The Staggers

The New Statesman’s rolling politics blog

NHS reform is a never-ending nightmare for Cameron

The Prime Minister could end up with a reputation as the man who broke the NHS.

By Rafael Behr Published 14 October 2011 12:28

The NHS bill cleared a legislative hurdle in the Lords this week . But that doesn't really solve any of the political problems facing the government's reforms. Of those problems, one of the biggest is that the coalition doesn't seem to have a clear grasp of why Andrew Lansley's plans are causing so much difficulty.

The one thing everyone can agree on is that the plans have been appallingly presented. Lansley cooked them up in the Department of Health without much input or scrutiny from Downing Street. (So blindsided was the prime minister that the episode triggered a whole re-organisation of the Number 10 policy operation earlier this year.) According to one senior civil servant at the heart of the operation, when Cameron was first presented with Lansley's plan he skimmed the introduction and then turned to his aides in shock and disbelief and said "have you read this stuff?!" He had, until then, had no idea of the scale of what was being planned.

There was a moment, towards the end of January, when a u-turn was still an option. But Cameron feared looking weak by abandoning such a huge public sector policy drive - and, reasonably enough, worried that dropping the reforms would implicitly confirm voters' suspicions that the Tories had some hidden agenda on health. A u-turn would make it look as if they had been rumbled. The way senior figures in government tell the story, Cameron's foot hovered between the brake and the accelerator, finally choosing the latter. That now looks like a huge mistake.

The essential miscalculation was the PM's assumption that if he personally threw some weight behind the cause - deploying the powers of persuasion in which he has considerable confidence - the public mood might shift. Of course, the Conservatives did not count on a Lib Dem backlash, sanctioned from the top of the party as a device to "differentiate" the junior coalition partner (fearful of losing its identity) over an issue of famous toxicity to the Tories. Some of the Lib Dem turbulence around the NHS earlier this year was principled objection to the reforms but some is retaliation for the Tories' personal attacks on Nick Clegg during the referendum campaign on the alternative vote. The compromise package that ended up before the Lords this week was therefore a mangled monster consisting of the original Lansley plan with heaps of ad hoc Lib Dem caveats, brakes, disruptions and supposed safeguards.

And there lies the government's problem. The reform it is now trying to sell is the expression of Westminster political choreography and not a coherent response to the needs of the health service. Everyone in the NHS knows it and voters can sense it.

Cameron and Lansley have tried to sell the need for reform on the grounds that the health service cannot cope with rising levels of demand without major structural change (especially when there is no more money to fund the existing system). My own impression is that they haven't got that message across too well. One thing, however, is certain and that is their failure to persuade people of the follow-up assertion that the only solution lies in much more private sector involvement using much more vigorous competition to provide services. The Lib Dems and Labour are just as queasy about bald expressions of that view - it is, essentially, the Blairite model of public sector reform and has advocates in all three main Westminster parties.

But opponents of Lansley's plans don't need to rebut the theoretical premise on which it rests because (a) they can just accuse the government of unleashing needless revolutionary chaos in the NHS, which is plainly true and (b) they can accuse the prime minister of reneging on a pledge not to do (a), which is also true. Plus, (c) voters' mistrust of the Tories over the health service is visceral. Whatever it is the Tories are doing will raise suspicions of an ulterior motive; Cameron and Lansley have done everything possible to confirm that view by failing to sell the reforms on their own terms. You can't credibly insist that there will be no privatization of the health service when the core concept of the reforms is to promote more competition and more private sector involvement. OK, so it's not privatization in way that BT and BA were sold off in the Eighties, but it's hardly reinforcing the "national" in National Health Service.

The only way to actually persuade people that the Lansley plan is any good would be to sell the first principle of increased marketisation in health care but, implicitly, the Tories have accepted that such an approach is toxic to their political reputation. Besides, changes demanded by the Lib Dems have corrupted Lansley's vision enough that - even if it were the best way forward (which I doubt) - it can't be implemented as the health secretary envisaged. Meanwhile, there are £20bn of "efficiency savings" to be found, which will feel like cuts and inflation at around 5 per cent, which will have an impact on health budgets that will also feel like cuts. Every doctor and nurse in the country will have motive and cause to blame the government for every refused treatment and every bad outcome.

David Cameron needs to wake up to the fact that he has allowed a process to get underway whose long term outcome could easily be an historic reputation for him as the man who broke the NHS.

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Tags: NHS

More from Rafael Behr

View the discussion thread.

22 comments

Fri, 2011-10-14 13:41 — celeriac (not verified)

I think they are unable to sense that policy can and actually does, translate into life and death situations for the average 'man in the street'.

Cameron already has a reputation as an enthusiastic lightweight, we are just watching how out of depth he is, play out.

Fri, 2011-10-14 13:45 — Anton Jury (not verified)

David Cameron and other Tories will only be satisfied when all the lower classes are begging for food, dying and suffering because of lack of health care.

Under these evil Tories we are heading towards Barbaric Times !

I bet Cameron and Company feel Almighty !

