Liz Kendall uncovers NHS document which outlines five layers of management for new GP-led commissioning system
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Liz Kendall, the shadow care minister, says Andrew Lansley's NHS reforms are an "utter shambles" after an NHS document showed there would be at least five layers of management. Photograph: John Stillwell/PA Archive/Press Association Image
Andrew Lansley is once again having a wretched time.
The health secretary, whose NHS reforms are in severe trouble in the House of Lords, gave vent to his frustration on Thursday when he accused the BMA of being "politically poisoned" in the way it is opposing his health reforms. Denis Campbell noted that this echoed the language of Nye Bevan, Labour's founding father of the NHS, who famously had to battle against BMA claims that his blueprint looked "uncommonly" like a step towards Nazism.
Downing Street is deeply nervous about the health and social care bill which will be considered at report stage in the House of Lords on 8 February. No 10 sources say they are more nervous about Lansley's bill than the welfare reform bill even though the latter has suffered high profile defeats in recent weeks. Sources share Lansley's believe that the BMA and the Royal College of Nursing are behaving like hidebound trade unions. But there is a feeling that Lansley's failure to win over the medical profession – he was meant to have forged strong relations with "stakeholders" – is fuelling opposition in the House of Lords.
If all that sounds tricky, the shadow care minister Liz Kendall has uncovered a document which appears to raise questions about one of Lansley's central claims – that handing commissioning powers to GPs will make the NHS more efficient. Kendall has tweeted that a document prepared for a meeting of the NHS Commissioning Board next week suggests that it will take at least five layers of management to run the new GP-led commissioning system.
I reported this morning that the document says:
In most cases, there should be no more than five layers of management in each directorate, from national director to the 'front line'. The exception to this will be the performance and operations directorate, where an additional layer (or layers) will be required to link through to the local offices. The principle of no more than five layers of management is based on extensive evidence of effective organisational structures which has been applied in [the department of health] and other public sector organisations.
I also reported Kendall as saying:
Cameron's health bill is an utter shambles. He claimed it would cut costs and red tap but we now know there will be at least five layers of management with total confusion about who does what and how. None of this is in the legislation currently before parliament or been discussed by MPs. This chaos must end – Cameron should listen to doctors and nurses and drop the bill.
Andy Burnham, the shadow health secretary, will feel vindicated. As health secretary, he wrote in the Guardian in 2009 that Lansley was "turning Britain's best loved institution into the world's biggest quango".