The savages are circling around Andrew Lansley and his NHS reforms. Or translated into something more politically correct, the indigenous tribes have cornered the contemptuous invader, and are closing in for the kill.
Stories have been floating in the press that David Cameron is about to sack Mr Lansley and give way on most of his reforms, and particularly those that need legislative approval. Mr Cameron’s expressions of “full confidence” cuts little ice in this football-mad country, where club chairman habitually express full confidence in managers the day before sacking them. Mr Lansley and the reforms appear friendless. The various medical lobbies are building up against them; every few days another comes out against. The Tory press is hostile to indifferent. Lib Dem colleagues are urging me to sign a petition against the Health & Social Care Bill which is at their centre.
I can’t quite bring myself to sign, as somebody that basically supports reform. But I now think that they were a political mistake not really worth fighting for. And that may well be Mr Cameron’s view too. The risks of persisting with it are rising. There seems little chance of things settling down in time for the 2015 election, by which time chaos in the NHS could well be a top political issue. When the Coalition took over, the NHS had recovered its previously poor political standing. So far as the public was concerned, it wasn’t broke so didn’t need fixing. On the other hand if the government U-turns now, there is quite a good chance that the matter will blow over. Financial crises and hospital closures are bound to continue, but the whole thing will be rendered less toxic without these reforms to blame for everything. The political calculation seems quite clear, which is why a growing number of Tories are pushing for Lansley to go.
What would happen if Lansley went and the Bill was dropped? The new health secretary would be left with an enormous amount of executive power to continue a reform process – after all that is why the administrative reforms have made so much progress without the Bill becoming law. Ironically a lot of the Bill was about curbing this executive power and making it more accountable. But the focus of reform would be explicitly to make the service more efficient as demographic changes place it under ever more pressure. This would be a lot more difficult for Labour to attack, since that was what they were saying when in power.
It hasn’t happened yet, of course. I feel a bit disappointed that things have come to this. I dislike much of the criticism that the reforms have attracted, and especially to the resistance to the use of private sector providers, and the sharing of facilities with fee paying patients. The current NHS comprises a lot of good services swimming in a sea of mediocrity, and it has reached the limit of what can be provided if funded only from taxation. The GP side in particular is inefficient and lacks accountability. Beneficial changes require extraordinary amounts of effort to implement. There was a lot of nonsense and gobbledegook in the PCT-led commissioning introduced by the last government, largely designed by management consultants.
Still the reform process was too broad and too fast, and became ever more muddled as the process encountered resistance. I won’t mourn its passing.