Dear All,
Yesterday the Prime Minister David Cameron, Deputy Prime Minister Nick Clegg and Health Secretary Andrew Lansley travelled to Frimley Park hospital in Surrey to try and rescue the Government’s health policy. In front of an invited audience of health professionals and hospital staff, and flanked by his two colleagues, the Prime Minister announced what he called a period of pause and reflection in the legislative progress of the Health & Social Care Bill, which many had feared was being driven through Parliament at breakneck speed. The pause in the process of health reform was signposted as a time for the Government to ‘listen’ to the views of doctors and patients by undertaking a series of public meetings around the country. However, the announcement had much more to do with political choreography between the Coalition partners in the face of widespread Lib Dem dissent, than a sudden desire for wider consultation. It was clear from the tone of the announcement that this ‘listening exercise’ is not going to lead to a change in the overall direction of the Bill.
In his speech yesterday, Cameron admitted that staying with the Health & Social Care Bill as it currently stands was not an option. However he outlined his support for the broad goals of the policy which would include giving more control to GPs and patients, reducing bureaucracy, and giving greater freedom to hospitals. Cameron was firm that the NHS needed to adapt to meet the burden of an ageing population and warned the public that in order to keep the NHS free at the point of use, it would have to be made more efficient. He announced the creation of a panel of experts known as the NHS Future Forum, headed by former chairman of the Royal College of GPs, Professor Steve Field. The Forum will take the lead on the exercise over the next two months. In addition, Chief Executive of Acevo, Sir Stephen Bubb will chair a panel on competition and choice. By bringing in ‘experts’, the Government is trying to temper speculation that the reforms are ideologically motivated and to protect themselves against any future controversy by being able to say that the plans were reviewed and amended by independent experts.
Some aspects for reform have already been earmarked by the Health Secretary, most notably opening the NHS up to private sector providers. In his speech, Lansley observed that the previous Labour Government had given preferential deals to private providers and that, unlike Labour, this Government would take steps to protect against so-called ‘cherry-picking’ by the private sector. The Prime Minister also indicated that the Government would take seriously suggestions to improve the accountability of GP consortia.
The main issue for the Government, as highlighted in previous updates, is that Andrew Lansley has failed to communicate his vision and has allowed the public debate to plunge into a panic at the perceived privatisation of the NHS. Furthermore, the policy heaps a great deal of extra work on the shoulders of NHS staff and GPs in particular, at a time when they are trying to make cuts and continue to improve quality. The timeline for the reforms had clearly been drawn up on the basis of the next general election rather than on the timescale necessary for them to be properly implemented. As with all radical change, shrieking headlines were always going to dog the policy but it was the lack of any concerted effort on the part of Lansley to counter the arguments and be clear about the intentions of his policy that has led to this dramatic intervention. Lansley has repeated the mistake of previous Labour governments which failed to get buy-in to their policy from NHS staff, culminating in the need to bring in Lord Darzi to re-sell health reforms to the health service. It was as result of this that in 2008, there was speculation in the press that Labour was no longer the party to be trusted with the NHS.
Although there was no great detail, the policy was in the Conservative manifesto. The manifesto said ‘We will strengthen the power of GPs as patients’ expert guides through the system by giving them the power to hold patients’ budgets and commission care on their behalf... putting them in charge of commissioning local health services.’ It would have been highly irresponsible for David Cameron to have expended so much energy during the 2010 election campaign in trying to prove the Conservatives could be trusted with the NHS if he had not read the policy proposed by Lansley and fully endorsed it. The Grand Overseer of Government policy, Oliver Letwin, gave the reforms his backing in the autumn 2010 after their announcement produced a frenzy of protest in the media. Ultimately, this indicates that the Conservatives are happy with the policy and the Government will try and achieve the intended outcomes, one way or the other.
Cameron will happily tinker with the Bill to save face, while Lansley is wedded to his plan as it was originally conceived. However, having been forced to make an intervention Lansley will have to accept whatever revisions to the Bill Cameron deems politically expedient. The pause may save enough face for the Bill to be salvaged with a few reasonable amendments such as the extension of deadlines and the qualification of language.
A Government memo has been leaked to the Guardian outlining some red lines that will not be changed, essentially the broad principles outlined above such as establishing GP consortia and making all hospitals Foundation Trusts. However, it also suggests that the expansion of the role of Monitor and the abolition of Strategic Health Authorities will be delayed until July 2012.
It has been a difficult episode for Andrew Lansley, who was not supported by a single Cabinet Minister on the front bench when he gave his statement to the Commons on Monday. David Cameron has publicly stated his support for Lansley, but that was probably for the sake of presenting a united front and in reality, Lansley is now firmly out in the cold. Giving the Opposition ammunition to accuse the Conservatives of wrecking and privatising the NHS is an unforgivable offence for a Conservative team who had dedicated all their energy to making the Tories look caring.
Portcullis Public Affairs
