Friday, February 10, 2012

Layer 516 . . . Killing the NHS Bill, Marketising the Health Service, and Sensible Conservatism

In the previous blog there was a piece about the future of Conservatism. The Conservative party is very much in the news again today.

Tim Montgomerie's an interesting chap. He runs a blog called ConservativeHome. Some time ago he wrote a column for the Guardian in which he said, among many other things,
I’m not defending the financial sector. Greedy banks hid toxic debts in increasingly ingenious financial vehicles that fooled every auditor, every regulator and every ratings agency until it was too late. But who was really fooling who?
Capitalism is not immoral but amoral. It does what its users demand of it . . . It will invent whatever instruments governments and consumers want, and if not given limits, its inventiveness knows few bounds.
These limits come from two sources: politicians and culture. And ultimately, it’s the culture that counts.
We have entered a vicious cycle where both government and capitalism have eaten into the culture’s ability to be a countervailing and moderating force.
Liberal capitalism requires social conservatism. It needs the virtue-generating institutions or there’ll be no thrift, no duty, no honesty, no Protestant work ethic.
Civilisation is a project that starts anew with every generation, else we’re all on the road to the Lord of the Flies. It has traditionally been the work of the family, church, synagogue or mosque, but in an era when families are weaker and places of worship are in decline, there are big questions as to who will discourage people from getting into impossible debt in order to buy things that can’t give them happiness. 
We need to tax unearned wealth more and wealth creation less. Big companies should feel greater obligation to employ local labour.
But arguments about the integrity of capitalism are, in the end, just diversions from the underlying weakness of our time. How do we put moral limits on big business, big government and the people who operate them? More pertinently, how do we put limits on ourselves?

The country needs thoughtful Conservatives like Mr Montgomerie - if only to keep in check the Nasty Party and the right-wing nutters.

Today's Guardian website contains the following article:

Cameron should scrap NHS bill and drop Lansley, says influential Tory blog

ConservativeHome editor says health secretary has failed to win public support for health and social care bill

David Cameron has been urged to replace Andrew Lansley and drop large chunks of the health bill by the Conservative party's most widely read and influential website.

Tim Montgomerie, the editor of ConservativeHome, said in a post published on Friday that Lansley, the health secretary, had failed to win public support for the legislation and that, if the Tories did not back down, every problem with the NHS over the next three years would be blamed on the bill.

The ConservativeHome intervention is particularly damaging to Cameron because Montgomerie says he was encouraged to speak out by three Conservative cabinet minsters who believe that pressing ahead with the bill would be folly.

"One was insistent the bill must be dropped. Another said Andrew Lansley must be replaced. Another likened the NHS reforms to the poll tax," says Montgomerie in his article.

"The consensus is that the prime minister needs an external shock to wake him to the scale of the problem."

ConservativeHome is not officially linked to the Conservative party. But it is read by thousands of activists, whose views it broadly represents, and, although it does criticise government policy, it is generally supportive and not given to gratuitous attacks on the party leadership.

On Friday Montgomerie told the Today programme why he had decided to publish his article. "I wrote this blog this morning because I think the feeling is David Cameron isn't listening enough to internal party feeling and this is why I have gone public," he said.

Montgomerie says Cameron faces a choice. "Path one involves removing all contentious components of the bill," he writes. A gutted bill could then be passed with cross-party agreement. "It would be humiliating to forge such a cross-party deal but the humiliation would subside over a few weeks.

"Path two involves pressing on. It's the path that, despite his rhetoric, Ed Miliband prays the coalition will tread. Pressing on avoids the immediate political pain but leaves the chronic electoral problem in place. By 'succeeding' in enacting a contentious bill every inevitable problem that arises in the NHS in the years ahead will be blamed on it. That's a heavy price to pay for a bill that is neither transformational nor necessary."

Montgomerie, who says that Cameron's "greatest political achievement" as leader of the opposition was to stop the Conservatives being seen as an anti-NHS party, says Lansley should go. "He hasn't been able to communicate these reforms in a streetwise way," Montgomerie says.

The ConservativeHome broadside was published after it was revealed that Lib Dem activists want to call a vote on scrapping the bill at the Lib Dem spring conference next month.

Lansley faced fresh embarrassment on Friday when a report by the right-of-centre thinktank Reform said the government's entire reform of public services was being undermined by the Department of Health's management of NHS changes.


Denis Campbell, the Guardian's health correspondent, had this column in the paper:

ConservativeHome attack on NHS reform may prove game-changing

A consensus is emerging over which parts of the bill should survive if Andrew Lansley's 'big bang' reforms are dropped

Among Conservative Home editor Tim Montgomerie's telling points in his potentially game-changing piece about the government's NHS plans is his description of the health and social care bill as "not only mangled and bureaucratic but also unnecessary".

