Health Policy InsightEditorial Tuesday 7 February 2012: The Times, they are for changing (the Health Secretary)
Valentine's Day is a week today, and it looks as if some of the Tory High Command are getting their Massacre in early.
Briefing from inside Number 10 Downing Street provides a fascinating column on Andrew Lansley in The Times by political journalist Rachel Sylvester.
......................................................................
......................................................................
The noise over the Bill has been growing inexorably for a fortnight with outright opposition from nurses, midwives, physiotherapists and the RCGP heightened by the BMJ, HSJ and NT troika editorial.
The timing of publication on the morning of the Cabinet meeting is deliberate. The un-named Number 10 spokesperson has done this chapter and verse from the New Labour Book Of Unattributable Knife-Your-Own-Side Briefings.
The headline gives a knowing journalistic nod to Independent political commentator John Rentoul's now-infamous series of Questions To Which The Answer Is No, asking whether Mr Lansley (saviour, liberator) is "the exception to the no-sacking policy". This was borne of Mr Cameron's determination not to be shoved around by bad media headlines, and also, Sylvester says, from former Cabinet Secretary Gus O'Donnell's advice to end annual Cabinet reshuffles.
Much good has it done Mr Lansley - and indeed Mr Cameron, who, as we have long pointed out, chose to invest his political capital in Mr Lansley's reforms. Mr Cameron's signature is right there on page one of 'Equity And Excellence: Liberating The NHS'.
Mr Cameron's NHS journey: from liberation to frustration
Yet today, Sylvester reports "deep frustration in No 10 about the Health Secretary's handling of the 'pause' ... strategists have watched in dismay as, far from attempting to win over his critics, the Health Secretary has used the time to further annoy NHS staff and alienate voters ... Andrew Lansley should be taken out and shot".
Sylvester goes on to comment (not obviously reporting a source) that Mr Lansley "seems emotionally incapable of showing any understanding of other people's concerns and intellectually unwilling to consider alternative ideas".
It takes a remarkably unperceptive Number 10 operation to only just be noticing this.
Sylvester's Downing Street source says "We're back to square one ... Andrew Lansley is a disaster". He is also described as a "law unto himself", with the cited example of the long-term care talks before the next election. (The example of those care talks is an interesting choice: I've heard both Andy Burnham and Norman Lamb claim to have initiated them. Mr Lansley was certainly the person who, at Mr Cameron's insistence, stopped them.)
Fantasy Health Secretary - Alan Milburn in the national interest?
The column takes a turn into the deeply bizarre when it reports that Number 10 have been considering asking Alan 'Quiff Of Doom' Milburn to be kicked upstairs and become a Health Secretary of national unity "with a guaranteed free hand to change the policy, he would be asked to complete for the coalition the reforms he began under Mr Blair".
This would, the piece suggests, "neutralise the issue of the NHS".
Somebody in Number 10 must have been smoking something serious to even consider this.
Milburn undoubtedly hated Gordon Brown (hence his infamous 'flying fuck' strategy over his own 2003 Health And Social Care Bill, which created foundation trusts), but is basically a Labour tribalist. Milburn is going to accept a Coalition peerage like he's going to dance naked down Whitehall: only in someone very weird's dreams.
If that were not clear enough, Milly went on "the Government’s U-turn places real power in the hands of the national NHS Commissioning Board – the daddy of all quangos... it is the biggest nationalisation since Nye Bevan created the NHS in 1948. I’m not sure whether he would be laughing or turning in his grave at the prospect of the Conservative Party championing such a policy. Bevan would be equally perplexed to see the Conservatives abandon competition as a driver of NHS improvement. When I introduced private sector providers, some claimed it would be the end of the health service as we had known it. In fact, they strengthened it".
This was an extension of his piece for HSJ last May, which observed that "The reforms are a failure of politics. They also contain failures of policy ... they can be either a revolution or an evolution. But they can’t be both".
Milburn also told Lansley that he would not apply for the chairmanship of the NHS Commissioning Board (but apparently hinted he would accept being appointed without having to apply. Well, why not? It worked for Comrade Sir David.)
No, Alan Milburn is not in the Number 10 Big Society tent. Nor even the wigwam.
At stake, two futures: Mr Lansley's and the Bill's
There are two different things writhing in discomfort here: Mr Lansley's political career, and the Health Bill's future.
Lansley is apparently a genial man personally. He is also a staggeringly inept politician, who can neither persuade others of the merits of his plans nor see the difficulty in his stance that his opponents are, in his catchphrase, "completely wrong".
Lansley's plans for a permissive and enabling NHS Commissioning Board were euthanised when George Osborne, Stephen Dorrell and Oliver Letwin insisted that Sir David 'Tight Stalinist Grip' Nicholson be put in charge, rather than Lansley's preferred provider Mark Britnell (of whom the PM has of course never heard).
Rarely have truer words been spoken than Mr Lansley's to Gavin Esler on BBC Newsnight last April: "I'm not in this for the politics, I'm in this for the NHS". There is a bitter sense of the unrequited here, because I suspect Andrew Lansley really does love the NHS - it just doesn't love him back. Perhaps it's because his love for the NHS is absolutely right, and any other kind is completely wrong. Who knows?
The policy zombie as Secretary Of State
Former Conservative health minister Enoch Powell wrote in his 1977 biography of Joseph Chamberlain that "all political lives, unless they are cut off in midstream at a happy juncture, end in failure, because that is the nature of politics and of human affairs". Mr Lansley's career has been ending in slow-motion since the publication of his White Paper announcing the very same top-down NHS-wide reorganisation that the Coalition Agreement explicitly ruled out.
It may not end today, or even this week. The health policy community is well-acquainted with Robert Evans' excellent concept of "healthcare zombies: discredited ideas that will not die": Mr Lansley shows what happens when one becomes Secretary Of State.
Mr Lansly may lumber on for a while: Telegraph deputy editor and Cameron supporter Benedict Brogan has weighed in with a report that after a meeting yesterday, the PM, deputy PM and Lansley agreed to push ahead.
Brogan's information is that Mr Cameron "wants to go into the 2015 election with the NHS in good shape, and believes that without these reforms the health service would be worse off". His Conservative sources in Number 10 say, "we have shed blood on this issue because we believe in this Bill. There is no appetite for concessions. We have already had a listening exercise, now it's time to get on with it. The government will stand firm."
Interestingly, he hears from Nick Clegg's office that "our view is any further disruption would be bad for the health service. What the NHS needs is stability. The vested interests of the BMA and the royal colleges are positioning themselves to be able to blame the government for any future problems. They have always been opposed to reform. It would be deeply irresponsible not to proceed".
Other voices which echo Sylvester's sources in Number 10 are being raised: top-value Conservative MP Nadine Dorries tweeted, "If No10 aide said Lansley should be taken out and shot, Cameron said it first. If rumour is Alan Milburn for health, Cameron started it".
James Kingsland: "We have to just get the law in place – forget about whether it is right or wrong"
But the Bill couldn't buy itself a friend just now. It is in serious trouble with the professions.
Clinical commisisoning's longstanding main cheerleaders NHS Alliance (for whom I do some comms work) and NAPC have warned of the risk of NHS Commissioning Board uber-centralisation.
In a stunning intervention, NAPC president and DH national clinical lead for the NHS clinical commissioning community Dr James Kingsland is reported in Pulse to have told a conference that "we have lost the narrative of the reforms and there is a short time until the Queen's Speech – if we don't make it, the bill will fail. We have to just get the law in place – forget about whether it is right or wrong".
'The Health Bill, right or wrong' is not much of a rallying cry.