too complicated, too disruptive, and also too expensive.

Getting rid of quirks

The prime minister has now publicly committed to a better deal for the health service in general, with a promise of a longer term settlement and more resources.

But I'm told that new money would come with strings attached, more reform.

And government is considering whether or not those reforms could include scrapping or changing bits of the 2012 legislation.

No-one anywhere near it in Whitehall and Westminster wants another enormous set of administrative changes.

But there is appetite to get rid of some of the quirks, to tidy the legislation up.

Eyebrows raised

As if by magic, the cross-party Health Committee in Westminster is soon to report on precisely this question. If they find that changing the law without too much disruption would be worthwhile, it may well emerge as part of the government's overall plan.

In the background, however, there's a bigger struggle going on over how much extra cash can really be found, and whether the health secretary's hopes of a 10-year funding deal are realistic.

Some eyebrows have been privately raised over whether it is really possible to sign a deal for a decade.

The prime minster's political plan is to have a significant and convincing announcement to go alongside the 70th anniversary of the health service in July.

Political cost

But money is tight, and the NHS already takes up a huge chunk of the government budget.

Suggestions that Jeremy Hunt has been pushing for a 4% annual increase are too high a pitch, I'm told.

But he is understood to be pushing for more than Whitehall hawks, who believe that depending how much you assume the NHS can save from "efficiencies", the increase to the overall health budget might be not much more than 2%.

The prime minister and the chancellor have only just started what will be a long series of meetings about the Budget, with a hope to do a deal on the NHS ahead of all other government departments, in the next month or so.

But Number 10, Number 11, and the Department for Health are a long way off finding an accord.

Tweaking the legislation again might be controversial, but it comes with a political, not necessarily a financial, cost.