The health secretary, Andrew Lansley, a minister for whom the word embattled could have been invented, has previously admitted that many of the radical changes he wants to see in the NHS in England do not actually require the gargantuan, hugely unpopular legislation that is now dividing the cabinet and may yet end his career rather than prove the defining high point he hopes. Many of the best-informed health policy experts, such as those at the King's Fund thinktank, have said the same thing.

All the way through this bill's tortuous, increasingly divisive passage significant voices have argued consistently that the NHS should be concentrating on meeting Nicholson's £20bn savings challenge by 2014-15, not being blown up and put back together in the sort of top-down reorganisation that David Cameron pledged not to implement. Stephen Dorrell, the last health secretary in the last Tory administration and now chair of the Commons health select committee, has cogently argued that position for months, his committee's reports increasingly sceptical about the bill's many likely negative impacts, but without ever explicitly criticising Lansley's plan. At least three of his colleagues in Cameron's cabinet are clearly less reserved.


Tim Mongomerie's own blog, reproduced in a column in the Guardian today, says:

NHS bill may be the death of Tories' election prospects

Unless David Cameron kills off the bill, it, and the Conservatives, will be blamed for every NHS problem for years to come

The NHS was long the Conservative party's achilles heel. David Cameron's greatest political achievement as leader of the opposition was to neutralise health as an issue. The greatest mistake of his time as prime minister has been to put it back at the centre of political debate.

Many Conservatives think that the NHS needs fundamental reform, but for far-reaching reform to succeed certain preonditions must be met. The public needs to have been persuaded that substantial change is necessary. The government cannot be distracted by other consuming projects; its best brains must be focused and single-minded in ensuring the policy's success. The Whitehall machine needs to be prepared and co-operative. The health secretary needs to enjoy significant goodwill amongst NHS staff and possess exceptional communication skills.

Few – perhaps none – of those preconditions exist.

Earlier this week David Cameron and Nick Clegg decided again that they would plough on with the health and social care bill. Clegg was particularly reluctant. Cameron was resigned to doing so. Neither were enthusiastic.

ConservativeHome supports the government's radicalism on schools, welfare and the deficit. We'd like to see much more ambition on competitiveness and changing Britain's relationship with Europe. The NHS bill is not just a distraction from all of this, but potentially fatal to the Conservative party's electoral prospects. It must be stopped before it's too late.


Polly Toynbee's recent column on the NHS bill:

The NHS bill could finish the health service – and David Cameron

The market ideology of the health and social care bill shows that the pragmatic prime minister is on another planet

Andrew Lansley's last refuge is his most disreputable argument so far: his health and social care bill must pass as so much has already been implemented without waiting for royal assent. None can recall such flagrant flouting of parliament.

All but abolished are 151 primary care trusts – replaced by 279 clinical commissioning groups – while strategic health authorities are to become four hubs. The new national commissioning board already has a chief executive and finance director with seven board members recruited on salaries of up to £170,000 before the bill is passed. Brass plate shifting has squandered £2bn, while the NHS suffers cuts of £20bn. McKinsey and KPMG already have fat contracts to take over much commissioning supposed to be done by GPs. Which sector will they instinctively favour for contracts? Yet none of it has yet passed into law.

"Too late," the health secretary says with grim glee, and Lansley's alarmed party believes it's so. Of course it's not and the bill could be withdrawn. A U-turn would be greeted with guffaws by the opposition, but that would be less politically dangerous than the cataclysm likely to engulf the NHS shortly. Andrew George, the Lib Dem MP and member of the health select committee, puts it like this: "It will now cause havoc either way, but going ahead is even more catastrophic".

Opposition is unprecedented as the government scrapes around for support from insignificant medical groups, most with commercial links. The BMA tends to oppose change, from Nye Bevan to Ken Clarke and Blair. But it's remarkable that so many royal colleges are opposed, even the Royal College of GPs, supposed to be a beneficiary. Editors of the three medical journals object. The health select committee, dominated by coalition MPs, issues dire warnings.

Will the voters understand? They know one big thing: Cameron promised to protect the NHS, yet hundreds of units will go bust as waiting times soar. Ed Miliband put it crisply: the money wasted could pay for the 6,000 nurses the NHS is cutting. On the NHS Labour did well, eliminating long waits, with its highest ever public approval; the OECD named it the one of the best performers in the world. This is Labour turf. Cameron will regret digging it up.

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