Anyone care to convince me that NHS reforms are more than all kinds of scary?

There are lots of many wonderful things about living in Scotland. I love being back here amongst fabulous scenery, wonderful cities, an education system which I still think trumps the English system in a long way and, most importantly, it's outwith the reach of English Health Secretary Andrew Lansley. However, many of the people I care about in the world do reside within his grasp and I don't want them to suffer as a result of the Government's reforms.

I have to be honest and say that I don't know that much about the internal workings of the NHS, but when I read some of the reforms proposed by the Westminster Government to that organisation, I come over with about 117 different types of fear.

I'm open to persuasion that these proposals will improve things, but let me outline why it is that I'm quaking in my boots.

For me as a liberal, the most important thing about any public service is that it should deliver the best possible results for people, that there should be decentralisation of power to the lowest practical level, it should be fair, clearly democratically accountable and there should be strict checking of the quality of the service so that problems are quickly identified and resolved. I fully accept that the current level of bureaucracy within the NHS is stultifying and does not deliver the best results for patients. I know of at least one example where it was only through someone using their own private health insurance to access a test not available on the NHS which identified a problem which, if left untreated, could have had horrendous and permanently disabling consequences.

It seems to me that the proposed reforms deliver local decision making but without any sort of central democratic accountability to ensure that things are being done correctly. Surely there has to be someone with a proper overview over the whole service to collate and disseminate information on best, evidence based practice? I'm not sure an "independent" board with one presumably very powerful chief executive is the way to go. It feels like the Government is going from on extreme to the other.

The idea that GPs can access a variety of different services seems to me to be a good one in principle, though. My sister-in-law was treated for breast cancer in Italy, initially 15 years ago. At the time at least, survival rates and treatment protocols were much better and robust than they were in the UK. Sadly, she died after a recurrence of the disease in 2001 but she received more chemo at the time than she would have had over year. Also, her GP was able to choose where to send her for each part of her treatment - she went to one place for diagnosis, and another for treatment, both places easily accessible locally. She had great confidence in the people who were treating her, too.

I need to be reassured that our Government's proposals are going to ensure that people really can access a wider and better range of facilities and treatments. And that's all people. I'm slightly concerned about patients being able to choose which hospital they want to go to for things like hip and knee replacements. We allegedly have the same thing for schools, yet the popular schools are always over-subscribed and inaccessible to many. The same is bound to happen to the "best performing" hospitals. A huge, time consuming bureaucracy has grown up around assessing applications to schools. Is that going to be the same with hospitals? I think there needs to be some flexibility, but I'm wondering whether we could end up with some sort of multi-tier system with different standards of care, which is not, to me, what the NHS is about.

I have to be honest and say that I'm deeply suspicious of private involvement in health care. That doesn't mean I oppose it per se, but the reason they can afford all the swanky facilities and posh equipment is that they don't tend to bother with anyone who's going to cost them money.  Now, if there are things the private sector can provide without charging way over the odds, I can see how that would help, but there would have to be guarantees that people with long term and costly conditions will continue to receive the treatment they need on the NHS.

If you have these organisations of GPs controlling budgets, what happens if you happen to fall ill and need some extensive poking about at the end of the financial year when they have no money left? Will you have to wait, or will you be treated straight away. As far as I'm concerned, treatment decisions should be made on clinical, not financial need. Most GPs, I think, would see it that way too, so is there a possibility they could run out of money? I remember that there were similar worries when the Social Fund was set up - what would happen if someone needed a loan in March, for example, when there was not much left in the kitty? That hasn't come to fruition in my experience, although the Social Fund is far from perfect and you have to be quite robust sometimes, to access it.

The thing that worries me most is that there doesn't seem to be one single group of people apart from the Conservatives in the House of Commons (and Liberal Democrat MP Gordon Birtwhistle who seems to think that these reforms would have kept his local A and E open) who thinks that the proposed changes are a good idea. I tend to automatically factor out unions in just about anything because they seem to automatically oppose everything, but when doctors, nurses, patients and the Health Select Committee in Parliament are all expressing concern, surely you have to take notice? They can't all be wrong. I'd say Ed Miliband had a rare victory over Cameron when he tackled him on this issue at PMQs today.

I will not, however, be listening to anything the Labour Party has to say on the subject. They will think nothing of indulging in maximum strength scaremongering. I've seen it before. When the Lib Dem/SNP administration on Fife Council announced that some people would have to pay home care charges, Labour were wicked with some of the things they said, to the extent that people who never had any chance of being charged were absolutely terrified that they would not get their much needed care any more. Labour can't be trusted to be responsible, so I will generally choose to ignore them.

So while I'm scared, I'm open to persuasion by people who know that what the Government wants to do will improve care for everybody and won't end up creating some sort of artificial market which disadvantages the sickest.

Update: As Ed has mentioned in the comments, Lib Dem Health Minister Paul Burstow has written about the reforms on Lib Dem Voice. I am far from convinced still, though. I think there needs to be more democratic accountability at a national level - if it's a public service, you do need political interference as long as it's proportionate, and he doesn't answer what happens when facilities are over-subscribed.