Fri, 2011-10-14 13:51 — ang (not verified)

Well, when it does break-up and believe me it will, Cameron will thoroughly deserve his reputation to be relegated to the gutter.
Leave our public services alone you over-privelaged, out of touch toff!!!!

Sat, 2011-10-15 12:46 — Sid Nanobot, Neasden (not verified)

I suspect Cameron will have cause to wish the vote had been lost in the Lords. That way he could have thrown up his hands in mock despair and abandoned the bill due to circumstances beyond his control.

Fri, 2011-10-14 14:56 — Arturo Bandini (not verified)

Oh, poor Luddite - you sound worried, mate!

Fri, 2011-10-14 14:59 — JacquesOuze

Penetrating analysis as ever Luddite.

Fri, 2011-10-14 15:03 — Livers (not verified)

We'll cut the deficit not the NHS.

Looks like they're heading for a fail on both. That Electoral poster will come back and haunt them BIG TIME.

Sun, 2011-10-16 20:32 — Saltley Gates (not verified)

Tom

Those who forgetb their past are destined to repeat it

Fighting Privatisation of the NHS IS RIGHT I FIGHT WITH ANYONE WILLING TOO FIGHT I have worked in front line NHS for 30 yrs Fighting Tory Labour and now ConDems

Labour has paved way for these changes
Labour PFI
Labour Foundation Trust
Labour Internal Market
Labour Privatised NHS Logistics
Labour began GP Commissioning
Labour outsourced jobs and services
Labour weakened pension rights
Labour attacked Trade Unions
Labour smashed Community Health Councils
Labour X Ministers as CONsultants are pimping the NHS to highest bidder.

Burnham is already talking of making a deal with Tories on GP Commissioning
That is why it matters, you have to remember Labours shameful role; because in this fight whose side are they on. Not on the side of the NHS...not on our side
So we have to know who our enemies are

Where is the fight NOT with GPs or Drs who could easily stop these changes. They could stop it tomorrow by arranging referendum amongst themselves to discuss proposals and action against Bill and send PM letter saying withdraw Bill

But Medics wont do this and its up to Health Workers as usual to defend core principals of NHS

LABOUR WONT FIGHT FOR CORE PRINCIPALS
The Labour Party have not organised a single meeting, leaflet or march
in opposition to Bill and in defence of NHS
IT IS WORTH ASKING WHY

Labour Sells Out

Only Direct Action Will Save the NHS

Fri, 2011-10-14 16:15 — Nilsey105

"The Prime Minister could end up with a reputation as the man who broke the NHS". he may, but i think he will be known as;

David Cameron,The biggest liar in British Politics ever. Even being more adept at lieing than Tony Blair.

Fri, 2011-10-14 16:33 — Nick2 (not verified)

Nilsey, I don't think Cameron is at at all adept at lying: he's always getting found out!

Sat, 2011-10-15 20:41 — Saltley Gates (not verified)

Remember Labour paved the way for the ConDems NHS Privatisation Bill

Labour could have stregnthened Democracy,Co-operation, Accountabilty, Ownership and Solidarity in the NHS

Instead Labours Foundation Trusts introduced from the USA by Milburne, now a privatisation consultant, without any manifesto promise or discussion.

The break up was increased by Labours backing bullying management whose aim was competition and profit.

Labour re-introduced the Tories Internal Market driving more competition.

Labour opened up variopus Services to Private Sector so that Mental Health is now 20% in private sector with some Clinical areas having Private Sector Providers as the main providers

Labours PFI was another mechanism taking assetts outside NHS and into private sector There has been massive looting by the Private Sector whose profit margins can be massive.

Labour dismantled any real accountabilty or regulation So Community Health Councils abolished to make way for increasingly tame, Management or Corporate CAPTURED organisation with few powers, no real democracy and little impact

Labours real attack was on pay and conditions of Health Workers continously outsourcing jobs, allowing more Temporary contracts,poorer pensuions rights
Health Workers were told over and over to shut up and any one speaking out fpr patients was victimised with Labour Party sitting on sidelines allowing it.

In place of real accountability and Democracy we got the stupid NHS Constitution a long list of platitudes, wishes and half truths with no real meaning but lots of glossy pamphlets and posters

Conclusion Labour wanted to do to the NHS just what the ConDems are now doing
Burnham now Shadow Health Secretary is a rightwing Neo Liberal Blairite
Burnham pioneered GP Commissioning Burnham wants to have nice talkas with ConDems to pave way for GP Commisioning but stop rest of Bill
Like saying we will accept the Cancer so long as you withdraw the Diptheria and Small Pox

The Labour Party has been spineless
where were they in Demos against this Bill How many meetings and rallies did Labour Run?
How many Hospital Meetings, Pamphlets,Blogs or even Leaflets

Lets face facts Labour would do the same as the Tories Thje NHS is an embarassment that they want to destroy.

Ideologically Labour has caved in to Neo Liberal views of HealthCare Labour have accepted the lies about the NHS and want more privatisation and competition Labour are incapable of fighting for the NHS

Labour has sold out our NHS

NHS Privatiser Burnham must GO.

