NHS: Yet another necessary rethink

In February, this section printed an article critiquing Andrew Lansley’s bill ‘Equity and Excellence: Liberating the NHS’. Since then the bill has undergone heavy criticism and resistance which resulted in David Cameron’s ‘listening exercise’.

One of the main concerns this paper had about the bill was its outwardly sordid appearance; Lansley was shown to have strong links to groups with a vested financial interest in the marketisation of the NHS giving the bill a distinctly underhand feel. And, besides this, the bill received no mention in the Conservatives’ manifesto and so there was a question of whether the party had any sort of mandate to carry out these kinds of changes. In response to these and other problems, Cameron put the bill on hold with the express intention of taking criticism on board.

Naturally, cynical voices expressed doubt over how much listening Cameron would actually do
and whether he just planned to wait out resistance to the bill. But the results of the re-evaluation promise to be considerably more substantial than this.

Firstly, Lansley’s 2013 deadline for the transfer of 65 percent of the NHS’s commissioning budget to GP consortia has been altogether scrapped. Cameron said that the bill would advance at its own pace and would only go ahead ‘when groups of GPs are good and ready’. This is significant because it takes a lot of the imperative out of the bill, making it a rather more permissive piece of legislation.

Cameron also reassured his audience that the primary role of Monitor, the body in charge of
regulating the NHS, was only to promote competition as a route to improving patients’ welfare,
not as a goal in itself. These two changes, combined with a promise to increase NHS spending in
real terms over the next four years, will reassure many who were concerned that the bill would
turn the NHS into something closer to the American model of healthcare provision. Certainly the
Conservatives seem to have won over many of the Lib Dems who were the main threat to the bill’s

However, Cameron’s announcements seem so great a compromise as to attract accusations of
another policy U-turn for the Conservatives, joining ones on cutting funding for school sports,
capping housing benefits and the scrapping of NHS Direct. Obviously Cameron’s Conservatives
didn’t invent the U-turn and a U-turn isn’t some sort of unforgivable sin; what is concerning in this case, though, is that the bill is still going through.

Ultimately we are presented with two scenarios: In one, Cameron’s promises are vacuous and
Lansley’s proposed changes will go through regardless of Cameron’s words. However, Cameron
has clearly distanced Lansley from the centre of the party and he has certainly been cited by many sources as one of the biggest losers in this affair, suggesting that Cameron intends to stand by his promised changes to the bill.

But this second scenario is equally troubling, though for a different reason: In this scenario the bill has become, in the words of Ed Miliband, a ‘bureaucratic reorganisation’ and an expensive one at that. The vision of the bill given in Cameron’s speech at Guy’s hospital is of a meaningless reshuffle of NHS resources and responsibilities that, because of its permissive nature, in no way improves how the service operates.

Lansley’s changes were priced at £1.4 billion. Cameron’s alterations to the bill should bring the cost down but now voters are left asking exactly what they are paying for, especially when the Tories’ other mouth is telling us that we need to cut public spending.


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