Health Policy InsightEditor's blog Wednesday 1 June 2011: Lansley Telegraphs his endurance and reform vision
The Daily Telegraph has this article from Andrew Lansley and also a commentary piece by their political editor Andrew Porter and health correspondent Martin Beckford.
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With considerable understatement, the commentary piece suggests that Lansley's article will "serve as a warning to his Cabinet critics who have privately been suggesting that the Health Secretary might resign or be sacked over his handling of the NHS changes".
Porter and Beckford also write that "NHS reorganisation has become Mr Cameron’s most pressing problem. After spending his time in opposition trying to neutralise perceptions that the Tories were enemies of the NHS, often through using examples of his own experiences when caring for his son, he is now faced with accusations from inside the Coalition and from Labour that the reforms will cause widespread and detrimental upheaval.
"The unexpected nature of the reforms – which critics argue were not in the Coalition Agreement – has led to heavy criticism. Mr Lansley, who has held the Conservative health portfolio for eight years and had been trusted to deliver the vital changes by Mr Cameron, has had his reputation battered".
It's all hard to argue.
So.
What is Mr Lansley's case for reform?
Don't just save £4bn a year for 4 consecutive years; do something!
"Doing nothing is not an option. I will not leave the NHS to neglect".
Oh dear. Oh dear, oh dear.
To begin at the beginning, let us state the obvious: doing nothing is certainly an option. It happens all the time in public policy. Let's look at reform of the banking and financial sector, shall we? That's just about the single biggest problem facing the UK government.
And what have we done since the system so spectacularly imploded, leaving us taxpayers as the insurers of last resort?
That's right. We have done as close as possible to nothing.
Doing nothing is always an option. Any other suggestion is a pointless rhetorical flourish.
More to the point, it is just possible that Mr Lansley is aware of The Nicholson Challenge: that of the NHS making £4 billion a year efficiency and productivity gains over the next four successive financial years to make up for funding increases that were expected but, due to the global banking crash, are now not coming.
I think we would almost certainly say that is doing something, wouldn't we?
What is the next bit?
Oh, people are getting older, and living longer in infirmity. Fuck my old boots: that's not been an ongoing process since 1948 (and indeed before), has it?
We now replace hips in the over-85s, you know. Sheeesh.
The drugs don't work
But it gets better: "Another challenge to our health service is posed by the rising cost of drugs". No, honestly, he wrote that down out loud, in real life.
OK, Mr L, so just possibly if you didn't make up a NICE-undermining National Cancer Drugs Fund to waste taxpayers' money on marginally-effective and over-priced drugs, this wold be less of an issue.
Jesus H. God-Dancing Christ on a bike: even The Economist has spotted that this t'ut is over-priced, writing that new drugs are "horribly expensive ... not all of these drugs work". Its article quotes Otis Brawley, chief medical officer for the American Cancer Society, as admitting, “we are not buying a lot of life prolongation with these drugs”.
Lansley's case also says that, "Today, almost three quarters of the population expect the NHS to provide drugs no matter what the cost". This reminds me of Ben Page of Ipsos MORI, who presented at the 2008 NHS Alliance conference the figures that 41% of people surveyed think the NHS should offer any drugs and treatments that work, no matter what the costs – and 31% think the NHS should offer any drugs and treatments even if ineffective, no matter what the costs.
It is essentially mere proof that opinion research samples the stupid as well as the clever; and also that without due context, questions can tease out pub-talk wisdom which adds no practical value to the debate of public spending prioritites.
Lansey isn't quite this stupid: he told a conference fringe at the Conservative Party confrerence that "there must and will be rationing in the NHS" - it probably helped that chair Dr Phil Hammond pushed him hard to admit this.
So when he writes, "it is absolutely right that people get access to the best medicine, but the cost of these new drugs adds several hundred million pounds every year to the NHS’s bills, only a hollow laugh is permitted in response.
The British Journal Of Cancer 5,000 deaths 'fact'
Now then, fact fans, I know what you want to know. Surely, he's not going to use the 'European cancer 5,000' stat from the Number 10 crappy brochure that we noted and which was elegantly deconstructed by Ben Goldacre?
Happy days, folks: "if our cancer survival rates were at the European average, we know we would save 5,000 extra lives a year".
Ambassador, you are spoiling us with this bullshit!
This is followed by vast swathes of risible rhetoric with all your favourite catchphrases (no decision about me without me ... empower patients ... locally accountable), all of which takes scant account of the fact that what we have got now, and will have for some time to come, is a much more tightly centralised NHS - as in Nicholson Health Service.
The opening of Lansley's last paragraph promises, "we will never privatise our NHS". It is a mark of the extent of his failure as Health Secretary that he must introduce this concept, which is pure political poison. He must do so in respect of airing a hypothesis that the NHS will become unaffordable without reform.
It's not actually a wholly unreasonable hypothesis.
Unfortunately, there is no evidence that a major, system-wide, top-down reorganisation will make it more likely for the NHS to make the efficiency gains it must - and there is a wide range of experts, from Civitas to ex-health secretary, health select committee chair and Conservative MP Stephen Dorrell to the Kings Fund and the Nuffield Trust and the NHS Confederation, who suggest that Mr Lansley's reforms will make it harder to achieve the required financial controls.
Lansley seems to want to give the message, "I'm still here". That much is unmistakable.
The other message, coming across louder and clearer, is that there has been very little real listening.