Is the Secretary of State for Health falling into the same trap that a Blairite minister did, of announcing the outcome before the listening exercise is complete?

The Rt Hon Andrew Lansley says he "won't accept any changes" unless they are good for the nation.  But the whole point of the listening exercise is to understand what is good for the nation, and quite frankly, perhaps the new health legislation is wrong in principle, even if some bits of the detail are right.

So let's have a look at it:

RIGHT

Doctors should decide what is best for the patient, and have the freedom to act on it

Doctors should understand the costs of the health service, and propose alternative pathways which both benefit patients and make best use of resources

Patients should have a choice of provider, which will improve patient experience as the money follows the patient

WRONG

Competition isn't intrinsically good.  If you don't set constantly improving standards, or don't monitor them, or don't have the teeth to act when someone falls short, then quality of clinical outcomes will fall just as fast as the hotel services to make the patient feel good improve

A health regulator needs to have one sole purpose - ensuring quality healthcare for the present and the future.  This means financial probity as well as clinical standards.  It does not mean distractions such as encouraging Competition or Cooperation (if they raise standards then they will evolve naturally, if they won't raise standards then they have no place)

It shouldn't speak with forked tongue.  Either the Doctors are in charge, or the Secretary of State for Health is micro-managing.  On present evidence, the Secretary of State and Department of Health can't help themselves and have to interfere with the fine detail of the health service.

GPs aren't accountable to the local population.  They are businesses and they stand or fall on their money management.  If you want health services to be accountable to the local population, then ask local authorities to do the commissioning! Leave the decisions on individual patients to the Doctors, and decisions on the marketplace to the Local Authority (no, PCTs weren't accountable to the local population either - it's difficult to say who they were accountable to).

GP consortia are too small to negotiate with Hospitals.  We're going back to the situation we were in in 2004, when hospitals had all of the information and all of the activity, and simply said to PCTs "this is what we're offering, take it or leave it".  Again, about the only organisations with the financial and legal muscle to enforce quality standards and information reporting are local authorities.

Start again

So don't cling to a bill just because it has your name on it.  Listen to your listening exercise.  Be prepared to do what is right for the country!  Be the first!