Clik here to view.
Unfortunately for Andrew Lansley, the more the small print is studied, the more it is disliked
Coming to the Commons as the face of a bill which is currently being rewritten by other people, the health secretary Andrew Lansley had a horrendous task yesterday. He tackled it by suggesting his masterplan was less about what he wanted than empowering medical staff. A pity, then, that a few hours before the chair of the Royal College of GPs, the very medics he would put in the driving seat, had said the English NHS was skidding towards a crash. The proclaimed "natural break", imposed midway through the law-making process, is in fact quite unprecedented, and it has provoked a degree of scrutiny of the devilish detail that few bills get, though many might benefit from. Unfortunately for Mr Lansley, however, the more the small print is studied, the more it is disliked.
Bismarck likened laws to sausages, saying you would do well not to watch either being made, and in the slow-motion passage of the health and social care bill, everyone can sniff out one ingredient or another than makes them queasy. For top managers the breakneck timetable is the most acute worry, and for many Liberal Democrats it is the abject lack of democratic oversight in the proposed new structures. Meanwhile, Nick Clegg – talking tough after his mauling last week – has now signalled he thinks it folly to foist purse strings on those family doctors who are unwilling or unable to take them. Each of these objections is important, and each must be addressed. But amid the great mass of concessions now on the table, it is essential to keep focused on the one which is, by far, the most important of the lot.
Even before the general election, these columns warned on the basis of documents buried away on the Conservative website that, for all the soft soap in their manifesto, the Tories would unleash a destructive gale through the service by recasting the regulator so that it actively promoted competition, as opposed to merely policing it. This is not to dispute that challenging state monopolies can sometimes improve things. And there is no doubt some public hospitals need improving, if you doubt it think Mid Staffordshire. But the experience of Royal Mail, which underwent a similar regime change some years ago, provides a chilling precedent of what aggressive regulators can do, and also of the snare that European competition laws potentially lay for public services when they are transformed into players in a market.
In medicine, of course, the complexities are infinitely greater than in mail. The patient is not sovereign as other customers might be, but is instead beholden to expert advice. Then there is the need to see to adequate training, the geographical spread and the proper integration of care, all of which requires planning. None will be properly attended to if the invisible hand is left to regulate between rival hospitals bidding for discrete procedures. Mr Lansley can point to all sorts of safeguards in his bill, but the risks can never be decisively banished until the order for competition to set off on a march with no specified end is qualified.
It is true that the Labour party that now presses this case once rigged the NHS rules in favour of private providers, and also that Mr Clegg, who is now charged with seeing to it that it prevails, has said disobliging things about the health service in the past. He also foolishly signed off on the original Lansley plan with excess haste. But none of this detracts from the urgency of what the deputy prime minister now needs to do. His instinctive tendency to regard markets as a medicine for public services is less important than it would be for a Conservative or New Labour leader, since the Lib Dems really are democrats in nature as well as name, and his party has given him explicit instruction. With the wind of public and medical opinion blowing their way, the Lib Dems now have a chance not simply to adjust the timetable and the implementation, but also redirect the marketising thrust of the plans. They must seize it.