Good morning.

Today's sermon will be from the launch of the new document by Norman Lamb MP, Lib Dem health spokesman. If you want to get ahead of the game, read this opinion piece in today's Guardian.

The pamphlet, The NHS - a liberal vision, sets out five broad guiding principles:
1. a fundamental shift away from central bureaucratic control to local accountability and responsibility
2. better use of financial leaders to achieve key policy objectives
3. no state monopoly of provision
4. more freedom, thereby liberating the NHS workforce
5. giving power and responsibility to patients in respect of their own healthcare

Lamb's analysis of the NHS's centralised bureaucracy is undoubtedly correct. His belief is that much greater localism will follow from having elections to PCT boards, and allowing the PCTs tax-raising powers. He also believes that mutual ownership of provider organisations (if perhaps not buildings) by NHS staff, in the voguish John Lewis Partnership model, will release the innovation of front-line staff and also help to address problems of slow adoption of best practice.

Warning against the 2006 financial recovery approach of slashing public health, mental health and training budgets to address the slowing of growth and the need to save £15-20 billion a year by 2015, Lamb stressed the need to:
1. reduce bureaucracy and regulatory overlap wherever possible
2. align financial incentives with upstream and preventative care, especially for long-term conditions - he again quoted Mark Britnell's remark (while still in post at the DH) that "we have got to radically reform or abolish payment by results"
3. maximise staff input
4. achieve a balance between patients' rights and responsibilities - Lamb cited the need to look at actions on people attending A&E after significant alcohol abuse and behaving abusively to staff - whether they are being directed to treatment services, and whether they should be charged for their care.

Chris Ham - integration, yes, but competition too
In responding remarks, Professor Chris Ham (whom Lamb repeatedly cited as an influence on much of his thinking) emphasised the importance of three areas in the next stage of NHS reform:
how to calibrate the appropriate balance between top-down and bottom-up approaches
an emphasis on mutuality (JLP)
how to achieve integration - and how to get to it from where we are starting

Ham reported that the integrated care pilot in Torbay is achieving real reductions in emergency acute and community bed day use for the PCT, thanks to an integrated community health and social care team working with GP practices to deliver the best community services for older people with long-term conditions.

He also supported the piloting of mutual approaches, to "get staff more directly involved in improving both the quality of performance and patient experience". Ham added that greater integration needed to be accompanied by competition, to prevent new monopoly providers creating stagnant services.

This is a thoughtful document, which recognises the reality of the current situation. It is no small compliment that many of the Lib Dem policy positions have made their way into Labour and Conservative policy. Pre-electoral policy paralysis will, sadly, mean that there won't be any progress on loking at mutual approaches, or resolving the eternal sticking point of the NHS pension (still, according to the speakers, the sticking issue for NHS community service providers).

But this is a meaty contribution to the policy conversation from Lamb and Ham.