The Health Secretary’s career is on life support after a vicious assault in the pages of the Times. Rachel Sylvester (behind the paywall) is the conduit for some pretty incendiary briefing from inside Number 10. According to a Number 10 person, for his botched handling of NHS reforms the health secretary “should be taken out and shot,” apparently. Which is charming.
There are conflicting signals about what the Prime Minister’s intentions really are. Someone well-plugged in told me last week that Lansley was “a dead-man walking,” another a few days later that Cameron would stick with him as he still, after everything, feels loyal towards him. He wouldn’t want to go for a major re-shuffle unless he absolutely had to.
Andrew Lansley must be feeling as though last week’s anti-Goodwin energy is now being channelled in his direction. I am not defending his stewardship of the NHS. I can no longer work out what the government is actually trying to achieve on health, other than aiming to make the subject go away so the voters don’t notice. But the Prime Minister should share any blame.
Something quite basic went wrong with David Cameron’s handling of health reform. He campaigned in the election on leaving the NHS alone (an understandable mistake when he was hunting for votes). The problem is that particularly in a time of scarce resources, marketisation becomes even more important.
I know people don’t want to hear it. But if you want those scarce resources to go further you need to drive productivity improvement. The best motive known to man for doing this is the profit motive. Imploring people to improve and setting targets centrally or locally is not much use. That doesn’t mean dismantling the free at the point of use principle, but it does mean creating diversity of provision and giving purchasers, in this case GPs, incentives. This is what Tony Blair came to understand, but Gordon Brown never did.
I have never seen why wedding oneself to a collectivist model, which has inefficiency inbuilt, makes us more caring. But it is decreed by the British consensus to be so. Continental Europeans, who do things differently, would think we’re mad.
David Cameron – who understands health policy very well and who cares about the NHS – knows all this. It is baffling that he allowed Lansley to get to this point.
After the election the PM sanctioned a bill, despite promising not to introduce more NHS reorganisation. The bill seems to have had very little scrutiny in Number 10, with the rest of the cabinet either busy or bemused. All Lansley knew was that Cameron said he was terrific (his man to reform the NHS) and that he should charge ahead.
Once the bill subsequently got into trouble, Cameron then announced a pause. The Lib Dems – who had signed up to the bill, it seems without reading it – objected to the markestisation. The only important part of the bill, which was the establishment of health regulator Monitor as an economic regulator to enforce competition, was then so watered down that it was all but scrapped.
What is left is a confusing shambles of a bill and a health secretary who has every right to feel abandoned by his boss. More importantly, those who work in and use the NHS are also pretty confused.
What was David Cameron thinking? I pose the question not to be rude, but because I don’t know the answer and wonder if anyone does.