Is the NHS reform overhaul merely cosmetic?

The government has accepted "core" changes to its NHS reform -- but the coalition's NHS headache is

The Health Secretary Andrew Lansley has confirmed significant changes to the government's NHS reforms, following a 10 week "listening exercise".
This looks like a significant victory for the Liberal Democrats, who resoundingly voted against moves to introduce greater competition. Reportedly, Nick Clegg was cheered by his MPs last night when he told them their demands had been "very, very handsomely met". In another victory for Clegg, the bill will return to committee stage in the House of Commons, meaning that it will not become law until next year.

At a joint press conference with David Cameron and Lansley, Clegg said that the government now has a plan "we can all get behind". The two key changes are watering down Monitor's role in promoting competition, and relaxing the 2013 deadline for reform.

While this is a significant step forwards, however, the coalition's NHS headache is not over yet. Cameron now faces the challenge of winning over Tory backbenchers who are angry at the way Lansley has been treated. It is believed that he was subjected to unfair briefings, given that his white paper on health was agreed by Clegg and Cameron last year.

However, Lansley and Cameron have both stressed that while the detail has been modified, the fundamentals of the plan -- giving greater commissioning powers to GPs and allowing greater competition in the health service -- are unchanged.

Gary Gibbon suggests that even these changes to the detail could be merely cosmetic:

Changing the terms for Monitor, the NHS regulator, is an interesting one too. I just asked a very senior member of the NHS Future Forum what was the difference is between an economic regulator and a sector regulator. "There's no difference," he said. If Monitor is no longer about "promoting" competition, what is its role on competition I asked. "Enabling" competition, came the answer. These are "totemic" changes, he said. You don't need a regulator to "promote competition" if you've created the space for competition. It'll just come, like breathing.

My source said the Forum frequently felt it was trying to put the original plans into politically acceptable language, not make radical change to the original Lansley reforms.

All this could be wishful thinking by supporters of the original reforms but I pass it on.

Conservative MP Sarah Wollaston, a former doctor and critic of the original bill, described these new proposals as "a change in emphasis". The Lib Dems are certainly entitled to their jubilation at these concessions -- but at this stage, it is impossible to tell what this will mean in practice.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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The NS leader: Cold Britannia

Twenty years after the election of New Labour, for the left, it seems, things can only get worse. 

Twenty years after the election of New Labour, for the left, it seems, things can only get worse. The polls suggest a series of grim election defeats across Britain: Labour is 10 points behind the Conservatives even in Wales, putting Theresa May’s party on course to win a majority of seats there for the first time in a century. Meanwhile, in Scotland, the psephologist John Curtice expects the resurgent Tories, under the “centrist” leadership of Ruth Davidson, to gain seats while Labour struggles to cling on to its single MP.

Where did it all go wrong? In this week’s cover essay, beginning on page 26, John Harris traces the roots of Labour’s present troubles back to the scene of one of its greatest triumphs, on 1 May 1997, when it returned 418 MPs to the Commons and ended 18 years of Conservative rule. “Most pop-culture waves turn out to have been the advance party for a new mutation of capitalism, and so it proved with this one,” Mr Harris, one of the contributors to our New Times series, writes. “If Cool Britannia boiled down to anything, it was the birth of a London that by the early Noughties was becoming stupidly expensive and far too full of itself.”

Jump forward two decades and London is indeed now far too dominant in the British economy, sucking in a disproportionate number of graduates and immigrants and then expecting them to pay £4 for a milky coffee and £636,777 for an average house. Tackling the resentment caused by London’s dominance must be an urgent project for the Labour Party. It is one that Mr Corbyn and his key allies, John McDonnell, Emily Thornberry and Diane Abbott, are not well placed to do (all four are ultra-liberals who represent
London constituencies).

Labour must also find a happy relationship with patriotism, which lies beneath many of the other gripes made against Mr Corbyn: his discomfort with the institutions of the British state, his peacenik tendencies, his dislike of Nato and military alliances, his natural inclination towards transnational or foreign liberation movements, rather than seeking to evolve a popular national politics.

New Labour certainly knew how to wave the flag, even if the results made many on the left uncomfortable: on page 33, we republish our Leader from 2 May 1997, which complained about the “bulldog imagery” of Labour’s election campaign. Yet those heady weeks that followed Labour’s landslide victory were a time of optimism and renewal, when it was possible for people on the left to feel proud of their country and to celebrate its achievements, rather than just apologise for its mistakes. Today, Labour has become too reliant on misty invocations of the NHS to demonstrate that it likes or even understands the country it seeks to govern. A new patriotism, distinct from nationalism, is vital to any Labour revival.

That Tony Blair and his government have many detractors hardly needs to be said. The mistakes were grave: the catastrophic invasion of Iraq, a lax attitude to regulating the financial sector, a too-eager embrace of free-market globalisation, and the failure to impose transitional controls on immigration when eastern European states joined the EU. All contributed to the anger and disillusionment that led to the election as Labour leader of first the hapless Ed Miliband and then Jeremy Corbyn, a long-time rebel backbencher.

However, 20 years after the victory of the New Labour government, we should also acknowledge its successes, not least the minimum wage, education reform, Sure Start, a huge fall in pensioner poverty and investment in public services. Things did get better. They can do so again.

The far right halted

For once, the polls were correct. On 23 April, the centrist Emmanuel Macron triumphed in the first round of the French election with 24 per cent of the vote. The Front National’s Marine Le Pen came second with 21.3 per cent in an election in which the two main parties were routed. The two candidates will now face off on 7 May, and with the mainstream candidates of both left and right falling in behind Mr Macron, he will surely be France’s next president.

“There’s a clear distinction to be made between a political adversary and an enemy of the republic,” said Benoît Hamon, the candidate of the governing Parti Socialiste, who had strongly criticised Mr Macron during the campaign. “This is deadly serious now.” He is correct. Mr Macron may be a centrist rather than of the left but he is a democratic politician. Ms Le Pen is a borderline fascist and a victory for her would herald a dark future not just for France but for all of Europe. It is to Donald Trump’s deep shame that he appeared to endorse her on the eve of the vote.

This article first appeared in the 27 April 2017 issue of the New Statesman, Cool Britannia 20 Years On

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