Steve Richards: No U-turn on NHS reform? We're halfway there

There are deep parallels between what is happening now and the poll tax in the late 1980s
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Here we go again. The Prime Minister holds a summit at No 10 with carefully selected specialists to discuss a defining reform. The message is seemingly clear. The Prime Minister presses on with the controversial measure. The Prime Minister is not for turning. In the anatomy of major U-turns, I place the Downing Street summit at around about the halfway stage, a panic-stricken gesture of defiance amid a growing sense of crisis.The gesture only reinforces the sense of crisis.

Politics is largely an art form, but sometimes patterns form and the art moves closer to a science. There is a pattern for titanic U-turns. In the case of the NHS reforms, there is a very clear parallel with the poll tax, which began as the flagship policy of Margaret Thatcher's third term in 1987. At one of the crisis points for the tax, Thatcher held a summit with selected specialists. To the despair of many, including a substantial section of her Cabinet, the message from the summit was clear: the PM was determined to make the poll tax work.

The parallels between now and then are deep. In the 1987 election campaign, the poll tax was not an issue, in the same way that the NHS reforms played no part in the 2010 election, although in fairness to Thatcher, her policy was buried away in the Conservatives' manifesto. Only after the 1987 election when the poll tax proposals were unveiled did the row begin within the Conservative party and beyond.

The legislative journeys are almost exactly the same, too. In both cases, the near revolutionary objective of the proposals was wholly contradicted by the amendments passed. For David Cameron and Andrew Lansley, the original aim was radical devolution of power – to patients, local providers and the private sector. The amendments lead in the opposite direction.

The Health Secretary will retain his responsibilities in relation to the NHS. A new giant quango will be even more hyperactive from the centre. There will be centralised constraints on the private sector, and some PCTs will survive alongside the new GP consortia. A Bill aimed at reducing bureaucrats will create many more layers of bureaucracy. A Bill aimed at cutting out the responsibilities of ministers at the centre will lead to a Prime Minister worrying about the performance of every hospital ward in the land, because the political stakes are so high.

In the case of the poll tax, the objective was to make councils more accountable and efficient by introducing the same flat-rate charge for every voter. But the Lords amended the Bill to exclude some of the low-paid and those on benefits. They also insisted that rebates could be paid out. The clear but iniquitous objective of the original proposal was countered wholly by a slightly fairer but complex policy that no longer included a universal, flat-rate tax.

At the outset, Thatcher had assumed her policy would be popular. She made her name during her brief period as Shadow Environment Secretary in 1974 when she pledged to abolish the rates, the old way of raising local revenue. Finally she was fulfilling that pledge. Cameron made his name as Tory leader when he supported Tony Blair's education reforms, creating a new informal alliance between Blairites and the Conservative party. He assumed the same dynamic would apply in relation to NHS reforms. As far as he showed interest in the policy, he expected wide praise for carrying on where Blair had left off.

Thatcher liked her Environment Secretary, Nicholas Ridley, who pioneered the poll tax, but he was not a media performer and alienated voters. Cameron likes his old boss, Andrew Lansley. Ridley got the legislation through Parliament. At which point Thatcher replaced him with the most emollient non-Thatcherite minister available, Chris Patten. Later this year, Cameron will replace Lansley with a less ideological, more media-friendly Health Secretary. Thatcher hoped, as Cameron will hope, that a change of minister could save a policy.

It did not work. It will not work. Patten quickly realised he had inherited a monster. Lansley's successor will discover the same. Patten attempted to make the poll tax more palatable. He persuaded Thatcher to accept that local poll tax levels could be capped from the centre and that rebates would be more generous – two further moves that contradicted the original policy. Wait for further concessions in relation to the NHS reforms, on top of the hundred-plus amendments already agreed.

Throughout the poll tax crisis there was an assumption that a U-turn was impossible. Huge sums had been spent switching to the new tax. Bills had been sent out. Expensive computers were in place. Electoral registers had been updated. Now we hear that there will be no U-turn in relation to the NHS, on the same grounds of practicality and fear of political humiliation.

Of course the poll tax was scrapped, albeit under a new leader, and the Conservatives went on to win the subsequent election in 1992. The new Environment Secretary in 1990, Michael Heseltine, replaced it with the Council Tax. Recently he admitted to me that the Council Tax was exactly the same as the old rates but with a new title. Expect a similar outcome for the NHS. But we have a long way to go yet.