Lansley tells Cameron: “Back me or sack me”

The Health Secretary issues an ultimatum to Cameron after Clegg’s latest intervention.

After a week that has seen Nick Clegg threaten to dismantle most of Andrew Lansley's key NHS reforms – without a hint of dissent from David Cameron – it's not surprising that the Health Secretary's patience is wearing thin.

Four months ago, Clegg, like almost every other Liberal Democrat MP, voted in favour of the Health and Social Care Bill at its second reading. Yet he now insists that the NHS will not be open to any "any qualified provider" and that the reforms must promote co-operation, rather than competition.

Today's Daily Mail reports that Lansley has told Cameron to "back me or sack me", in a final attempt to persuade the PM to come to his aid. The Health Secretary came close to issuing such an ultimatum in public when he declared: "I don't want to do any other cabinet job. I'm someone who cares about the NHS who happens to be a politician, not the other way around."

Lansley's threat prompts the question: at what point would he walk away? He has already accepted that Monitor, the health regulator, will not be used to enforce competition and that GP-led consortiums will now include nurses and local officials on their commissioning boards. But he is less likely to accept the abandonment of the "any qualified provider" clause – one of the defining features of his proposals.

The key question remains whether Cameron shares Clegg's objections to the reforms, or whether his deputy is merely freelancing. It is hard to see how Cameron could accept Clegg's demands without precipitating Lansley's departure and further antagonising his increasingly restive backbenchers.

George Eaton is political editor of the New Statesman.

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Brexit could destroy our NHS – and it would be the government's own fault

Without EU citizens, the health service will be short of 20,000 nurses in a decade.

Aneurin Bevan once said: "Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community."

And so, in 1948, the National Health Service was established. But today, the service itself seems to be on life support and stumbling towards a final and fatal collapse.

It is no secret that for years the NHS has been neglected and underfunded by the government. But Brexit is doing the NHS no favours either.

In addition to the promise of £350m to our NHS every week, Brexit campaigners shamefully portrayed immigrants, in many ways, as as a burden. This is quite simply not the case, as statistics have shown how Britain has benefited quite significantly from mass EU migration. The NHS, again, profited from large swathes of European recruitment.

We are already suffering an overwhelming downturn in staffing applications from EU/EAA countries due to the uncertainty that Brexit is already causing. If the migration of nurses from EEA countries stopped completely, the Department of Health predicts the UK would have a shortage of 20,000 nurses by 2025/26. Some hospitals have significantly larger numbers of EU workers than others, such as Royal Brompton in London, where one in five workers is from the EU/EAA. How will this be accounted for? 

Britain’s solid pharmaceutical industry – which plays an integral part in the NHS and our everyday lives – is also at risk from Brexit.

London is the current home of the highly prized EU regulatory body, the European Medicine Agency, which was won by John Major in 1994 after the ratification of the Maastricht Treaty.

The EMA is tasked with ensuring that all medicines available on the EU market are safe, effective and of high quality. The UK’s relationship with the EMA is unquestionably vital to the functioning of the NHS.

As well as delivering 900 highly skilled jobs of its own, the EMA is associated with 1,299 QPPV’s (qualified person for pharmacovigilance). Various subcontractors, research organisations and drug companies have settled in London to be close to the regulatory process.

The government may not be able to prevent the removal of the EMA, but it is entirely in its power to retain EU medical staff. 

Yet Theresa May has failed to reassure EU citizens, with her offer to them falling short of continuation of rights. Is it any wonder that 47 per cent of highly skilled workers from the EU are considering leaving the UK in the next five years?

During the election, May failed to declare how she plans to increase the number of future homegrown nurses or how she will protect our current brilliant crop of European nurses – amounting to around 30,000 roles.

A compromise in the form of an EFTA arrangement would lessen the damage Brexit is going to cause to every single facet of our NHS. Yet the government's rhetoric going into the election was "no deal is better than a bad deal". 

Whatever is negotiated with the EU over the coming years, the NHS faces an uncertain and perilous future. The government needs to act now, before the larger inevitable disruptions of Brexit kick in, if it is to restore stability and efficiency to the health service.

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