Lansley fights another day as Cameron backs NHS reform

The PM moves to squash speculation about the Health Secretary's future as the Lords prepare to debat

The Health and Social Care Bill has had anything but an easy ride. A year on from its introduction, the bill -- more controversial than ever -- is returning to the House of Lords.

Yesterday saw intense speculation about the future of the bill, and of its creator, Andrew Lansley. Writing in the Times (£), Rachel Sylvester quoted an anonymous Downing Street source saying that the Health Secretary should be "taken out and shot". She also discussed rumours that the former Labour health secretary, Alan Milburn, could be given a peerage and parachuted into the cabinet.

Rather provocatively, the Times (£) has followed up today with a piece by Milburn, in which he issues a stinging criticism of the bill:

The Health and Social Care Bill is a patchwork quilt of complexity, compromise and confusion. It is incapable of giving the NHS the clarity and direction it needs. It is a roadblock to meaningful reform.

The article is an edited extract of an essay Milburn has written for Reform's The Next Ten Years, published at the beginning of next month, and as such makes no reference to the current speculation. While arch-moderniser Milburn reiterates his belief in the urgency of reform, he also states that he does not "believe that the current government can or will make these changes". Perhaps he will not benefit from a cabinet reshuffle after all.

Indeed, David Cameron is reportedly keen to squash rumours of the imminent demise of Lansley and his bill. Public and professional hostility remain: 90 per cent of respondents in a British Medical Journal poll said the reform should be scrapped, while 50,000 people (including celebrities such as Stephen Fry and Jamie Oliver) have signed a petition to drop it. But it appears that rather than back-tracking, Cameron will throw his weight behind the reforms to get them on the statute book sooner rather than later.

And this might just be possible, as Liberal Democrat peers have indicated that they will end their war on the reform, saying that the changes they secured -- the bill has had more than 1,000 amendments over the last 18 months of battle -- will safeguard the NHS and regulate competition.

So it looks like full steam ahead. But Cameron has some serious work to do if he wants to get the public on board and convince voters that, after his careful work detoxifying, this is not a return to business as usual for the Tories and the NHS.

Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Like it or hate it, it doesn't matter: Brexit is happening, and we've got to make a success of it

It's time to stop complaining and start campaigning, says Stella Creasy.

A shortage of Marmite, arguments over exporting jam and angry Belgians. And that’s just this month.  As the Canadian trade deal stalls, and the government decides which cottage industry its will pick next as saviour for the nation, the British people are still no clearer getting an answer to what Brexit actually means. And they are also no clearer as to how they can have a say in how that question is answered.

To date there have been three stages to Brexit. The first was ideological: an ever-rising euroscepticism, rooted in a feeling that the costs the compromises working with others require were not comparable to the benefits. It oozed out, almost unnoticed, from its dormant home deep in the Labour left and the Tory right, stoked by Ukip to devastating effect.

The second stage was the campaign of that referendum itself: a focus on immigration over-riding a wider debate about free trade, and underpinned by the tempting and vague claim that, in an unstable, unfair world, control could be taken back. With any deal dependent on the agreement of twenty eight other countries, it has already proved a hollow victory.

For the last few months, these consequences of these two stages have dominated discussion, generating heat, but not light about what happens next. Neither has anything helped to bring back together those who feel their lives are increasingly at the mercy of a political and economic elite and those who fear Britain is retreating from being a world leader to a back water.

Little wonder the analogy most commonly and easily reached for by commentators has been that of a divorce. They speculate our coming separation from our EU partners is going to be messy, combative and rancorous. Trash talk from some - including those in charge of negotiating -  further feeds this perception. That’s why it is time for all sides to push onto Brexit part three: the practical stage. How and when is it actually going to happen?

A more constructive framework to use than marriage is one of a changing business, rather than a changing relationship. Whatever the solid economic benefits of EU membership, the British people decided the social and democratic costs had become too great. So now we must adapt.

Brexit should be as much about innovating in what we make and create as it is about seeking to renew our trading deals with the world. New products must be sought alongside new markets. This doesn’t have to mean cutting corners or cutting jobs, but it does mean being prepared to learn new skills and invest in helping those in industries that are struggling to make this leap to move on. The UK has an incredible and varied set of services and products to offer the world, but will need to focus on what we do well and uniquely here to thrive. This is easier said than done, but can also offer hope. Specialising and skilling up also means we can resist those who want us to jettison hard-won environmental and social protections as an alternative. 

Most accept such a transition will take time. But what is contested is that it will require openness. However, handing the public a done deal - however well mediated - will do little to address the division within our country. Ensuring the best deal in a way that can garner the public support it needs to work requires strong feedback channels. That is why transparency about the government's plans for Brexit is so important. Of course, a balance needs to be struck with the need to protect negotiating positions, but scrutiny by parliament- and by extension the public- will be vital. With so many differing factors at stake and choices to be made, MPs have to be able and willing to bring their constituents into the discussion not just about what Brexit actually entails, but also what kind of country Britain will be during and after the result - and their role in making it happen. 

Those who want to claim the engagement of parliament and the public undermines the referendum result are still in stages one and two of this debate, looking for someone to blame for past injustices, not building a better future for all. Our Marmite may be safe for the moment, but Brexit can’t remain a love it or hate it phenomenon. It’s time for everyone to get practical.