Andreas Whittam Smith: The Utopia Lansley dreamt of is beyond politics

The NHS would be turned into a clockwork universe - a perfectly incentivised perpetual motion machine

Share

It cannot be often that when a Bill completes all its stages of parliamentary scrutiny and becomes an Act that a distinguished commentator feels moved to publish a book a few months later entitled Never Again? Or that a newspaper serialises it, as The Independent did last week. In fact, Nicholas Timmins's account of the making of the legislation that will transform the National Health Service, the Health and Social Care Act 2012, could as well bear the title "Arrogance in Public Office: A Study in Coalition Government and Policy-making".

The arrogance is Andrew Lansley's, the Secretary of State for Health. When he came into office in May 2010, the National Health Service was in better form than it had been for a long time. It had just enjoyed a sustained period of increased resources. Waiting lists had never been so short. Public satisfaction was at its highest ever. An international comparison of national health systems had just placed the UK second in excellence, behind the Netherlands but ahead of Australia, Canada, Germany, New Zealand and the United States.

Lansley, however, isn't a man to leave well alone. This is a characteristic of politicians. It reflects the fact that they generally don't have long in high office. Lansley probably thought this was his only chance to leave a mark. But he could have contented himself with pushing further ahead in the direction that the Labour government had set, which is what the speeches he had been making in Opposition suggested he would do. There had been 20 reorganisations of the NHS since 1974 and an argument could be made for a bit more streamlining.

Instead, Lansley put forward a Utopian proposal. The NHS would be redesigned so that it became a self-improving organisation, running without direction by Government ministers, one in which, as Timmins explains, choice and competition, money following the patient, independent regulation of foundation trusts, quality inspections, the use of internal market prices and the great variety of NHS providers would produce an organisation whose performance would improve as a result of these assorted pressures, penalties, incentives and oversight. The NHS was to be a clockwork universe or a perfectly incentivised, perpetual motion machine.

But this wasn't the limit of Lansley's ambitions. The whole new structure would be fixed in place by legislation. Executive decisions, which would have sufficed, weren't good enough. One advantage of legislation was that it would make it much harder for Lansley's successors to undo what he had wrought. He would create Utopia and make it stand for ever. Admittedly, this required a Bill that was monstrously long. It was three times the size of the 1946 Act that founded the service. And it was complex. Near the end of its prolonged scrutiny, Professor Malcolm Grant, who was newly appointed as chair of the NHS Commissioning Board, gave the Commons Health Select Committee his considered opinion that it was "completely unintelligible". When asked whose fault it was that people did not understand, the Secretary of State replied: "What's not to understand?"

Naturally, Lansley wouldn't listen to criticisms. Civil servants told Timmins that "the biggest challenge was trying to get the Secretary of State to focus on the money – the £20bn and the sheer scale of the financial challenge". One source in Timmins's book characterised Lansley's approach thus: "I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this because I think they are the right things to do. And I have thought it all through." Didn't the financial crisis change things? "He completely ignored it." And when even 6,000 people took the trouble to comment on the White Paper, Lansley was more or less unmoved.

Only four months have passed since the Bill became law, so it is too soon to see how it is working out. But some preliminary observations can be made. Once the Utopian nature of Lansley's plans was perceived, alarm bells should have started ringing in Downing Street and elsewhere in Whitehall. But Messrs Cameron and Clegg were, as the saying goes, asleep at the wheel. Otherwise, they would have remembered that the ideal society described by Sir Thomas More's Utopia has never been put into practice. The rule is simple: if it is Utopian, it cannot be done. The NHS will never become a self-improving organisation requiring no outside intervention. Alastair Campbell once said of Downing Street, "We don't do God." Nor should it try Utopia.

Instead, I fear something quite different. In its final form, the legislation comprises 309 clauses and 23 schedules. But as every facet of the NHS had been enshrined in law, every action that anybody disapproves of will be challengeable at law. If the consultants don't think their views are being taken seriously, or the health unions are complaining, or the poor patients feel neglected, then any or all of them will be able to go to the courts. There will always be an actionable case. The NHS will become a lawyers' paradise. Unlike Utopias, lawyers' paradises do exist.

a.whittamsmith@independent.co.uk

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Austen Lloyd: Private Client Solicitor - Oxford

Excellent Salary : Austen Lloyd: OXFORD - REGIONAL FIRM - An excellent opportu...

