David Cameron's NHS speech: not much good, prime minister

Will the prime minister's speech last Tuesday help the patient? Not a lot, I am afraid. His five commitments to the NHS are just the normal motherhood and apple pie. It is nice that he has reinstated the previous government's 18 week target for treatment. But he should have realised earlier that it is a fundamental law of any bureaucratic organisation, of which the NHS is one, that if you don't set targets, however crude, time-scales will slip out of control. As they have done since Andrew Lansley relaxed the targets last year, surprise, surprise. My GP says I need an echo-cardiogram, and my dentist is initiating some serious hospital-type dental work. I'll keep you posted whether these happen in an acceptable time-scale. Neither is life-threatening, so I expect a long wait. So watch this space, to hear whether my local clinicians hit David Cameron's targets. That nurses and hospital doctors are going to join GPs in doing the commissioning does not seem to help the patient much. In fact, it makes no logical sense. I thought the idea was that GPs should be the customers, commissioning services from hospitals, the suppliers. But, surely, the nurses and hospital doctors come from the hospitals, the suppliers. They will be biased towards their own hospitals. And why only the doctors and nurses? Why not the other clinicians in healthcare, as well as the social workers, pathologists and pharmacists? Particularly the pharmacists, who like GPs would bring much-needed business know-how as well as clinical experience to the consortia. Monitor, the financial regulator, is now supposed to "integrate" all these different stakeholders, as well as its original task of overseeing competition. In the long term this will, I suppose, benefit patients, but not in my lifetime. I look at last month's review by the National Audit Office of the NHS's expensive and disastrous attempts to integrate electronic health records over the last nine years, and despair. This "integration" was driven by a dedicated section of the Department of Health, Connecting for Health, cost billions and has only scratched the surface. What chance has part of Monitor to impose more general integration, not just IT integration, on the GP consortia? I sense more power struggles between the centre and the front line. David Cameron announced yet more bureaucratic structures with "clinical senates'" to "take an overview of the integration of care over a wide area". Rather like strategic health authorities? Not much immediate help for the patient there. The final thing that Cameron conceded was to remove the 2013 deadline for the switch to GP commissioning. As I have claimed previously, this will leave everybody in limbo with a dual primary care trust/GP commissioning infrastructure until 2015 at least. Not good for the patient, particularly geriatrics like me. And then there are the £20bn cuts in the NHS over the next four years, which could strangle the new structures at birth. Why couldn't David Cameron have scrubbed the whole bill, and concentrated, as I suggested last week, on what is urgently needed by patients , particularly the old and disabled, which is an all-out attack on neglect, cronyism and regulatory dysfunction? This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.