Sun, 2011-10-16 01:33 — Tom (not verified)

@ Saltley Gates
Never mind who did what in the past, the crucial thing is to stop the damage now and reverse these policies before the whole thing falls apart.
Lansley has done his best to take the NHS beyond the point of no return before the bill even becomes law.
If the public make it a party political issue and focus on apportioning blame rather than saving the day, total destruction and privatisation will flood in while we argue.
The medical profession must continue to speak out against these reforms. They could withdraw their goodwill and co- operation. We must be prepared to support them in this.

Sun, 2011-10-16 02:24 — Tom (not verified)

Cameron's problems neither stem from how the plans were presented nor that the public 'sense' that the 'compromise package' is not a 'coherent response to the needs of the health service'. They stem from the fundamental point that the changes are unsound and are driven solely by Tory ideology and greed. Both the original and amended bill will not solve anything but instead create a system that will cost far more and deliver far less. The only beneficiaries will be the private healthcare companies, their shareholders and party funds.

Before the sham 'pause' and 'listening' exercise we were told that opposition to the bill was caused by them, because they had not explained matters to us properly. They can be as patronising as they like, but the truth is we understood things only too clearly. There is no way on earth that any form of presentation of this criminal outrage could make it acceptable to the people of this country.

It is within Cameron's power to end his 'never-ending nightmare'. He can sack Lansley, sack Hilton and withdraw the bill.

Tue, 2011-10-18 16:02 — Broga

Cameron is the heir of Blair.Neither of these privileged "I'm in politics for the power and the fame" public schoolboys have the faintest notion of the life of what used to be called the working class. Bullingdon Boy Cameron and Holy Tony Blair (currently earning £millions) learned how to fake sincerity. Now the extent of their faking may be starting to be revealed.

Sun, 2011-10-16 09:46 — dr kim holt (not verified)

There was no mandate for these refroms and thousands if not hundreds of thousands of health staff oppose them.It is because they do understand them and they are not going to help the most needy and complex patients. Our opposition is because many of us genuinely care that this will lead in our view to splitting up of health services and privatisation.

Sun, 2011-10-16 09:22 — simon (not verified)

The problem with the planned changes to the NHS is that the Tories have made it too explicit that they want to privatise. They should have pretended that they did not want any competition, but continued the drive the reform forward. That way the public would be none the wiser and private health care could have been delivered in the UK in the next few years.

The bottom line is that we MUST PRIVATISE the NHS. If people can't afford treatment and care that is natural selection, and we should respect it.

Sun, 2011-10-16 12:44 — Tom (not verified)

@ simon 16 October 2011 at 08:22

It is typical of a Tory to propose lying to get your way.

The only natural selection that this country needs is to cleanse ourselves of you foul, corrupt Tory Nazi types.

You have not thought it through properly - not all Tory voters are actually wealthy enough to afford total health care, also you need the riff-raff (and by that I mean the nice decent people) to do the jobs that are beneath you, to prop up the country and pay taxes to keep the infrastructure going. This allows you to live in luxury, feeling superior while large nmbers of you avoid paying your taxes.

By the way, we did not rumble the privatisation plan because of the competition element, it was perfectly obvious when Lansley introduced the GP plan.

Sat, 2011-10-15 03:51 — Chir0n

Yes Mr Behr, you’re absolutely right. We, the people, have failed to get behind the NHS reforms because they haven’t been properly explained to us and, being idiots, we haven’t understood.

The electorate is not behind the Health and Social care bill because it is rubbish and we understand completely that it will likely lead to privatisation of the health service, and despite your claim that “opponents of Lansley's plan don't need to rebut the theoretical premise on which it rests”, plenty have. Neither my friends and acquaintances nor I are plugged-in political commentators like you, but we are responsible voters and, particularly on this issue, we can more than “sense” what’s going on, we know. Historically, the NHS has been such a toxic issue for the Tories because of their own very real toxicity, and never before has this been more obvious nor their agenda so bold and never before has the electorate been more justified in not trusting them on national health.

Sat, 2011-10-15 09:06 — matthew fox (not verified)

Luddite's caps lock seems to malfunctioned.

It will be ironic in few years time, when Luddite dials 999, which by then will be premium line charged £1.50 per minute, and handled by a call centre in Bangkok.

Once he has agreed to pay for the cost of the ambulance, using a payment plan which comprises of five monthly payments, I think he will see the errors of his way.

Fri, 2011-10-21 19:44 — mike cobley (not verified)

Saltley, its pretty straightforward - New Labour was the triumph of the rightwing Blair-led cabal and post-election Labour is still being run by the fagends of the Blair/Brown regime. Until they've been sidelined, Labour will not be able to remake itself, starting with an open repudiation of much of the Blair program. Until then, true opposition can only come from the grassroots and ordinary people.

Sun, 2011-10-16 14:51 — bmh_123 (not verified)

There seems to be a nieve assumption here that Cameron is a moderate. He isnt. He is part of these plans to kill the NHS. I find it amazing the assumption that this guy is a moderate one nation Tory. He is not. He is just as much on the far right of his party as Liam Fox. Take it from me. He lies