Many eyebrows were raised this week when (naturally un-named) “senior Tory officials” told The Times (£) that the latest NHS reforms were a “huge strategic error” that George Osborne “kicks himself” for not stopping.
This is not because anyone connected with the NHS thinks that the reforms were anything other than a “huge strategic error.”
Instead, it’s because it’s hard to imagine how Osborne could have missed the massive opposition to the pointless, expensive and distracting reorganisation of the NHS imposed by former health secretary Andrew Lansley; or to the privatising thrust of parts of his ‘Liberating the NHS’ white paper.
Unison threatened legal action, on the grounds that the then-chief executive of the NHS, Sir David Nicholson, had pre-empted the legislation required to enact the reforms, by telling managers to start implementing them immediately.
Then, over the next few months, all of the Royal Medical Colleges came out against the Health and Social Care Bill, forcing the government into an unprecedented “pause” in the passage of the legislation.
Ministers had to find a tame clinician, Professor Steve Field, to run a “future forum” to come up with a few, cosmetic changes to get the bill through; with Dame Shirley Williams whiffing on her earlier opposition and bringing the Lib Dems into line.
It’s not clear whether The Times remembered this history when it allowed a (naturally un-named) “senior official” to say Osborne “had the opportunity [to stop the changes] and didn’t take it”; since it’s clear that he had any number of opportunities, and didn’t take any of them.
But one way and another, the paper doesn’t seem to have asked the next, obvious question, which is: “Why not?” Or, perhaps, it was happy to take the offered line, which was that it was all Lansley’s fault. Which won’t really do.
A (naturally un-named) “insider” told The Times that his plans were “unintelligible gobbledegook”, which is on the harsh side of true.
In a feature for eHealth Insider at the time, I described ‘Liberating the NHS’ as “flimsy, rushed, and lacking in clarity”; the product of Lansley putting together plans to address a number of specific policy issues that had come up over his six years as shadow health secretary, that failed to form a coherent whole.
Yet white papers didn’t use to be like this. Legislation used to start with a green paper; that went into options and had specific points for consultation. Then it became a white paper; or detailed set of proposals for Parliament. Then it became a bill; that ordered specific changes.
New Labour started the trend for skipping the green paper stage and moving straight to a ‘command paper’ that hovered between the green and white stages; and that, increasingly, came to include more pretty pictures than specific points for debate or legal input.
The Coalition has continued this. If future governments really wanted to avoid debacles like the NHS reforms, they might go back to following the old legislative pattern; but this seems unlikely.
Meantime, a (naturally un-named) “No 10 advisor” told The Times that Lansley had told Downing Street his “grand plans had the backing of the medical establishment and we trusted him.”
It is certainly the case that, when Lansley issued his plans, it became popular to say that the reason he wanted to dismantle the entire NHS commissioning structure and hand it over to GPs was that his wife was a GP.
It’s also true that some GPs liked the press’ interpretation of this – that they’d be the ones in charge of most of the NHS budget. However, that only lasted until they realised that what they were being offered was the chance to head up a commissioning organisation.
And that commissioning meant trying to prop up stressed hospital services while looking for cheaper ways to care for an aging population; and not buying new kit for their practices.
The initial enthusiasm probably delayed the BMA’s opposition to the bill. However, GPs are hardly “the medical establishment.”, and even if they were, “the medical establishment” is not the only player with a stake in the effective functioning of the health service.
Osborne and the rest of the government failed to listen to any of the many experts who told it the plans were misguided: either because they dislike experts; or because they found it easy to dismiss their objections as ideological, being deeply ideological themselves; or they really don’t care about the impact of what they are up to, unless it becomes a PR and media headache.
If future governments really wanted to avoid debacles like the NHS reforms, then they’d not only go back to running a proper legislative process, but engage with critics during its consultation phases; but this seems so unlikely that it’s only worth mentioning how unlikely it is to point out the degree to which we no longer expect good, non-PR focused government.
So, The Times article was funny; in that it raised a hollow laugh. It was probably a success; in that it allowed Osborne to get out ahead of the blame that will be heaped on the Tories if the NHS faces a financial meltdown, which looks increasingly likely before the next general election. But it ducked the failure of government that the NHS reforms represent.
On a final note, a (naturally un-named) “cabinet minister” also told The Times: “We’ve made three mistakes that I regret. The first is restructuring the NHS. The rest are minor.” Which makes you wonder what those minor mistakes are. The entire conduct of economic policy? The welfare reforms?