NHS reforms: can the Coalition achieve what it wants?
Just back from University College Hospital in Bloomsbury where David Cameron is trying to speak about the NHS in a language the voters understand. So he’s touching on his personal experience of using the NHS, talking about pledges on NHS values, making promises on waiting times.
None of which is what the NHS “pause” is about … but David Cameron’s time since Ibiza has been focused on getting the message right on the NHS as well as trying to work out the nitty gritty of the technical, managerial solutions.
On Monitor – that’s the regulator that the Health Secretary said would act like Ofgem promoting competition to force down prices in the NHS – David Cameron says it’ll have the additional (some of the right will say “incompatible”) duty to support “integration” of NHS services.
He’s also promised there will be no private sector cherry-picking of NHS services.
He doesn’t take delivery of the NHS Forum’s report until around the end of the week but he’s decided to jump in ahead of it. He insisted he hadn’t seen it – it’s still being drafted – but the government clearly expects to find it acceptable and is planning to welcome and accept its (10 or so) recommendations next Tuesday before coming forward with some detail on how it’ll change its own bill 10 to 14 days later.
Tonight Nick Clegg will brief his MPs and peers on what David Cameron’s been telling us in his speech. They may well be encouraged by changes to Monitor’s terms of reference but on this and other areas some will want to see the detail of the amendments before saying anything definitive.
Read more: David Cameron outlines changes to NHS reform
Likewise, they’ll want to know in more detail what exactly the government’s planning to do on GPs’ consortia. It sounds as though GPs may be able to keep these to themselves but have obligations to consult/take account of/submit plans to others in the NHS. Andrew Lansley might be a bit more pleased about that.
What has gone is the compulsory deadline for GPs to form consortia (actually there was always scope in the original Bill for latecomers to come late to the party on this).
In the range of concessions there is, as it has become known in Whitehall, “one for Shirley” – a specially tailored concession for Baroness Shirley Williams that puts back into statute the Health Secretary’s responsibility for the entire NHS (even if all sorts of decisions have been delegated down the line).
David Cameron was asked at the speech if he wished he’d never got started on all this. He insisted that wasn’t how he thought. But George Osborne has been heard to say just that in private.
Most of the Lansley proposals could’ve been achieved without legislation, former Health Secretary Stephen Dorrell has suggested. But the fanfares, pace and proclamations created a mighty storm and have cost the Coalition dear in negative publicity. Have their concessions harmed their project?
Most ministers including the Prime Minister still believe in the fundamentals of the Lansley plan – driving down costs in the NHS through competition – but the jury’s out on whether, on their own terms, the Coalition has come up with something – post-Pause – that will achieve what they wanted.