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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What Jeremy Corbyn gets right about the single market

Technically, you can be outside the EU but inside the single market. Philosophically, you're still in the EU. 

I’ve been trying to work out what bothers me about the response to Jeremy Corbyn’s interview on the Andrew Marr programme.

What bothers me about Corbyn’s interview is obvious: the use of the phrase “wholesale importation” to describe people coming from Eastern Europe to the United Kingdom makes them sound like boxes of sugar rather than people. Adding to that, by suggesting that this “importation” had “destroy[ed] conditions”, rather than laying the blame on Britain’s under-enforced and under-regulated labour market, his words were more appropriate to a politician who believes that immigrants are objects to be scapegoated, not people to be served. (Though perhaps that is appropriate for the leader of the Labour Party if recent history is any guide.)

But I’m bothered, too, by the reaction to another part of his interview, in which the Labour leader said that Britain must leave the single market as it leaves the European Union. The response to this, which is technically correct, has been to attack Corbyn as Liechtenstein, Switzerland, Norway and Iceland are members of the single market but not the European Union.

In my view, leaving the single market will make Britain poorer in the short and long term, will immediately render much of Labour’s 2017 manifesto moot and will, in the long run, be a far bigger victory for right-wing politics than any mere election. Corbyn’s view, that the benefits of freeing a British government from the rules of the single market will outweigh the costs, doesn’t seem very likely to me. So why do I feel so uneasy about the claim that you can be a member of the single market and not the European Union?

I think it’s because the difficult truth is that these countries are, de facto, in the European Union in any meaningful sense. By any estimation, the three pillars of Britain’s “Out” vote were, firstly, control over Britain’s borders, aka the end of the free movement of people, secondly, more money for the public realm aka £350m a week for the NHS, and thirdly control over Britain’s own laws. It’s hard to see how, if the United Kingdom continues to be subject to the free movement of people, continues to pay large sums towards the European Union, and continues to have its laws set elsewhere, we have “honoured the referendum result”.

None of which changes my view that leaving the single market would be a catastrophe for the United Kingdom. But retaining Britain’s single market membership starts with making the argument for single market membership, not hiding behind rhetorical tricks about whether or not single market membership was on the ballot last June, when it quite clearly was. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.