The pressure rises on Andrew Lansley

The Health Secretary failed to rebut the charge that his reforms are "a disruption and a distraction

The coalition's decision to embark on the biggest reorganisation of the NHS in its history always sat uneasily with the need for the service to make record efficiency savings of £20bn. Indeed, the project was once succinctly described by the British Medical Journal as "mad". Now, the health select committee, chaired by the former Conservative health secretary Stephen Dorrell, has warned that the reforms are acting as a "disruption and distraction" and are hindering the NHS's ability to make savings. The committee argues that the health service is relying on short-term cuts and "salami-slicing" to save money, instead of re-thinking the way care is delivered. It all sounds much like the "perfect storm" that Hamish Meldrum, the head of the British Medical Association, spoke of in his interview with NS editor Jason Cowley in this week's magazine.

"It is self-defeating to cut services for patients in order to then re-invest to improve them", an anxious-sounding Andrew Lansley declared on the Today programme this morning (see below). But that is exactly what the Health Secretary stands accused of doing. Moreover, he failed to rebut the central charge that his reforms are undermining the NHS's attempt to save £4bn a year.

Lansley: NHS efficiency savings being done "the right way" (mp3)

David Cameron worked hard in opposition to convince the public that the Conservatives could be trusted with the NHS but it has become one of the biggest headaches for his government. Lansley's chaotic reforms have destroyed Cameron's ambition to depoliticise the issue. As Lord Ashcroft recently observed in his report Project Blueprint: Winning a Conservative majority in 2015, "nobody seemed to know why the reforms were needed and how, even in theory, they were supposed to improve things for patients." Just 20 per cent of voters believe that the NHS is "safe in David Cameron's hands" and Labour has established a 12-point lead over the Tories on health policy.

So, as Lenin asked, what is to be done? Lansley's opponents are determined to see the bill dropped but the widely-respected Dorrell insisted on Today that it was too late to go back. A dramatic U-turn would cause even more disruption, he suggested.

Lansley's own future is less certain. The Health Secretary has failed in the eyes of NHS staff and increasingly lacks the political authority needed to explain and defend the reforms. Should Chris Huhne's legal travails force Cameron to reshuffle his cabinet, he may well take an opportunity to move the discredited Lansley.

George Eaton is political editor of the New Statesman.

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The Conservative-DUP deal is great news for the DUP, but bad news for Theresa May

The DUP has secured a 10 per cent increase in Northern Ireland's budget in return for propping up the Prime Minister.

Well, that’s that then. Theresa May has reached an accord with the Democratic Unionist Party to keep herself in office. Among the items: the triple lock on pensions will remain in place, and the winter fuel allowance will not be means-tested across the United Kingdom. In addition, the DUP have bagged an extra £1bn of spending for Northern Ireland, which will go on schools, hospitals and roads. That’s more than a five per cent increase in Northern Ireland’s budget, which in 2016-7 was just £9.8bn.

The most politically significant item will be the extension of the military covenant – the government’s agreement to look after veterans of war and their families – to Northern Ireland. Although the price tag is small, extending priority access to healthcare to veterans is particularly contentious in Northern Ireland, where they have served not just overseas but in Northern Ireland itself. Sensitivities about the role of the Armed Forces in the Troubles were why the Labour government of Tony Blair did not include Northern Ireland in the covenant in 2000, when elements of it were first codified.

It gives an opportunity for the SNP…

Gina Miller, whose court judgement successfully forced the government into holding a vote on triggering Article 50, has claimed that an increase in spending in Northern Ireland will automatically entail spending increases in Wales and Scotland thanks to the Barnett formula. This allocates funding for Wales, Scotland and Northern Ireland based on spending in England or on GB-wide schemes.

However, this is incorrect. The Barnett formula has no legal force, and, in any case, is calculated using England as a baseline. However, that won’t stop the SNP MPs making political hay with the issue, particularly as “the Vow” – the last minute promise by the three Unionist party leaders during the 2014 independence referendum – promised to codify the formula. They will argue this breaks the spirit, if not the letter of the vow. 

…and Welsh Labour

However, the SNP will have a direct opponent in Wales. The Welsh Labour party has long argued that the Barnett formula, devised in 1978, gives too little to Wales. They will take the accord with Northern Ireland as an opportunity to argue that the formula should be ripped up and renegotiated.

It risks toxifying the Tories further

The DUP’s socially conservative positions, though they put them on the same side as their voters, are anathema to many voters in England, Scotland and Wales. Although the DUP’s positions on abortion and equal marriage will not be brought to bear on rUK, the association could leave a bad taste in the mouth for voters considering a Conservative vote next time. Added to that, the bumper increase in spending in Northern Ireland will make it even harder to win support for continuing cuts in the rest of the United Kingdom.

All of which is moot if the Conservatives U-Turn on austerity

Of course, all of these problems will fade if the Conservatives further loosen their deficit target, as they did last year. Turning on the spending taps in England, Scotland and Wales is probably their last, best chance of turning around the grim political picture.

It’s a remarkable coup for Arlene Foster

The agreement, which ticks a number of boxes for the DUP, caps off an astonishing reversal of fortunes for the DUP’s leader, Arlene Foster. The significant increase in spending in Northern Ireland – equivalent to the budget of the entirety of the United Kingdom going up by £70bn over two years  – is only the biggest ticket item. The extension of the military covenant to Northern Ireland appeals to two longstanding aims of the DUP. The first is to end “Northern Ireland exceptionalism” wherever possible, and the second is the red meat to their voters in offering better treatment to veterans.

It feels like a lifetime ago when you remember that in March 2017, Foster was a weakened figure having led the DUP into its worst election result since the creation of the devolved assembly at Stormont.

The election result, in which the DUP took the lion’s share of Westminster seats in Northern Ireland, is part of that. But so too are the series of canny moves made by Foster in the aftermath of her March disappointment. By attending Martin McGuinness’s funeral and striking a more consensual note on some issues, she has helped shed some of the blame for the collapse of power-sharing, and proven herself to be a tricky negotiator.

Conservatives are hoping it will be plain sailing for them, and the DUP from now on should take note. 

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

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