When the government announced their “pause for reflection” on reorganising the NHS it seemed pretty obvious they were not intending to fundamentally change the plan. If the idea was to take the sting out of the story it may end up doing the opposite.
When the government announced their “pause for reflection” on reorganising the NHS it seemed pretty obvious they were not intending to fundamentally change the plan. There was no suggestion Health Secretary Andrew Lansley thought he had got much wrong. The idea of a pause then seemed to be at least partly about news management : take a minor kicking, make small changes seem like big concessions and plough on quietly in a few months. But as opponents exploit the hiatus the government could be in bigger trouble than it expected. If the idea was to take the sting out of the story it may end up doing the opposite.
Norman Lamb isn’t the highest profile Lib Dem in the world, but the Deputy Prime Minister’s Chief Political Adviser’s decision to come out against Andrew Lansley’s big idea on Sunday was significant because of his proximity to Nick Clegg and the fact he says the leader knew he was going to do it. That makes it much easier for other Lib Dems to do the same and air their grievances with the NHS policy. At the same time Ed Miliband is finally finding a groove on the NHS that he seems to be comfortable with – playing on the natural small c conservatism (or is it fear?) many people feel about meddling with our big national institutions.
However it is hard to see how the main planks of the reorganisation can be changed without effectively scrapping them. Getting rid of Primary Care Trusts and Strategic Health Authorities (and all the administrative staff they both employ) to make GPs decide how the majority of the NHS budget is spent seems to be an article of faith for Andrew Lansley. And although the scale of the reorganisation came as a surprise to most we can’t say we weren’t warned entirely : giving GPs more commissioning power was in the Tory manifesto and the coalition agreement. If you include hospital doctors, pharmacists, patients and others in the process it turns into something quite different, something not unlike a health authority or primary care trust. And further integration of private companies into NHS delivery is something you either do or you don’t. There isn’t really a half way house. It is hard to see what ground the government can give that opponents will see as a substantial enough change to drop their fears.
So the government finds itself in a battle of public opinion over something most Tories probably never wanted to have a huge fight about, and Lib Dems didn’t want to do. And many on boths sides of the coalition clearly didn’t see it coming. For although the coalition agreement talked about more GP powers it also suggested Primary Care Trusts would be strengthened and made more accountable, not scrapped :
“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT)……The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.”
The question is did David Cameron know this was exactly what the policy was going to be when he went into the election and then the coaltion negotiations? Either he did and he quietly kept it out of the pre-election debate, or he didn’t and has been pushed into it by his Health Secretary after the event. If that’s the case it might explain why you still hear whispers the man some in the government really want to take over the health brief is one Stephen Dorrell, Health Secretary from 1995-97. Could we see another great comeback to go with a great rethink?