The Coalition's revolutionaries appear to have gone into reverse. In recent months we have had a comprehensive retreat from the Government on its forests policy, embarrassing disarray on tuition fees, and now ministers are signalling a change of course on their NHS reforms. David Cameron and Nick Clegg have promised a "listening exercise" on the Coalition's health service plans. Action is out and consultation is in. Ideology has given way to pragmatism.
It remains to be seen whether this is a prelude to a watering-down of the Health and Social Care Bill, or merely an attempt to sell the reforms better. The Health Secretary, Andrew Lansley, insisted in the House of Commons yesterday that the substance of the Bill will still be implemented. But it is clear that the Government is determined to ditch the revolutionary posture – "Maoist", as Vince Cable memorably put it – adopted in the early months of the Coalition.
This change of approach on health, in particular, has a profound political significance. The NHS was one of the pillars of David Cameron's modernisation of the Conservative Party. The Government's ring-fencing of the health budget from the cuts imposed across the rest of the public sector was intended to demonstrate to the public that the Tories could be trusted with the NHS. But now Downing Street has woken up to the fact that the old suspicions about Conservative attitude to the public provision of healthcare are still very much alive. The medical profession has been uniformly critical of the Government's health Bill and the general public is increasingly alarmed. Mr Cameron is pushing the pause button because he realises the seriousness of the threat to his project of detoxifying the Tory brand.
The problem with Mr Lansley's NHS reforms was never the principle. Giving GPs a greater role in commissioning care could, in theory, be good for patients. And allowing more private-sector providers to perform routine surgery could drive up efficiency across the service, again to the benefit of patients. The problem lies in the blinkered and ideological manner in which Mr Lansley has gone about implementing these reforms.
The Conservatives never spelt out their intentions on health reform during the election campaign. They neglected to build a base of support for their proposals among the health profession. Had they done so, their job now would be much easier.
The reform was also recklessly hasty. The sensible way to proceed would be through a series of pilot schemes and evaluations of the outcome, noting what works and where problems arise. But Mr Lansley wanted to implement the policy before road-testing it. He set a target for consortia of GPs to take over care commissioning responsibilities from Primary Care Trusts by 2013 – whether they were ready for these new responsibilities or not.
The Health Secretary also proposed to push through this comprehensive administrative reconfiguration at a time when the NHS, despite the budget ring-fencing, needs to make efficiency savings of around 4 per cent each year simply to cope with additional demand for its services arising from an ageing population. Such savings alone will be a significant challenge for a health service that has grown used to large revenue increases. Pushing through this vast structural reform as well was begging for trouble.
There is no shame for the Government in thinking again on NHS reform. Ministers are right to alter their course if they are headed for an obvious car crash. What they should be ashamed about – and what they could end up paying a high political price for – is that it took them so long to recognise that they were on a dangerous road.Reuse content