9 May 2011

NHS reform: pretty political dance, but what will change?

One senior figure in the NHS said to me this morning that for all the headlines about abandoning bills and the rest of it he felt the public and the media were having “a pretty dance” performed for them.

Nick Clegg has upped the rhetoric and his people are saying things have moved on from last month when Lansley, Clegg and Cameron went to launch the listening exercise near Farnborough. But how much have things really changed?

1) There might be no bill at all? Sources around the PM say that’s not going to happen. There is a school of thought (Stephen Dorrell amongst others) that says there never was any need for a bill in the first place. (Andrew Lansley’s view was that legislation would make it more difficult for subsequent Secretaries of State to undo what he was trying to do.) But Mr Lansley won’t have to put up with the humiliation of dropping the whole bill.

2) A stop to rampant competition in the NHS? Expect the duties outlined for Monitor to be added to. The body will not only be about competition but will be about “promoting co-operation” perhaps, or words to that effect, “promoting integration where appropriate” perhaps too.

3) Slamming on the brakes? Nick Clegg says he wants no compulsory signing up to consortia for GPs. But back in January, Sir David Nicholson said any GPs who weren’t ready to join up into consortia wouldn’t come in anyway. Even opponents of the reforms amongst GPs may find that it’s not something they can afford to stand aside from.

Read more in the Channel 4 News Special Report: NHS uncovered

Nick Clegg is trying to look like the man in charge of the ambulance (Lloyd George’s first attempts at health cover through national insurance were known as “Lloyd George’s Ambulance Wagon”). Sources around David Cameron say that’s not surprising but the DPM is positioning himself to take the credit for something (changes to the NHS reforms) which will happen anyway.

What does all this mean for Andrew Lansley? Well, the word from No. 10 is that he’s staying put. But thinking short to medium term, it occurs to me that the easiest way to dress up “not much fundamental change” as “a radical re-think” would be to get rid of the architect of the reforms, slip in someone like Jeremy Hunt to make soothing noises about a fresh pair of eyes and then (more quietly) plough on with what you were planning to do anyway.

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