Leading article: An opportunity wasted by failing to communicate

Not only is the debacle over Andrew Lansley's NHS reforms a masterclass in how not to conduct government, it is also a regrettable missed opportunity for Britain.

After an enforced "pause" for reflection, the Health and Social Care Bill continues its faltering progress through Parliament with a House of Lords debate this week at which as many as 80 peers are expected to speak. And with many of the Bill's opponents unappeased by the Health Secretary's concessions, there are real concerns that the reforms may be kicked so far into the procedural long grass that they are effectively defeated.

It was never going to be easy. The introduction of competition into the NHS is so emotive a subject it can be difficult to reach a consensus on even the basic facts. While research covered in this newspaper today concludes that rivalry between hospitals may not improve quality, other equally well-respected experts maintain that hospitals in more competitive areas do consistently outperform their peers.

Sadly, in place of the deft political handling required by so nuanced a subject, the Government's efforts at reform have been crass and confusing, adding to the sense that, notwithstanding Mr Cameron's protestations about his own experiences with his late son Ivan, the top tier of the Conservative Party is still not really interested in the NHS.

Left to himself, the Health Secretary produced a bill that was over-ambitious, ill thought out, and subject to vastly unrealistic timetables. But the principles at its heart – to reduce top-down management, increase patient choice, and use competition to improve efficiency – deserve support.

The truth is the NHS is in urgent need of reform. Although it is misleading to link the proposals to the need for £20bn-worth of annual savings, the dire financial climate has helped to expose the reality that simply increasing the health service budget year after year is neither effective nor affordable.

Lamentably, Mr Lansley's failure is as much one of communication as of policy. The issue of "privatisation" in the health service is immensely sensitive in Britain, far more so than in other countries. Yesterday's anti-reform demonstration in Westminster is just the latest evidence of the passions roused by politicians seen to threaten the NHS. But arguments over reform too often conflate the issue of who provides the care with the question of who pays for it.

Increased competition among healthcare providers, and the involvement of private companies in the health sector, does not necessarily result in a two-tier service that prices the poor out of decent hospitals. Care can remain free at the point of need, regardless of what kind of entity is providing it. But by spectacularly failing to clarify the distinction between supply-side reforms and structural issues such as GP commissioning, the Government has allowed erroneous accusations of "marketisation" and "privatisation" to flourish unchecked, much to the detriment of the calibre of the debate.

What happens next? Choice and competition are sound goals. The Prime Minister backed down over policies on forests and jail sentences. On the NHS, he needed to hold his nerve. Instead, rushed concessions have rendered a bad Bill even worse, watering down the regulator's role to "promote competition where appropriate" and adding bureaucracy to plans for GP commissioning. Both look like retrograde steps, adding to the confusion.

Successive governments have lacked the courage to change the terms of debate about the NHS. Alas, after just 18 months, it looks as if this Government's political initiative may have already been thrown away. Britain's health services are the biggest loser.