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Lansley, Blair and the normalisation myth

Will the health reforms play out as the ex-PM describes? Unlikely.

Well known students of the Tony Blair playbook, David Cameron and his inner circle doubtless have committed the following passages to memory. Taken from the former prime minister's autobiography, A Journey, it recalls an earlier battle with domestic legislation, this time the introduction of university top-up fees in 2003-04.

Blair wrote of those difficulties:

It is an object lesson in the progress of reform; the change is proposed; it is denounced as a disaster; it proceeds with vast chipping away and opposition; it is unpopular; it comes about; within a short space of time, it is as if it had always been so.

He went on:

Rereading the daily news about the changes, I am struck by how fevered each story was at the time, and how forgotten each story is today.

Blair's take is this: a. change can be unpopular but, hey, that's leadership; b. the media obsesses about the minutiae of a revolt but, in time, can barely remember what all the fuss was about; and c. reform, once brought about, becomes the new status quo, the new normality.

All of which should provide some comfort to the Health Secretary Andrew Lansley and his boss. After all, the passage of the Health and Social Care Bill appears -- so far at least -- to have followed the script.

Almost daily, it has been the subject of bad headlines. Take the last week: the uninvited Downing Street guests; the Lansley ambush by a protestor; the inevitable intervention from Tim Farron; and, today, a letter in the Sunday Telegraph that's at once both fawning and a deliberate snub to the Health Secretary.

The bill has led to unpopularity. Having worked hard to repair the Conservatives reputation on health prior to the election, Cameron now finds his party trailing Labour by 15 points as the one that has the "the best approach to the NHS". Moreover, just 20 per cent of voters believe that the health service is "safe in David Cameron's hands". (It is now difficult to believe that in late April 2010, on the eve of the General Election, the Tories led on the management of the NHS).

But if we stick with the Blair diagnosis, Cameron and Lansley need only plough on and the bill will become an act; and life will move on.

This presupposes, however, that the narrative reflects reality.

For every example that seems to bear it out -- such as Margaret Thatcher's council house sell off, hugely contentious at the time but part of the political consensus by the beginning of the 1990s -- there are others that do not, such as the disastrous introduction of the poll tax by the same prime minister.

Or how about the subject Blair writes about, university funding?

Blair's own troubles with tuition fees were not just about hostility towards the policy, they stemmed from an apparent abandonment of a manifesto pledge to do nothing of the kind. There are echoes here of Nick Clegg's own tuition fees U-turn but, more pertinently, of Cameron's promise of "no more top down reorganisations" of the NHS.

Blair's bill passed, thanks to the largesse of his plotting chancellor, and he went on to win a third election in 2005. Yet, nobody can seriously suggest that university funding stopped being a politically contentious issue in 2004.

Meanwhile, Cameron always knew Lansley's bill would be problematic -- declaring "we're fucked" on being briefed on it in May 2010. He'll hope that Blair's narrative plays out and that changes to the NHS will seem as if they had "always been so".

Just don't bet on it.