It was only when he was ensconced in The Bridge House, lunchtime curry on order, pint of Broadside to hand, reading Rachel Sylvester in The Times, the truth hit home. Andrew Lansley and his NHS Bill are truly, irredeemably in the cess-pit.
A peep behind the pay-wall
Starting half-a-dozen paragraphs in (after a tour d’horizon of past ministries and their resignations) we get to the meat:
It is extraordinary that Andrew Lansley is still in position as Health Secretary having so monumentally mishandled the Government’s NHS reforms.
This week peers will give another mauling to the Health and Social Care Bill, which is already bent double under the weight of amendments and concessions. The Royal College of GPs— whose members are supposed to benefit most from the changes — has now joined the Chartered Society of Physiotherapy, the British Medical Association, the nurses and the midwives in calling for the “damaging, unnecessary and expensive reorganisation” to be scrapped. A joint editorial by the three leading health journals describes the planned reforms as “an unholy mess”. Mr Lansley has failed spectacularly to persuade either the professionals or the public of the purpose of this legislation. What was intended as a symbol of modernity has become an emblem of obstinacy that will do little to improve patient care.
There is deep frustration in No 10 about the Health Secretary’s handling of the “pause” in the passage of the Bill — which was announced last April in an attempt to show that the Government was listening. 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.
“We’re back to square one,” says one exasperated insider. “Andrew Lansley is just a disaster. Dogged and determined at his best, the Health Secretarey is at his worst described as a “law unto himself”: during the last general election campaign he entered into talks with Labour on long-term care for the elderly without telling Mr Cameron. He seems emotionally incapable of showing any understanding of other people’s concerns and intellectually unwilling to consider alternative ideas.
This matters to the Conservatives, of course, because proving that they could be trusted on the NHS was central to the detoxification of the Tory brand. Now Ed Miliband has been given an opening to echo Tony Blair’s 1997 line that there were only “24 hours to save the NHS”. with his call for a cross-party campaign to block the health reforms.
“Andrew Lansley should be taken out and shot,” says a Downing Street source. “He’s messed up both the communications and the substance of the policy.”
Both Mr Cameron and George Osborne are remarkably loyal to Mr Lansley, who was their boss at the Conservative Research Department. But many senior figures, Lib Dem and Tory, now admit privately that it was a mistake to introduce a flagship Bill on health when most of the key changes could have been implemented without primary legislation. Indeed, Nick Clegg considered calling publicly for the whole thing to be abandoned then decided, for the sake of coalition unity, to back substantial amendments instead.
“Health reform should have been carried out by stealth,” says one strategist. The contrast is drawn with Michael Gove’s education reforms, which have been presented successfully as the fulfilment of Tony Blair’s schools policy rather than a complete break with the past.
Perhaps it’s too late to change direction. Maybe the Government now just has to minimise the damage and move on. But this issue still has the potential to destroy the Conservatives at the next election, and they know it.
Malcolm copies that at length, because the Murdoch policy on pay-walls means too many will miss that gem — correction, necklace of priceless diamonds.
The anatomy department
Of course, there are things, small and grand alike, adrift with the Sylvester biopsy.
Yes, the “24 hours to save the NHS” was a good ploy. It was from the 1997 campaign; and it was on Tony Blair’s watch. But it wasn’t original, and it wasn’t decisive. It wasn’t decisive because the battle had long since been won: this was merely the cherry on the sundae (well, Thursday, but who’s counting). It was merely a Blairite encapsulation of Neil Kinnock’s better, unscripted (?), uncontrived effort at Bridgend on 7th June 1983:
I warn you not to be ordinary, I warn you not to be young, I warn you not to fall ill, and I warn you not to grow old.
Thirty years on …
They had to stifle Kinnock’s oratory through a concerted Tory campaign: “the Welsh windbag” — and a bit of xenophobic abuse never went adrift among true English Tories. But — the point here is … what should we make of Sylvester’s systematic shafting of Lansley?
- First, and most obviously, this one came from His Master’s Voice. Consider the repetition of “deep frustration in No 10”, and all those “strategists” — safe bet, they’re one and the same source. In a sentence, the inner-cercle Cameroons are briefing against Lansley.
- Second, the hard-core parliamentary Tories have lost faith in Lansley. He has no political future, in office or on the back-benches, simply because he has demanded too much of the poor-boody-infantry. The Whips have registered this, and Lansley is dead meat.
- Third, whatever Lansley wanted to deliver (it was a semi-privatised system) is beyond the possible. So, now it’s down to palliative treatment. Somehow the Great British Public (who, lest we forget, see on every pay-slip a subscription of 9% of gross income to National Insurance) have to be convinced they are getting value-for-money.
- Fourth, Cameron hasn’t got the guts to knife Lansley from the front. Therefore, there’s this back-doors whispering to persuade him to be a sick man and spend more time flipping his second homes, pleasing his wife’s Pharma clients, Walker’s Crisps and Micky D’s (one expenses scandal and various financial subsidisers, if anyone missed out).
Above all, what concludes Sylvester’s essay is a very, very strange — even bizarre — final paragraph:
There is an intriguing idea circulating in No 10 — that Alan Milburn should be offered a seat in the House of Lords and his old job of Health Secretary. With a guaranteed free hand to change the policy, he would be asked to complete for the coalition the reforms he began under under Mr Blair. By creating in effect a government of national unity, this would neutralise the issue of the NHS. In policy terms, it would achieve many of the aims of the Bill without the controversy. That’s a reshuffle people would notice but it would certainly end the era of stability.
Huh? Milburn’s apotheosis suddenly makes him the angel of universal harmony? With a single bound our Dave is free? [I]n effect a government of national unity?
In your dreams!
All of the above should be read in conjunction with Paul Goodman on ConHome. He starts from Sylvester’s end-piece (subtly implying that her only one source is LibDem liaison in Downing Street, which may point a finger at Julian Astle or, even more likely, James Mcgrory). He then extends into a dystopian prognosis of what Cameron could, and should do:
He should keep the bill and stick with the Health Secretary till the reshuffle.
Then he should hand over the Act (as it will be) plus the coming NHS crisis – complete with patients parked on trolleys, ambulances marooned outside A & E wards and NHS managers closing wards while pleading bankruptcy – with his compliments and very best wishes to a new Liberal Democrat Health Secretary plus an entire team of Liberal Democrat health Ministers. And turn the Business Department over to a Conservative Secretary of State who, unlike the present incumbent, is enthusiastic about enterprise and deregulation.
So, if you thought things couldn’t get even worse ...