Chris Ham's King's Fund report, demolishing the NHS reforms, is excellent. But, like the 99 bus... a bit late.

In the turbulent days of 2010, healthcare's front line, commentators, academics, practitioners, politicians, Royal Colleges, unions and the public railed against the Health and Social Care Bill.

Then the KF wrote opaquely; "The King's Fund strongly supports the aims of the White Paper" and "... there are potential benefits if the reforms are implemented effectively" (and) ...significant risks if they are not" and "... there are strong arguments for moving quickly to test out how key elements... work in practice..." and "The organisation of the NHS could be progressively streamlined..."

Streamlined! Functioning organisations annihilated, replaced with a myriad of little ones, institutions demolished and senior people lost along with their a legacy, experience, history and knowledge. With one common-sense voice the NHS said; 'No!' What did the KF say?

They hid behind Don Berwick (Page 11).

The NHS has been ploughed up and nothing that was planted to replace it is growing.

KF's Ham now says; the NHS is "crying wolf" with "ill-founded" claims about privatisation. Rubbish.

Anyway, the NHS has always worked with private partners! But, carving out chunks of hard pressed services, gifting them to private companies, transferring NHS staff, unwillingly, into their ranks, to provide identical services just to create a profit opportunity has a touch of the King George about it...

We asked; if the private sector gets fed up or fails ... what happens? It took Southern Cross, Circle, Serco, a number of dodgy nursing homes and BUPA to show us. The NHS picks up the pieces.

Whilst all of us were saying all of that Chris Ham accused decent working people who had genuine concerns of grand-standing. Well, Chris, I'm pleased that there were people with the guts and the courage to stand in the grandstand and shout and boo, stamp their feet and chant. I'm amazed there wasn't a pitch invasion.

Ham is wrong about privatisation. The fear is not privatisation it is the fear of privatisation failure. Fears that have been realised. There is not enough money in the contracts for private companies to do a decent job and make a profit.

It's all about the money. Tarzan's pact with Porrima is predicated on extra money for efficiency gains. Trusts have given Monitor a two fingered salute. They can't and won't work with the proposed tariff. That pretty well ends Tarzan's hopes of efficiency gains and puts the 5YFV in doubt. Traditionally, the NHS delivers 1.5% pa efficiency. What hope is there of 3% without root and branch changes and major investment.

Ham says present focus on quality and integrated care is to be welcomed. After 15 years of inspection there is no evidence services are any safer. In fact, under such pressure, they are probably getting worse. Health and social care still march to a different drumbeat because no one has the courage to merge their regiments.

What are the common-sense voices of the NHS saying today?  This is what I hear, repeatedly:

• Dump Monitor, there is no market in healthcare and no prospect of one. Put the money into the front line.
• Bulldoze the TDA; being an FT is an artificial distinction. FTs are just as skint and capable of poor care as the rest. Put the money into the front line.
• Halve the number of CCGs and stop them tendering everything (they are terrified not to). Contracting costs around �16m and the money is better used at the front line.
• Move, immediately, to population based, capitated budgets and get the money into the front line.
• Cut admin and bureaucracy costs; use service level agreements to leverage front-line performance and quality.
• One last heave-ho; vertically integrate primary, secondary and community services, include social care and focus on end2end services... start with the patient facing front-line and work backwards.

Chris Ham wants to get the KF on the right side of history; it never was. I know it, you know it and he knows it and his report has hacked a lot of good people right off.  This and this have been doing the rounds on Twitter, as well as this.

The reforms were a mare's nest and pretty well every organisation came right out and said so, except the King's Fund who were impenetrable, ambiguous, equivocal and mostly missing. 

Ham may see a lot of us (and I include myself) as grand-standers but it's a whole lot better than being a by stander. 

But, it's not all bad; the KF does sell exceedingly good chocolate muffins and their refurbished cafeteria is nearly finish. 

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'What is the point of a select committee' come and join me in conversation with Dr Sarah Wollaston MP, chair of the Health Select Committee.

 Kings Fund 11th March - details here. 

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