The coalition's NHS U-turn

Andrew Lansley abandons plans to introduce price competition.

Two weeks ago, when I listed the coalition's ten biggest U-turns, I suggested that the NHS was next in line. "The smart money is on the government watering down its reforms," I wrote.

Sure enough, Andrew Lansley has announced a major U-turn over NHS price competition. The Health Secretary is planning to amend his own bill to prevent providers from charging a maximum, as opposed to a fixed, price for treatment. In other words, the private sector will not be handed free rein to offer temporary loss leaders and undercut the NHS.

The NHS Operating Framework, published in December, stated that hospitals would be free to offer services to commissioners "at less than the published mandatory tariff price". But Lansley now tells the Financial Times: "We want the tariff to be a nationally regulated price, not a starting point for price competition. These amendments will put our intentions beyond doubt."

It takes some chutzpah for him to claim that he never wanted to introduce price competition in the first place, but the U-turn should be welcomed all the same. As studies by the LSE and Imperial have shown, the limited experiment with price competition during the Major government led to a decline in standards of care.

One doubts that this will be the last concession. The "mad" decision (in the words of the British Medical Journal) to introduce the biggest upheaval in the service's history, just when the NHS is required to make unprecedented savings of £15-20bn, will return to haunt the coalition.

Here's the key passage from the BMJ's must-read editorial on the subject:

Sir David Nicholson, the NHS chief executive, has described the proposals as the biggest change management programme in the world -- the only one so large "that you can actually see it from space." (More ominously, he added that one of the lessons of change management is that "most big change management systems fail.")

Of the annual 4% efficiency savings expected of the NHS over the next four years, the Commons health select committee said, "The scale of this is without precedent in NHS history; and there is no known example of such a feat being achieved by any other healthcare system in the world." To pull off either of these challenges would therefore be breathtaking; to believe that you could manage both of them at once is deluded.

How long will the coalition remain in denial?

George Eaton is political editor of the New Statesman.

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Theresa May knows she's talking nonsense - here's why she's doing it

The Prime Minister's argument increases the sense that this is a time to "lend" - in her words - the Tories your vote.

Good morning.  Angela Merkel and Theresa May are more similar politicians than people think, and that holds true for Brexit too. The German Chancellor gave a speech yesterday, and the message: Brexit means Brexit.

Of course, the emphasis is slightly different. When May says it, it's about reassuring the Brexit elite in SW1 that she isn't going to backslide, and anxious Remainers and soft Brexiteers in the country that it will work out okay in the end.

When Merkel says it, she's setting out what the EU wants and the reality of third country status outside the European Union.  She's also, as with May, tilting to her own party and public opinion in Germany, which thinks that the UK was an awkward partner in the EU and is being even more awkward in the manner of its leaving.

It's a measure of how poor the debate both during the referendum and its aftermath is that Merkel's bland statement of reality - "A third-party state - and that's what Britain will be - can't and won't be able to have the same rights, let alone a better position than a member of the European Union" - feels newsworthy.

In the short term, all this helps Theresa May. Her response - delivered to a carefully-selected audience of Leeds factory workers, the better to avoid awkward questions - that the EU is "ganging up" on Britain is ludicrous if you think about it. A bloc of nations acting in their own interest against their smaller partners - colour me surprised!

But in terms of what May wants out of this election - a massive majority that gives her carte blanche to implement her agenda and puts Labour out of contention for at least a decade - it's a great message. It increases the sense that this is a time to "lend" - in May's words - the Tories your vote. You may be unhappy about the referendum result, you may usually vote Labour - but on this occasion, what's needed is a one-off Tory vote to make Brexit a success.

May's message is silly if you pay any attention to how the EU works or indeed to the internal politics of the EU27. That doesn't mean it won't be effective.

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

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