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22 March 2012updated 26 Sep 2015 8:02pm

The real reason Clegg saved the NHS bill

If the junior coalition party had killed the bill, Cameron would have appointed a Lib Dem health sec

By Rafael Behr

The Budget has blown most other political news off the agenda, so it is worth recalling that earlier in the week the cabinet was celebrating what it thought was the passing of a different headache: Andrew Lansley’s NHS reforms. There was apparently a hearty banging of the cabinet table on Tuesday in celebration of the Health and Social Care Bill’s gruesome completion of its parliamentary odyssey. I suspect that jubilation expressed relief rather than pleasure.

Either way, it was premature. Downing Street is hoping that the noisy fury around the NHS reforms will die down now that they aren’t the subject of legislative trench warfare, but no-one is so naive as to think the issue will go away. Every increase in waiting times, every closed ward, every bungled operation will now be firmly blamed (fairly or not) on the choices made by the coalition. This is one area where “clearing up Labour’s mess” really doesn’t apply as a defence.

It has been something of a mystery to me as to why the Lib Dems – who have been well aware of the political toxicity of the health reforms for over a year – didn’t demand that they be dropped. I know that there was some regret in Nick Clegg’s team that the “pause” declared in the passage of the bill was not turned into a full stop last year. I also know that quite a few senior Tories and Downing Street aides came to the same view and rather wished the Lib Dems had killed the monster when they had the chance.

But at that time, Clegg was still very much concerned about coalition being seen to work as a form of government and was wary of obstructing such a big public sector reform. The Tories would have milked the episode for plenty of concessions of their own. Eventually, the Prime Minister decided that it was better to take the pain of trying to implement the reforms than absorb the humiliation of a gigantic u-turn (especially since an irreversible budget squeeze ensured a dose of NHS pain either way). Once Cameron had made that call, the Lib Dems fell into line.

But if they had really wanted to stop the thing, they still could have insisted. And the threat of being contaminated with Tory toxicity on the health service was substantial. So why did Clegg still press ahead? One explanation given to me recently is highly revealing about the way coalition works. There were, I am told, senior Lib Dem discussions until very late in the day about whether or not to kill the NHS bill. The key problem, it was decided – no doubt with the help of dark warnings from the prime minister – was that the quid pro quo for blocking Tory reform of the health service would be total Lib Dem ownership of the issue in the future. In other words, if Clegg wanted to block Lansley, he would have to accept having a Lib Dem secretary of state replace him in the next reshuffle and take responsibility for whatever happened next.

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The message from Cameron was: you break it, you fix it. Wisely, Clegg decided that was not an opportunity he felt like taking. That explains also why there has been chatter about a Lib Dem taking the health portfolio in the near future. They weren’t rumours, they were threats. I’m now fairly sure it won’t happen. That doesn’t mean Lansley won’t be shuffled out – but he’ll have to be replaced by another Tory.