NHS reforms: a lesson in how not to do it

In assuming that Andrew Lansley had it all in hand, David Cameron and Nick Clegg have taken an enorm

"It all seems slightly dramatic to me, but I tend to hope that Lansley knows what he's doing," sums up what friends in the Conservative Party have said to me about the NHS reforms over the past few months.

This remains the danger within any government: to assume someone else is getting on with it and knows what they are doing. I remember a friend in the Labour Party once saying to me, as we debated during the lead-up to the Iraq war, "The thing is, I trust Tony. I assume he knows what he is doing." Well, the rest, as they say, is history.

Within government, within cabinet, everything should be challenged and nothing assumed.

The NHS reforms are turning out to be the perfect example of how not to do it. In assuming that Andrew Lansley had it all in hand, David Cameron and Nick Clegg have taken an enormous risk. Simply sending in their policy lieutenants from No 10 in the early days of drafting was an insufficient response.

It is these bread-and-butter issues – welfare, health, education and crime – that the Prime Minister and the Deputy Prime Minister need to challenge and challenge again until they are satisfied that the policies are right.

If either leader leaves this to others, they will be left with the results, good or bad. Getting the policies right is everything; presentation comes later.

With the Treasury totally tied up with structural deficit reduction, and the Cabinet Office pushing through so many other reforms, the fundamental challenge of these bread-and-butter issues is in severe danger of getting lost.

We are left with the impression that policy is continuing only because it has started, not because it is coherent. We are in danger of driving through a policy that is not a left or right issue, but one that places too much power in the hands of the producers – the GPs – rather than patients themselves.

We now are in a situation where uncertainty means that people will get the impression that the whole reform is a mess.

I remain convinced that we are oversentimental about any discussion regarding the NHS and that the issue is one of behaviour rather than structure. The interview by Claire Rayner's son Jay on the Today programme this morning (starts at 2hrs, 14mins, 25secs) about training people in compassion in the NHS said it all.

Then again, all that said, this is an early lesson for the coalition about the failure to challenge, and assumptions from the very top.

Olly Grender was director of communications for the Liberal Democrats between 1990 and 1995.

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Will Jeremy Corbyn stand down if Labour loses the general election?

Defeat at the polls might not be the end of Corbyn’s leadership.

The latest polls suggest that Labour is headed for heavy defeat in the June general election. Usually a general election loss would be the trigger for a leader to quit: Michael Foot, Gordon Brown and Ed Miliband all stood down after their first defeat, although Neil Kinnock saw out two losses before resigning in 1992.

It’s possible, if unlikely, that Corbyn could become prime minister. If that prospect doesn’t materialise, however, the question is: will Corbyn follow the majority of his predecessors and resign, or will he hang on in office?

Will Corbyn stand down? The rules

There is no formal process for the parliamentary Labour party to oust its leader, as it discovered in the 2016 leadership challenge. Even after a majority of his MPs had voted no confidence in him, Corbyn stayed on, ultimately winning his second leadership contest after it was decided that the current leader should be automatically included on the ballot.

This year’s conference will vote on to reform the leadership selection process that would make it easier for a left-wing candidate to get on the ballot (nicknamed the “McDonnell amendment” by centrists): Corbyn could be waiting for this motion to pass before he resigns.

Will Corbyn stand down? The membership

Corbyn’s support in the membership is still strong. Without an equally compelling candidate to put before the party, Corbyn’s opponents in the PLP are unlikely to initiate another leadership battle they’re likely to lose.

That said, a general election loss could change that. Polling from March suggests that half of Labour members wanted Corbyn to stand down either immediately or before the general election.

Will Corbyn stand down? The rumours

Sources close to Corbyn have said that he might not stand down, even if he leads Labour to a crushing defeat this June. They mention Kinnock’s survival after the 1987 general election as a precedent (although at the 1987 election, Labour did gain seats).

Will Corbyn stand down? The verdict

Given his struggles to manage his own MPs and the example of other leaders, it would be remarkable if Corbyn did not stand down should Labour lose the general election. However, staying on after a vote of no-confidence in 2016 was also remarkable, and the mooted changes to the leadership election process give him a reason to hold on until September in order to secure a left-wing succession.

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