It has been an extremely difficult week for Health Secretary Andrew Lansley and his proposed health reforms. First came reports that Prime Minister David Cameron was preparing to take personal control of the Health & Social Care Bill in order to limit the potential political damage to both the Coalition and Tory brands in the run up to local elections. Then came additional coverage speculating that Cameron was now listening to David Nicholson, not Lansley, over the direction of reforms.
This intense media speculation coupled with a cacophony of criticism from all manner of health groups and political commentators led to Lansley taking the unusual step of making a statement to the Commons on Monday afternoon in which he outlined his proposals to appease critics and defend his policy against not only those openly opposing the reforms but also his colleagues and the Prime Minister. Today the Prime Minister, Deputy Prime Minister and Lansley are expected to make a joint statement outlining the initiation of a ‘listening exercise’. The exercise will collect the views of doctors and patients over the next two months. The aim of this unusual consultation, right in the middle of the progress of the Bill, is to regain some of the confidence they have lost among NHS staff and also repair any damage to the Coalition in the public’s eyes.
On Monday, Lansley’s statement began by outlining why the reforms were necessary for the modernisation of the NHS and that the progress made so far was “very encouraging” with nearly 90 percent of the country now covered by pathfinder commissioning groups. However, he went on to admit that the “speed of progress has brought with it some substantive concerns”. While arguing that some of these concerns were “misplaced or based on misrepresentation” he did recognise that “some of them were genuine.” As such, Lansley announced that the Government was taking the “opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way.”
This is an astonishing turn of events considering Lansley’s single-mindedness since the reforms were announced in the autumn last year. He has ploughed on with the reforms outlined in his White Paper, despite the level of concerns voiced in the public arena. It is therefore questionable to what extent the Health Secretary jumped in making his statement and how much he was pushed. Newspapers have been full of comment about what it means for the future of the Health Secretary and the reforms. The Guardian commented that not “a single voting member of the Cabinet lent their support to the Health Secretary by sitting alongside him on the frontbench yesterday”, the Telegraph meanwhile ran an article by Dr Sarah Wollaston MP, Member of the Health Select Committee and a Conservative MP, who suggested that the Health Bill would require “emergency surgery” if it was to regain the support of patient groups and organisations.
Wollaston’s comments came as the Health Select Committee struck another blow to the reforms. The publication of the Committee’s report into commissioning came at the worst moment for Lansley. It was heavy in its criticism of the proposed GP commissioning consortia instead suggesting that the remit of commissioning be widened to include a range of medical and political stakeholders. It also called for amendments to the Bill to ensure greater levels of accountability for what it called “NHS Commissioning Authorities” (otherwise known as GP consortia plus). It has been speculated that this report could lead to the appointment of Committee Chair Stephen Dorrell MP if Lansley is forced to resign over the debacle. Dorrell was formerly a Health Secretary so he is more than qualified for the post. However, speculation of the removal is looking premature with the Prime Minister widely expected to use today’s statement to emphasise his support for Lansley. To remain publicly committed to the reforms seems to be the Government’s only option to salvage some credibility out of the situation, a position Lansley clearly took when he first announced his plans in 2010.
In the joint statement today, the Government is expected to argue that change is necessary and to rule out any complete U-turn. Even now, Lansley is reportedly still keen not to sacrifice parts of his plan to political pressure. Chancellor George Osborne is also concerned that to go pick apart the reforms would be an admission that the Conservatives are a risk to the NHS – a reputation he strove hard to put to bed in the election campaign. Ministers at the Department of Health reportedly believe that the reforms are greatly misunderstood and therefore Cameron, Clegg and Lansley are going to try to present a united front, supporting minor tinkering as opposed to backtracking. Arguably the concerns of Ministers are correct, Lansley has never clearly articulated his vision to the public or the NHS and perhaps the communication skills of more senior colleagues will be enough to get the message across. However, having opened themselves up to an unprecedented consultation on the Bill, mid-legislative passage, the Government will have to make some changes in order to prove it is ‘listening’. Professor Chris Ham of the respected health think tank the King’s Fund has said that ‘the real choice is not between the status quo or change, but between the right reforms, executed well, or poorly planned reforms that could undermine NHS performance.’ The Government is expected to announce the creation of an ‘NHS Future Forum’ headed by a supporter of Lansley’s reforms, Professor Steve Field, former head of the Royal College of GPs. It will include a choice and competition panel chaired by Sir Stephen Bubb, Chief Executive of Acevo.
The Bill will and must progress if the Coalition is to continue to be seen as authoritative. David Cameron, who spent so long trying to detoxify the Tory brand, will go to great lengths to ensure this. The “natural break” indicated by Lansley is seen by some within Westminster to mean after the local and devolved elections in May, with the Coalition hoping that the reforms will be off the front page by then. As for Lansley, it seems unlikely that Cameron will shuffle him out of the Cabinet just yet. After all, getting rid of the Health Secretary would be tantamount to admitting that the reforms were wrong - something that the Prime Minister will want to avoid considering the difficult first year in power that he and his colleagues have faced.
