Andrew Lansley felt the need to go to the Commons yesterday and express confidence in his bill
The need for a public vote of confidence is reliably more instructive than the ringing terms in which it is couched, as many a football manager knows to his cost. After being hung out to dry in the press, Andrew Lansley felt the need to go to the Commons yesterday and express confidence in his health bill. He did so even though he has already steered his legislation most of the way through that house, and even as he announced a review so vague that the bill's final shape is utterly unknown. No wonder he sounded miserable.
The pretext for yesterday's pause for thought was the "genuine concern" of many who work in the service; in truth the opposition of the medical profession had long been expected. Having left Mr Lansley alone in the lab to brew up explosive plans, David Cameron wobbled as to the wisdom of exposing the potion to sunlight at the turn of the year, but with the bill about to be published he resolved to take the doctors' brickbats, keep calm and carry on. What has really changed is the party politics.
As Liberal Democrats have studied the small print that Mr Cameron did not bother with until the ink had dried, the realisation dawned that a coalition which they are a part of was proposing to dismantle a nationwide structure in whose founding Liberals had once played a proud part. Mealy-mouthed for too long in addressing Tory excesses, Nick Clegg has been forced by his party to stand up to his partners on this one. With terrible judgment, the Lib Dem health minister Paul Burstow signed off on the abolition of the primary care trusts that his own party's manifesto and the coalition agreement had committed to democratise. Former doctor Evan Harris rallied Lib Dem opposition around this flagrant breach of promise at his party's spring conference and among the lords. He has now set out a long list of "essential amendments" that would effectively rewrite the entire bill. Mr Lansley seemed at pains yesterday not to preclude any of these specific changes. Rarely if ever in history can a defeated backbencher have held the sort of cards in his hand that Mr Harris is holding today.
What matters, of course, is how far the open tone of Mr Lansley's remarks translates into an open mind in refining the bill. No one is pretending that the NHS can drift on as it is – money is tight, and about to get tighter, while the pressure of ever more elderly people will only intensify. But the health secretary can no longer pretend that he has all the answers. Simply delaying things while Messrs Cameron and Clegg go on a roadshow to tell worried members of the public to calm down will not suffice.
Disempowering the expert drug rationers of Nice from doing their nasty job, and sacking commissioners who have been getting better at their work, is institutional vandalism. It ought to stop – and now. Already, half of all trusts are muddling through with temporary executives, who now have no idea where they are supposed to be muddling to. Several MPs yesterday asked Mr Lansley to apologise to those staff who have already lost their jobs in his rush to reform. If his claim to deliberating afresh without prejudice is to have credibility, he must immediately desist from creating new facts on the ground.
The lack of accountability for the new GP consortiums, which could be gobbled up by corporates and prone to conflicts of interest, must also be addressed. Above all, the dogma that the regulator must actively promote competition from all comers has to be rethought. Unless it is, family doctors who value a relationship with their local hospital could end up in court under EU competition law – the point on which Ed Miliband recently rattled an unprepared Mr Cameron. Until yesterday many parliamentarians were understandably reluctant to get embroiled in competition law and governance structures, but these things now move centre stage. For lurking in this detail is the devil who could do for the NHS.