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 5 things the Tories aren't telling you about their manifesto

Turns out the NHS is something you really have to pay for after all. 

When Theresa May launched the Conservative 2017 manifesto, she borrowed the most popular policies from across the political spectrum. Some anti-immigrant rhetoric? Some strong action on rip-off energy firms? The message is clear - you can have it all if you vote Tory.

But can you? The respected thinktank the Institute for Fiscal Studies has now been through the manifesto with a fine tooth comb, and it turns out there are some things the Tory manifesto just doesn't mention...

1. How budgeting works

They say: "a balanced budget by the middle of the next decade"

What they don't say: The Conservatives don't talk very much about new taxes or spending commitments in the manifesto. But the IFS argues that balancing the budget "would likely require more spending cuts or tax rises even beyond the end of the next parliament."

2. How this isn't the end of austerity

They say: "We will always be guided by what matters to the ordinary, working families of this nation."

What they don't say: The manifesto does not backtrack on existing planned cuts to working-age welfare benefits. According to the IFS, these cuts will "reduce the incomes of the lowest income working age households significantly – and by more than the cuts seen since 2010".

3. Why some policies don't make a difference

They say: "The Triple Lock has worked: it is now time to set pensions on an even course."

What they don't say: The argument behind scrapping the "triple lock" on pensions is that it provides an unneccessarily generous subsidy to pensioners (including superbly wealthy ones) at the expense of the taxpayer.

However, the IFS found that the Conservatives' proposed solution - a "double lock" which rises with earnings or inflation - will cost the taxpayer just as much over the coming Parliament. After all, Brexit has caused a drop in the value of sterling, which is now causing price inflation...

4. That healthcare can't be done cheap

They say: "The next Conservative government will give the NHS the resources it needs."

What they don't say: The £8bn more promised for the NHS over the next five years is a continuation of underinvestment in the NHS. The IFS says: "Conservative plans for NHS spending look very tight indeed and may well be undeliverable."

5. Cutting immigration costs us

They say: "We will therefore establish an immigration policy that allows us to reduce and control the number of people who come to Britain from the European Union, while still allowing us to attract the skilled workers our economy needs." 

What they don't say: The Office for Budget Responsibility has already calculated that lower immigration as a result of the Brexit vote could reduce tax revenues by £6bn a year in four years' time. The IFS calculates that getting net immigration down to the tens of thousands, as the Tories pledge, could double that loss.

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines. 

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