No man who will don a moustache throughout November to support a prostate cancer charity, as shadow health secretary John Healey did, can be deemed to lack a certain reckless chutzpah (bless you).

Healey is carrying this verve and elan into his opposition, as this letter to PM David Cameron, cc'd to Andrew Lansley and Oliver Letwin, shows:

Rt Hon David Cameron MP
Prime Minister
10 Downing Street
London SW1A 2AA

01 December 2010

Dear Prime Minister

I welcome the review of the Health Secretary‟s plans for the NHS that you have asked Oliver Letwin to undertake, confirmed by No10 and the Treasury to the Financial Times and reported today.

This is the right time for the review, before the Government gets any deeper into the high-cost, high-risk internal reorganisation that Andrew Lansley set out in his White Paper in July.

My concern is for the future of the NHS, and this is entrusted to you and your Health Secretary for now.

This is set to be a period of severe financial squeeze for the NHS. Despite your promise to protect the NHS and to protect NHS funding, the health service is already showing signs of strain. This time next year, when the NHS will be operating on funding from the first year of your Spending Review, rather than the last year of ours, these strains will be much clearer to patients and the public.

This is a period during which the efforts of all in the NHS should be dedicated to making sound efficiencies and improving patient care. It is therefore exactly the wrong time to be forcing the NHS through what the King‟s Fund Chief Executive describes as “the biggest organisational upheaval in the health service, probably, since its inception”.

There are questions which the Health Secretary has been unable yet to answer, and on which you and Oliver Letwin will want to be fully satisfied if you are to allow him to press ahead with his plans. The ten must-answer questions for the Health Secretary are:

1. How does the Health Secretary justify breaking the promise you and the Deputy Prime Minister made to the Country in the Coalition Agreement, as your programme for Government?

2. How does the Health Secretary justify to the public and to patients, the £3 billion cost of internal reorganisation, especially within the financial pressures on the NHS over this Parliament?

3. To what extent will the Health Secretary‟s internal reorganisation distract from and make more difficult the action needed to meet the immediate challenge of sound financial efficiencies, whilst improving patient care?

4. Why have the Health Secretary‟s plans attracted universal concern from health experts, professional bodies and patients‟ groups about the risks, and why do fewer than 1 in 4 of GPs – who all other NHS professionals see as the "winners‟ in his new system – believe the reorganisation will improve patient care?

5. Why will there be more state (statutory) organisations in the NHS after the Health Secretary‟s changes than there are now, and why will there be more civil servants in the DoH than there are now?

6. How can the Health Secretary claim that his plans will lead to a “patient-led” NHS, when decisions on commissioning which will drive the provision of services will be made not by patients, or with the direct involvement of patients, but by “GP consortia”?

7. What financial risk assessment and due diligence has been done on the Health Secretary‟s plans which in 2 years‟ time will see £80 billion a year of taxpayers‟ money spent by organisations that do not yet exist?

8. What Parliamentary and public accountability will there be for failures in patient safety or services and for failures in financial management or probity under the Health Secretary‟s plans?

9. Is your Government prepared to see trust in the patient-GP relationship put at risk because GPs will make rationing as well as referral decisions on treatment, so that patients will question whether their GP is doing what is best for them or best for the GP‟s own budget and consortia business?

10. Is your Government prepared to see a two-tier health service as patients find important services will be commissioned and available in some areas but not in others?

I trust that you will ensure that the answers the Health Secretary provides to these essential questions will be fully tested.

If you feel able to share with me the conclusions you come to on these points, I would be grateful. Otherwise I look forward to seeing your conclusions reflected in future Government policy announcements and developments.

Yours sincerely.

As ever

John Healey MP
Shadow Health Secretary

cc: Rt Hon Andrew Lansley CBE MP
Rt Hon Oliver Letwin MP