Summary of expected statement
This intense media speculation coupled with a cacophony of criticism from all manner of health groups and political commentators led to Lansley taking the unusual step of making a statement to the Commons on Monday afternoon in which he outlined his proposals to appease critics and defend his policy against not only those openly opposing the reforms but also his colleagues and the Prime Minister. Today the Prime Minister, Deputy Prime Minister and Lansley are expected to make a joint statement outlining the initiation of a ‘listening exercise’. The exercise will collect the views of doctors and patients over the next two months. The aim of this unusual consultation, right in the middle of the progress of the Bill, is to regain some of the confidence they have lost among NHS staff and also repair any damage to the Coalition in the public’s eyes.
On Monday, Lansley’s statement began by outlining why the reforms were necessary for the modernisation of the NHS and that the progress made so far was “very encouraging” with nearly 90 percent of the country now covered by pathfinder commissioning groups. However, he went on to admit that the “speed of progress has brought with it some substantive concerns”. While arguing that some of these concerns were “misplaced or based on misrepresentation” he did recognise that “some of them were genuine.” As such, Lansley announced that the Government was taking the “opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way.”
This is an astonishing turn of events considering Lansley’s single-mindedness since the reforms were announced in the autumn last year. He has ploughed on with the reforms outlined in his White Paper, despite the level of concerns voiced in the public arena. It is therefore questionable to what extent the Health Secretary jumped in making his statement and how much he was pushed. Newspapers have been full of comment about what it means for the future of the Health Secretary and the reforms. The Guardian commented that not “a single voting member of the Cabinet lent their support to the Health Secretary by sitting alongside him on the frontbench yesterday”, the Telegraph meanwhile ran an article by Dr Sarah Wollaston MP, Member of the Health Select Committee and a Conservative MP, who suggested that the Health Bill would require “emergency surgery” if it was to regain the support of patient groups and organisations.
Wollaston’s comments came as the Health Select Committee struck another blow to the reforms. The publication of the Committee’s report into commissioning came at the worst moment for Lansley. It was heavy in its criticism of the proposed GP commissioning consortia instead suggesting that the remit of commissioning be widened to include a range of medical and political stakeholders. It also called for amendments to the Bill to ensure greater levels of accountability for what it called “NHS Commissioning Authorities” (otherwise known as GP consortia plus). It has been speculated that this report could lead to the appointment of Committee Chair Stephen Dorrell MP if Lansley is forced to resign over the debacle. Dorrell was formerly a Health Secretary so he is more than qualified for the post. However, speculation of the removal is looking premature with the Prime Minister widely expected to use today’s statement to emphasise his support for Lansley. To remain publicly committed to the reforms seems to be the Government’s only option to salvage some credibility out of the situation, a position Lansley clearly took when he first announced his plans in 2010.
In the joint statement today, the Government is expected to argue that change is necessary and to rule out any complete U-turn. Even now, Lansley is reportedly still keen not to sacrifice parts of his plan to political pressure. Chancellor George Osborne is also concerned that to go pick apart the reforms would be an admission that the Conservatives are a risk to the NHS – a reputation he strove hard to put to bed in the election campaign. Ministers at the Department of Health reportedly believe that the reforms are greatly misunderstood and therefore Cameron, Clegg and Lansley are going to try to present a united front, supporting minor tinkering as opposed to backtracking. Arguably the concerns of Ministers are correct, Lansley has never clearly articulated his vision to the public or the NHS and perhaps the communication skills of more senior colleagues will be enough to get the message across. However, having opened themselves up to an unprecedented consultation on the Bill, mid-legislative passage, the Government will have to make some changes in order to prove it is ‘listening’. Professor Chris Ham of the respected health think tank the King’s Fund has said that ‘the real choice is not between the status quo or change, but between the right reforms, executed well, or poorly planned reforms that could undermine NHS performance.’ The Government is expected to announce the creation of an ‘NHS Future Forum’ headed by a supporter of Lansley’s reforms, Professor Steve Field, former head of the Royal College of GPs. It will include a choice and competition panel chaired by Sir Stephen Bubb, Chief Executive of Acevo.
The Bill will and must progress if the Coalition is to continue to be seen as authoritative. David Cameron, who spent so long trying to detoxify the Tory brand, will go to great lengths to ensure this. The “natural break” indicated by Lansley is seen by some within Westminster to mean after the local and devolved elections in May, with the Coalition hoping that the reforms will be off the front page by then. As for Lansley, it seems unlikely that Cameron will shuffle him out of the Cabinet just yet. After all, getting rid of the Health Secretary would be tantamount to admitting that the reforms were wrong - something that the Prime Minister will want to avoid considering the difficult first year in power that he and his colleagues have faced.
Summary of expected statement
- Creation of an ‘NHS Future Forum’ headed by Professor Steve Field with a competition and choice panel headed by Sir Stephen Bubb
- Deadline of April 2013 for abolition of PCTs will not be an ‘absolute cut-off’
- NHS Commissioning Board to take control of local services where consortia are judged ‘not up to scratch’
- More accountability within GP consortia
- Measures to introduce ‘fair’ competition and prevent private firms cherry-picking the best services
Sam Blyth and Georgina Seagrave
Portcullis Public Affairs
St James House
13 Kensington Square
London W8 5HD
Information resources:
BBC news article: http://www.bbc.co.uk/news/health-12962003The Times article: http://www.thetimes.co.uk/tto/news/politics/article2974476.ece
