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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George Osborne's surplus target is under threat without greater austerity

The IFS exposes the Chancellor's lack of breathing space.

At the end of the last year, I noted how George Osborne's stock, which rose dramatically after the general election, had begun to plummet. His ratings among Tory members and the electorate fell after the tax credits imbroglio and he was booed at the Star Wars premiere (a moment which recalled his past humbling at the Paralympics opening ceremony). 

Matters have improved little since. The Chancellor was isolated by No.10 and cabinet colleagues after describing the Google tax deal, under which the company paid £130m, as a "major success". Today, he is returning from the Super Bowl to a grim prognosis from the IFS. In its Green Budget, the economic oracle warns that Osborne's defining ambition of a budget surplus by 2019-20 may be unachievable without further spending cuts and tax rises. 

Though the OBR's most recent forecast gave him a £10.1bn cushion, reduced earnings growth and lower equity prices could eat up most of that. In addition, the government has pledged to make £8bn of currently unfunded tax cuts by raising the personal allowance and the 40p rate threshold. The problem for Osborne, as his tax credits defeat demonstrated, is that there are few easy cuts left to make. 

Having committed to achieving a surplus by the fixed date of 2019-20, the Chancellor's new fiscal mandate gives him less flexibility than in the past. Indeed, it has been enshrined in law. Osborne's hope is that the UK will achieve its first surplus since 2000-01 just at the moment that he is set to succeed (or has succeeded) David Cameron as prime minister: his political fortunes are aligned with those of the economy. 

There is just one get-out clause. Should GDP growth fall below 1 per cent, the target is suspended. An anaemic economy would hardly be welcome for the Chancellor but it would at least provide him with an alibi for continued borrowing. Osborne may be forced to once more recite his own version of Keynes's maxim: "When the facts change, I change my mind. What do you do, sir?" 

George Eaton is political editor of the New Statesman.