Health Lexcomm: Crunch Time For Lansley

09/05/2011

The Liberal Democrat hierarchy, mainly in the form of Nick Clegg and Norman Lamb, have renewed calls for dramatic changes to be made to the NHS reform agenda as a way to salvage the Party’s tattered reputation following the resounding ‘No to AV’ vote. This somewhat pre-empts any conclusions of the ‘listening exercise’ Clegg jointly launched with the Prime Minister and Health Secretary last month. Of course, the Party’s grassroots delivered a damming verdict on the reforms at Lib Dem Spring Conference, calling for substantial changes to be made to ensure confidence in the purpose of remaining in Government. Mindful of this, the Deputy Prime Minister set out his stall over the weekend by calling for major concessions to the Bill and also raised the prospect that the proposals could be dropped all together if these are not forthcoming.

In a move that is more political posturing than real politik his comments are said not to be in keeping with private agreements with Cameron and Number 10 that the Lib Dems would rally behind the broad principles of the reforms to provide some respite from the torrent of criticism that they have received from almost all quarters. The aggressive stance has, however, met with some support from the Prime Minister who is increasingly concerned by the continuing row over the reforms and the potential for the debate to ‘re-toxify’ the Tory brand he worked so hard to reposition as trusted to run the NHS during the 2010 Election campaign. The Prime Minister is even, according to reports, warming to George Osborne’s ‘nuclear option’ of dropping the Bill on the table until Lib Dem demands are met. 

In reality, it will not be possible to drop the Bill in its entirety. So much is already in train. GP Consortia have formed to some extent in almost all areas of the country, with PCT staff transferring into the new structures and GPs taking on more of the responsibility for management of services. To now reverse this juggernaut is a near impossible task coupled with the inconvenient truth that the Bill was supported whole heartedly by the vast majority of Lib Dem MPs in its early passage through the Commons. In light of this and the existing listening exercise, concessions will most likely take the form of greater transparency within the new commissioning infrastructure and perhaps an easing of the timetable for implementation.

For its part, the Labour Party has been keen to paint the row as a clash of ideas over the rights and wrongs of ‘privatising’ the health service – goading left wing Lib Dems into joining their opposition to the greater use of private sector providers. This is of course a somewhat ironic position to take, given that it was New Labour itself that first introduced some plurality in providers to improve waiting lists and drive up standards. Egged on by the RCGP, who this morning claimed that the reforms could lead to charges for basic services and a fragmentation of provision, opposition Health Secretary John Healey today used an Opposition Day Debate to castigate the reforms as opening up the NHS to full-scale market forces with all areas open to private companies, removing measures for scrutiny, allowing NHS hospitals to go bust and face commercial insolvency and subjecting the NHS to competition law.

These developments pile yet more pressure on the man who has staked his political future on delivering the reform agenda – Andrew Lansley. The Health Secretary’s dogmatic approach to driving through a highly conceptual package of measures has faulted due to his inability to successfully sell them to a skeptical public. Forced into the already humiliating position of delaying the passage of the legislation and some public dressing downs from healthcare professionals, the extent to which he will be willing to accept further concessions is in serious question. He has received some backing from backbench Tories, upset at what they view as further unnecessary concessions on key planks of their reform agenda, although there have also been predictable interventions from the likes of Andrew George on the Lib Dem side, calling for a total re-think.

As the ‘man behind the reforms’ Lansley retains the trump card of being the only Cabinet Minister who fully understands the aims and ambitions of the measures going through Parliament and with so much already in progress, Cameron and others may view his loss as too heavy a price to pay for appeasing wounded Lib Dem pride. Perhaps of bigger concern is the headache of who could replace him. The retention of the Coalition balance will be resting uncomfortably on the shoulders of the Prime Minister as he considers his next move. It will be a key political test for him to retain the interest of his Health Secretary and the confidence of his junior Coalition partners.


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