Austen Lloyd: Clinical Negligence Associate / Partner - Bristol

Super Package: Austen Lloyd: BRISTOL - SENIOR CLINICAL NEGLIGENCE - An outstan...

Recruitment Genius: Sales Consultant - Solar Energy - OTE £50,000

£15000 - £50000 per annum: Recruitment Genius: Fantastic opportunities are ava...

Recruitment Genius: Compute Engineer

Negotiable: Recruitment Genius: A Compute Engineer is required to join a globa...

Day In a Page

Read Next
Syrian refugee 'Nora' with her two month-old daughter. She was one of the first Syrians to come to the UK when the Government agreed to resettle 100 people from the country  

Open letter to David Cameron on Syrian refugees: 'Several hundred people' isn't good enough

Independent Voices
Amjad Bashir said Ukip had become a 'party of ruthless self-interest'  

Could Ukip turncoat Amjad Bashir be the Churchill of his day?

Matthew Norman
Syria crisis: Celebrities call on David Cameron to take more refugees as one young mother tells of torture by Assad regime

Celebrities call on David Cameron to take more Syrian refugees

One young mother tells of torture by Assad regime
The enemy within: People who hear voices in their heads are being encouraged to talk back – with promising results

The enemy within

People who hear voices in their heads are being encouraged to talk back
'In Auschwitz you got used to anything'

'In Auschwitz you got used to anything'

Survivors of the Nazi concentration camp remember its horror, 70 years on
Autumn/winter menswear 2015: The uniforms that make up modern life come to the fore

Autumn/winter menswear 2015

The uniforms that make up modern life come to the fore
'I'm gay, and plan to fight military homophobia'

'I'm gay, and plan to fight military homophobia'

Army general planning to come out
Iraq invasion 2003: The bloody warnings six wise men gave to Tony Blair as he prepared to launch poorly planned campaign

What the six wise men told Tony Blair

Months before the invasion of Iraq in 2003, experts sought to warn the PM about his plans. Here, four of them recall that day
25 years of The Independent on Sunday: The stories, the writers and the changes over the last quarter of a century

25 years of The Independent on Sunday

The stories, the writers and the changes over the last quarter of a century
Homeless Veterans appeal: 'Really caring is a dangerous emotion in this kind of work'

Homeless Veterans appeal

As head of The Soldiers' Charity, Martin Rutledge has to temper compassion with realism. He tells Chris Green how his Army career prepared him
Wu-Tang Clan and The Sexual Objects offer fans a chance to own the only copies of their latest albums

Smash hit go under the hammer

It's nice to pick up a new record once in a while, but the purchasers of two latest releases can go a step further - by buying the only copy
Geeks who rocked the world: Documentary looks back at origins of the computer-games industry

The geeks who rocked the world

A new documentary looks back at origins of the computer-games industry
Belle & Sebastian interview: Stuart Murdoch reveals how the band is taking a new direction

Belle & Sebastian is taking a new direction

Twenty years ago, Belle & Sebastian was a fey indie band from Glasgow. It still is – except today, as prime mover Stuart Murdoch admits, it has a global cult following, from Hollywood to South Korea
America: Land of the free, home of the political dynasty

America: Land of the free, home of the political dynasty

These days in the US things are pretty much stuck where they are, both in politics and society at large, says Rupert Cornwell
A graphic history of US civil rights – in comic book form

A graphic history of US civil rights – in comic book form

A veteran of the Fifties campaigns is inspiring a new generation of activists
Winston Churchill: the enigma of a British hero

Winston Churchill: the enigma of a British hero

A C Benson called him 'a horrid little fellow', George Orwell would have shot him, but what a giant he seems now, says DJ Taylor
Growing mussels: Precious freshwater shellfish are thriving in a unique green project

Growing mussels

Precious freshwater shellfish are thriving in a unique green project