It's too early for the Lib Dems to declare "victory"

The battle over Andrew Lansley's NHS reforms isn't over yet.

He may once have boasted that Andrew Lansley's NHS reforms were in the Liberal Democrat manifesto but Nick Clegg is still hailing their dilution as his biggest "victory" since the coalition began. The cause of such excitement is the publication by Steve Field, the GP who led the government's "listening exercise", of a report into the reforms, although most of the key changes were announced in David Cameron's speech last week. To summarise, the 2013 deadline for the creation of GP-led consortiums will be "relaxed"; membership of the consortiums will be opened up to hospital doctors and nurses, and the main duty of Monitor, the health regulator, will be to promote "integration", not "competition".

To the consternation of the Tories, Clegg has published a "scorecard" showing that the Lib Dems have secured 11 of the 13 changes demanded by its conference. In the Independent, a jubilant Shirley Williams declares that, thanks to her party's efforts, "the Prime Minister will be able to say with confidence that the NHS is safe in the Coalition's hands".

More cautious types are reminding the Lib Dems that the political wrangling isn't over yet. Clegg, Cameron and Andrew Lansley will issue their own response to the report at a joint event tomorrow, and the Tory right are using the intervening period to demand a limit to the concessions.

Then there's the question of NHS funding, a landmine primed to explode at some point in the near future. As I noted last week, Cameron is on course to break his pledge to increase spending on the health service - higher inflation means that it faces a real-terms cut. The coalition's NHS woes are far from over.

But it would still be churlish to deny that this is some of the best press the Lib Dems have had since the coalition was formed. The government's decision to "modify" its £26,000 benefits cap has already been successfully spun as another victory for Clegg's party. Whether the voters will give them any credit, however, remains to be seen.

George Eaton is political editor of the New Statesman.

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The big problem for the NHS? Local government cuts

Even a U-Turn on planned cuts to the service itself will still leave the NHS under heavy pressure. 

38Degrees has uncovered a series of grisly plans for the NHS over the coming years. Among the highlights: severe cuts to frontline services at the Midland Metropolitan Hospital, including but limited to the closure of its Accident and Emergency department. Elsewhere, one of three hospitals in Leicester, Leicestershire and Rutland are to be shuttered, while there will be cuts to acute services in Suffolk and North East Essex.

These cuts come despite an additional £8bn annual cash injection into the NHS, characterised as the bare minimum needed by Simon Stevens, the head of NHS England.

The cuts are outlined in draft sustainability and transformation plans (STP) that will be approved in October before kicking off a period of wider consultation.

The problem for the NHS is twofold: although its funding remains ringfenced, healthcare inflation means that in reality, the health service requires above-inflation increases to stand still. But the second, bigger problem aren’t cuts to the NHS but to the rest of government spending, particularly local government cuts.

That has seen more pressure on hospital beds as outpatients who require further non-emergency care have nowhere to go, increasing lifestyle problems as cash-strapped councils either close or increase prices at subsidised local authority gyms, build on green space to make the best out of Britain’s booming property market, and cut other corners to manage the growing backlog of devolved cuts.

All of which means even a bigger supply of cash for the NHS than the £8bn promised at the last election – even the bonanza pledged by Vote Leave in the referendum, in fact – will still find itself disappearing down the cracks left by cuts elsewhere. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.